Replying to John.
Do I detect a 'tongue in cheek' response here? While the comment may be a
logical conclusion to present 'opt out' policies of our UK Govt., it doesn't
seem to be the 'dismantling of the state' envisaged by anarchists and
supporters of Trotsky - but more like complete abandonment - 'feeding the
people to the wolves'.
I would prefer a serious discussion of the the state's responsibilities in
healthcare - assessing need, overall planning for provision, co-ordinating
team work and facilitating a full contribution of all involved.
Janet Shapiro
----- Original Message -----
From: "John Rooke" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 10, 2003 7:52 PM
Subject: Re: 3 letters re: Blair says whole of NHS should be opened up to
competition
> Would a solution be to make the Government the sole purchaser of health
care
> (through GPs, PCTs or whatever) and leave supply up to the market? Or
would
> this be too radical for both left and right?
>
> Cheers,
>
> John
>
>
> ----- Original Message -----
> From: "Alex Scott-Samuel" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, June 10, 2003 5:36 PM
> Subject: 3 letters re: Blair says whole of NHS should be opened up to
> competition
>
>
> > --- Begin Forwarded Message ---
> > Date: Fri, 30 May 2003 05:53:41 EDT
> > From: [log in to unmask]
> > Subject: Re: Blair says whole of NHS should be
> > opened up to competition
> > Sender: [log in to unmask]
> > To: [log in to unmask]
> >
> > Reply-To: [log in to unmask]
> > Message-ID: <[log in to unmask]>
> >
> > Dear Alex
> >
> > I don't usually respond to these general
> > emails. But I do have to take issue with the
> > idea of a 'caring culture' in the NHS. Walk in
> > to any A&E department and see how caring it is.
> > Spent 10 hours being ignored by staff. There
> > are real problems with the NHS system - which I
> > happen to think this government does not really
> > understand - but I have come to the view that
> > "private bad/public NHS good" is not
> > sustainable.
> >
> > Hips, knees and eyes are examples of
> > procedures where the private/NHS provision
> > distinction is full of holes. As an anecdote,
> > I know of a surgeon that scedules 5 cataracts
> > per list in his NHS session and 12 per list in
> > the private session. To me that is an example
> > of how incentives can be used to improve
> > productivity, rather than an argument for
> > abolishing the private sector.
> >
> > The main area where the NHS fails patients is
> > in diagostics. A patient can spend 2 years in
> > an outpatient system being passed from
> > consultant to junior to pathologist to
> > radiologist, with no momentum. In the private
> > sector all those tests would be organised in
> > one week, with a speedy diagnosis, avoiding
> > real distress to the patient and cost to the
> > system.
> >
> > I could go on. - For example, my father was in
> > hospital for 2 weeks for 2 simple diagnostic
> > procedures that could have been done in half a
> > day. No real hurry to discharge, even though
> > he was desperate to get out. The point is that
> > this is based on experience, and the pressure
> > to change the NHS is supported by the contrast
> > that patients and doctors see between the
> > treatment here and abroad. We have a creaking
> > system and the 1948 structure (which is
> > effectively intact) is based on low
> > expectations. 'Caring culture' is like a red
> > rag to a bull when you've been on the receiving
> > end.
> >
> > Tessa Crilly
> >
> > On Fri, 30 May 2003 16:37:03 +0100 Theodore
> > MacDonald <[log in to unmask]>
> > wrote:
> >
> > Dear Alex:
> > It is to your correspondent Tessa that I wish
> > ti direct this reply and it is only my
> > IT-ineptitude that makes it difficult to get
> > onto her e-mail. However, now that I think of
> > it, it might as well hit the "general list".
> > I have often heard Tessa's argument from people
> > swho, like her, have had personally distressing
> > experiences with the NHS which disappeared when
> > they went private.
> >
> > However, I think such people might find it
> > valuable to stand back a bit and consider the
> > matter in the broadest context. Private, even
> > as things stand now, is often terrifyingly
> > worse because of lack of staff in some
> > private clinics. But let's leave that aside.
