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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