Many moons ago (I'll dig out the trackback later), I posted about the state of the local NHS hospital where my wife worked and one of the suggestions I made was that hospitals should be run as is they were a private hospital. Well on today's local South Today news (Meridian region) they've reported that a new hospital being built in the New Forest (Lymington) will be something along those lines. Obviously I am not taking any credit for this, or anything remotely like it, but it does appear that common sense has prevailed.
Unfortunately the only way that the NHS will be sorted out is if the whole infrastructure is torn down and it started again from scratch. What I gather is happening in the New Forest is that a new 36Million UKP hospital is being built but instead of being run and staffed by the local NHS trust, it will be completely managed by an external private company. It won't mean any job losses, it won't mean preferential treatment for those with private health insurance.
My criticism of the NHS is not entirely done without understanding of the problems that they face. For example, your local private hospital knows beforehand what type of patients it will receive and has a rough estimate of the number expected over any given period. The fact that most private hospitals will have a specialisation helps out. NHS hospitals cover a large catchments area and therefore know that they may receive patients with various conditions, but they don't know in what numbers and most often when. Obviously budgeting for this type of care management is fraught with danger. It is that part of the process that the current NHS structure is ill equipped to deal with and leads to a draining of resources.
A local hospital recently had to spend over £12,000 to cover a single night shift because it had to employ an agency worker. The agency supplying the worker was able to charge extortionate rates because of the situation. Now despite the fact that the hospital has said it won't use the agency again, this practice is widespread throughout the NHS if not at such extortionate and resource draining levels.
Over the past few years much has been made of the shortage of nursing staff in the UK. To that extent the government started a campaign of luring overseas nursing staff to help fill our voids. Some recent press has made light of the drain that this is putting on foreign nursing levels when it could be said that there need is greater than ours. Well if there was a shortage three or four years ago, there is going to be an even bigger shortage in another two or three years. The number of student nurses has not increased to cover any of the shortfall being taken up by the foreign workers. NHS trusts have realised that they can pay overseas workers the basic wage and they don't have to increase their pay over time as much. They see this as saving.
One of the main reasons that many of the foreign nurses come to the UK is the lure of coming to work in the UK for the NHS, the medical and health system that the rest of the world aspires to be. Even in the US where the medical coverage is nearly all private and of an excellent standard (but you do pay for it), they still claim to aim for the standards that the NHS pertains to have. One reason being free medical coverage. They don't believe me when I tell them the state of the NHS and how fast it is spiraling to new depths.
Well after being lured over with UK pay scales, the chance of working for the NHS, most of these new staff are shocked at the state of the NHS. Nurses from India, Africa and the Philippines are shocked at the state of the hospitals, management and actually think they have made a backward step. They even consider that their standard of living has dropped below that to which they were accustomed to in their own country. Many of them are trapped inside two, three or four year contracts and would leave tomorrow if they legally could.
Many indian nurses for example are shocked that they need to "muck out" for example and perform duties that would normally be done by lower casts. Even on their local wages most nurses would have maids, cooks, cleaners etc etc and still have a good standard of living. They are shocked to find that they can just about afford rent and the food to eat let alone having the money to bring their families over as first they thought.
Worse still is that many of the foreign nurses are better qualified and have superior training yet are held back in promotions and even on their everyday work duty because of the fact that they are foreign, and here only to help out. It appears that the image of the NHS that they aspired to based their own standards on, was the NHS of 25-50 years ago when it still functioned somewhat.
But then another drain on the NHS that we should also consider is that treatments today are so much more expensive. Not only are we living for longer, we are requiring more drugs to keep us doing so, more hip replacements, more cancer treatments etc etc. These are all costs that were not around many years ago. And let us consider pharmaceutical company A who invests millions in creating a treatment for Cancer Type A and finds that it is somewhat effective even if limited trials exist to prove its safety or real effectiveness. In order to recoup its investment, it must charge large amounts for its usage. Now imagine that a close member of your family has Cancer type A or B or X etc and there is a change that this new wonder drug might improve their chance of survival. Quite rightly, you would want that drug to be made available at whatever cost. Unfortunately, it is the NHS that has to pay for these high cost drugs. High cost drugs that again many years ago did not exist. It is these drugs that place such a high drain on its budgets.
So why would a private medical company make a better job of running a local hospital than the NHS? Well the main reason being a medical company usually has investors, and in order to survive it must make a profit, or at very best, not make a loss. If the NHS were any other company it would have been shut down years ago. But instead of cutting back on standards, or levels or service, cleaning, food etc etc, they reach their savings by simply being efficacies. As a business they rely upon getting new customers, or keep old customers returning. They are a business and as such must focus themselves on keeping the customer happy and making a profit.
For an average decent private medical insurance you can expect to pay £70 a month. And despite the cost of almost all simply operations costing more than would be paid by a policy holder in their lifetime, they still make a profit.
When you draw comparisons to the amount of money that the government chargers each NHS patient a year for providing medical coverage, it is hard to see why there is not enough funding available. (But to be honest simply throwing more money at the NHS is NOT the way to go). And in all honesty, most Governments (and not just the current Labour Party) probably charge us £x.xx and the NHS see about n% of that with the rest going to fund 'other' projects. But the point is, the NHS is not structured or currently able to support returning a first rate service and ultimately a profit back to the government. Because of earlier statements made above (the inability to plan for cases for example), it is probably never going to be possible to provide a profit in terms of cash, but that should not stop the level of service being sacrificed and it should be the general public or NHS customer that receives the profit back in terms of excellent healthcare coverage.
Update: I just caught the 22.20 local news and I caught the earlier details slightly wrong. So far it is only being proposed that a private medical company will run the hospital, since the local NHS trust is pretty much bankrupt. The new hospital is not due to open until the end of 2007.
Posted by Chris Wright at December 19, 2005 10:02 PM
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