> >
> > The real issue is political rationality. At the
> > fiscal level, there is no point in a group
> > running medical care privately UNLESS they can
> > make a porofit. Private business does not run
> > on charitable or broader philosophical lines.
> > It fails if it doesn't generate In theory,
> > publicly owned and administered enterprises (in
> > health or education or many other
> > enterprises)can use what would have been
> > profit" to increase the social impact of its
> > activities. Its criteria for "success" would
> > only be what proportio of the citizenry it can
> > reach and how effectively. From the beginning
> > the foundations of the NHS had to be
> > compromised by the fact that it was organized
> > within the broader concept of capitalism rather
> > than socialis. The great "saints" of our NHS,
> > politicians like Nye Bevan, thinkers like
> > Emanuel Shinwell, even Beveridge and Titmuss
> > himself, could not follow through on an
> > irrefutable socialist logic because that was
> > not the realpolitik.
> >
> > We CAN make the NHS do what it was intended to
> > do, but to do so involved a rather
> > comprehensive change in the prevailing
> > mind-set. Much more than the details of
> > healthcare are involved. There has to be a
> > sustained shift away from individualist
> > thinking toward community thinking. This will
> > not be easy. Almost all of the nicely packaged
> > pat formulae have so far let us down and many
> > people find themselves eschewing "poltics" and
> > routine political processes because they can't
> > stomach cant and propaganda. But I see many
> > positive signs. Among these are a growing
> > realisation that environmental issues are
> > fundamental to long-term civilisation. The
> > standard "politicos" and the media like to
> > assurew us that such concerns are "unrealistic"
> > Increasingly we are realising that they are the
> > only realistic concerns. The people who DON'T
> > want us to start thinking that way are making
> > lots of money and power out of the status quo.
> > The gap between the "haves" and the "have-nots"
> > is increasing, not shrinking. We can only
> > reject these uncomfortable facts by saying:
> > "Forget about the 30% living on less than $1.90
> > (US) daily". I can't believe that Tessa and
> > thousands of others who have coped with their
> > own health problems and suffered for it, want
> > to think like that.
> >
> > We all need, in our own little ways and through
> > organizations, do every thing we can to promote
> > what is logical and just world-wide. In doing
> > so, more localized problems like healthcare in
> > the UK, be improved. To try to go the other way
> > will only bring short-term relief to some and
> > will inevitably fall pray to that need for
> > the private alternative to generate a profit
> > for their stock-holders. The party won't last
> > long.
> >
> > In closing, may I thank Tessa for articukating
> > her despair so articulately.
> >
> > Theo MacDonald
> >
> > On Sun, 1 Jun 2003 09:29:08 EDT
> > [log in to unmask] wrote:
> >
> > I'm in a tabloid hell. "Neurotic woman
> > requires dose of intellectual rigour for rapid
> > enlightenment". Really? The mantle of
> > personal despair, as Theo puts it, is worn
> > lightly by me since I have been describing
> > typical experiences. The A&E debacle is not a
> > media construct; it is real and affects the
> > powerless most of all - people who sit and
> > hope rather than make themselves awkward.
> > Criticism of the current system has nothing to
> > do with favouring haves over have-nots.
> >
> > People travel. They go to France, come back
> > after their heart attack with a CD of digital
> > radiological images that they can drop in the
> > UK consultant's lap. (Delivered with some
> > satisfaction by the French cardiologist). GPs
> > go to Canada and realise that their colleagues
> > can arrange diagnostic tests immediately by
> > phone rather than sending the patient through
> > tedious outpatient assessment clinics. The
> > creaking health system I referred to is a
> > function of resource allocation,
> > hyper-complexity and an organisational
> > stuckness. I'm not advocating any specific
> > solution, but pleading that we should not get
> > boxed into a rigid approach that relies on how
> > we think a system should work, even if in
> > practice it doesn't happen quite like that
> > (back to the Caring Culture mantra).
> > Experience is data and theory has to bend to
> > reflect events, or we're forever
> > flat-earthing, while everyone else zips out of
> > sight over the horizon.
> >
> > Tessa Crilly
> >
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