Archive for the ‘Politics’ Category

It’s good to know that we in the UK have a National Health Service (NHS), unfortunately I sometimes think that we have lost the plot where it’s concerned.

Today in the news we are being told that one of the NHS trusts is in so much debt that it is likely to be closed down. Where has it all gone wrong, maybe it’s just the fact that the meaning of ‘National’ is not the same to highly educated politician than it is to the mere mortal, such as me. It would appear that to a politician ‘National’ means something like:

"Break things up into separate smaller units and autonomous regions"

So what we actually have is a service that is broken up into a number of ‘Trusts’ and of course there are those regional differences too, like Scotland or Wales. A good example in regional variations is the cost of a prescription, in England it is £7.65 whereas in Scotland it’s only £3. So maybe ‘National’ is a bit of a misnomer in this case and it should just be Health Service.

When the NHS was originally created it was so that medical treatment would be free at the point of delivery, which in everyday language means that if you need medical treatment it’s free, you don’t need your credit card before the medics pick you up off the road and take you to the hospital. However, that doesn’t mean that we don’t pay for the service it just means that we pay for it collectively rather than individually. Everyone of us, or at least those of us who are in employment, pay towards the service through our NI (National Insurance) contributions and employers pay an equivalent amount for each person they employ. So it’s a tax and a not totally uncomplicated tax at that, there are various classes of NI which depend on your employment status (self employed, employed etc.), you can even pay a voluntary contribution! Basically anyone that earns between £7,600 – £42,500 will pay 12% and anyone earning over that amount also has to pay pay 2% on the rest of their earnings. There’s lots of other things, like benefits in kind (company cars, private medical insurance etc.) that NI is also payable on, and of course the employer also pays a contribution.

I personally believe that much of the problem in our health service is mismanagement, not necessarily on the part of the managers within the NHS but squarely placed on the government and the huge department that oversees the service. One particularly bad move, and the one that appears to have caused the current problem for South London Healthcare NHS Trust, is a scheme called PFI (the Private Finance Initiative). The idea behind the scheme is simple enough though the outcome often isn’t:

  • A partnership is formed between the NHS Trust (or other public service) and a private enterprise
  • The private enterprise provides the needed funding, in the current situation it was for hospitals
  • The capital outlay is therefore provided by private funds
  • The public service then pays the private enterprise an annual fee

Quite often PFI enterprises are created by a consortium especially for the purpose, and we should of course remember that the main function of an enterprise is to make as much profit for its shareholders as it possibly can. So what might happen is that the public service would sell its assets (lets say hospitals) to the PFI and then these would be leased back to the service and obviously they might be upgraded or even rebuilt. Short term gain for an already stretch public purse but likely to be a long term noose on the ever increasing running costs.

Over the years I have seen first hand the sort of things that happen in government departments when ‘assets & functions’ have been out sourced, and from what I’ve seen it usually doesn’t lead to efficiency or long term cost savings. Private consortiums are very good at creating pretty watertight contracts that provide the bare minimum service required and then make a lot of profit on the things that invariably need to be done that aren’t in the contract. I’ve been in situations where to apply a small software patch to a system I’ve had to have a consultant from one part of a consortium to log me into a system, and he in turn has had to have an engineer from another part of the consortium to get him into the server! That’s three people being paid to do one job and of course it takes three times as long because the two parts of the consortium find it exceedingly difficult to coordinate their time, I think that’s why they like to charge by the hour!

It is often also the case that there are just too many tiers of management within our public services and the NHS is no exception to this. Also, the more tiers of management the less likely it is for an individual to actually make a decision, just incase they get it wrong. Then there’s the cost, the more managers the higher the payroll bill. We seem to have forgotten that public services are just that and we are now paying top rate salaries as if these services were generating revenues for profit. Don’t get me wrong I do understand that to get good people you need to pay good salaries, but at the same time we need to be realistic.

Is it now time to get back to basics, look at all of our public services, how they are funded and run, and make the changes that are needed. Let’s maybe reconsider the involvement of companies whose remit it is to make a profit because at the end of the day the profit they make is ultimately coming from the taxes we pay.

One final word on the NHS, if indeed it’s a ‘National’ service let’s make it the same nationally.

Read Full Post »