Sunday, 17 April 2011

End of days?

The NHS is facing a major challenge. Cuts across the board may soon erode frontline emergency services to the point where privatisation of certain key parts becomes inevitable. But the raging arguments for and against out-sourcing patient care often lose focus when politically-motivated speakers debate the issues.

Looking at it from a pragmatic view, there is something to be said for opting out of a publicly-funded, publicly-driven service. Private companies exist to make profits, that much is true. That means they can be seen as less inclined to care about the service they provide, but in any competitive market and for the majority of companies, this is not actually the case. How can they expect to keep their customers if they provide a poor standard of service? You find many more examples of poor service in areas where competition is weak or non-existent; nationalisation proved that and, although we still have a lot to complain about with respect to our railways due to the fact that customers are tied to routes, rather than having much in the way of choice, it’s a world better than the ‘don’t give a damn’ attitude that pervaded staff back in those days.

Public services have an advantage in that they are not subject to profiteering but, unless the people working within them really care about what they do, there is no motivation for them, or their bosses, to bother about the level of service they provide. As long as there is a pay cheque and a pension at the end of the day, just doing the job to the minimum required level and no more is adequate.

I would argue that most people who need medical care would prefer to be treated with the highest level of professionalism and the best equipment money can buy, rather than any service where they are seen as a nuisance, or a mere cog in the big wheel of a State funded organisation.

I’m not for one single minute suggesting that we are surrounded by people who don’t care but I think there are far too many managers, there is far too much red tape and far too few opportunities for good clinicians to shine. There is not enough development in healthcare because the money vital to driving it forward simply isn’t there. A corporate framework, promoted by commercial competition, could create cleaner, wealthier hospitals and surgeries, with happier, more motivated staff. It may even help to build new hospitals across the country.

You will have other ideas, I’m just spouting mine. Your politics will differ from mine but I work on the inside of a machine that I honestly see as dysfunctional at times. Too many people call ambulances for nonsense things because it is free and very easy to do. If there was a charge, even to dial 999, I wonder how many lives we’d save.

Obviously, there are those among you – there always are – who will nit-pick this and argue that people would die if they had to pay to make that 999 call… or they’d simply not call us if there exists the possibility of being charged because their problem was deemed ‘not an emergency’.

I agree that there is a risk here; the vulnerable would probably suffer. But what if we charged the drunk, the drugged up, the violent and abusive among us for their care, instead of passing the cost to tax paying Joe P? They all still go to hospital, they all get the care they require but when they sober up, straighten out and calm down, they get a bill for the services rendered.

Would we discourage enough of these calls to stimulate a better service for those who actually need us?

My own boss, the Chief Executive, stated on the news that we were receiving too many inappropriate 999 calls – it is universally understood, from the top down, that public services such as ours cannot continue to be abused at the cost of it’s core function.

The cost of it all is what needs to be re-assessed – the pure, dirty financial cost. It’s always about money – even when it comes to public services. Those at the top of the tree of public services benefit from tax pounds and their job is to run the service and save more tax pounds from being spent if possible but there is no commercial impetus to do this; there is no competition. The public have no choice but to use what exists, whether that service is good enough or not. Try to bear in mind that public services do not generate money, they spend it.

It’s ironic that the public sector is being slashed to the bone and jobs are being lost but that the private sector is reportedly thriving and jobs are being created. I think it says something about the state of affairs in the UK. We get poorer by not making things for profit; we get poorer by using tax money paid in by those who generate new money to create jobs for the public sector, whilst allowing surplus and waste to leak much of the benefit out of them. A lot of that money is used by councils to employ private companies anyway – such as refuse disposal companies because it’s cheaper than using directly employed staff, with all the vehicles and equipment that goes with them. There’s also no chance of union action shutting it down and holding the very people it serves to ransom (like the London Underground does on a regular basis).

When I was growing up, I experienced a lot of the negative aspects of public service and nationalised industry; the power would be cut every night for hours at a time whenever the coal industry went on strike. Rubbish would pile in the streets, attracting vermin and encouraging disease, just because of a dispute that served no purpose for the people paying for it.

There’s nothing wrong with standing up for your rights as an employee, of course not, but private company employees have rights too and they don’t need to punish the tax payer to enforce them.

Where is the evidence that private services in the health sector would lead to worse healthcare? When, in recent history, have we tried it en masse? Comparing the services provided in other countries, such as the USA, is simply not viable because we are not the same. Most of it exists by the back door anyway, so the whole argument is moot. Even seemingly stand-up Socialist-Green-Communist propagandists have profit in their blood so blow-by-blow evidence for one thing or the other is neutralising to me. It may be time to try something different.

I work in the public sector of course, so I am benefiting from the tax pound but I also generate new tax money. The services provided by the ambulance service, hospitals and other healthcare sources are exceptional but they are becoming less value for money because they are subject to abuse and the cuts necessitated by Government in these days of debt. There have already been heavy job losses in the NHS and there are more to come. Frontline staffing will suffer a blow for sure and whether or not it directly affects the quality of care provided will be down to a couple of things; the slowing-down or complete end of abuse of services by those who don’t even pay for them and the privatisation of aspects of the system that are just too big and expensive to run efficiently and cost-effectively.

We all want to be protected in our jobs; we all want to continue to sustain our families with income but what if there simply isn’t enough left to keep it going? What if our service-driven economy, coupled with the behaviour of the banks has led us to near-financial ruin?

Be safe (and hopefully employed).


Anonymous said...

I think the argument you gave Stuart is an excellent one, except for one of the premises: That private companies would have to up their services to continue having users.

Unfortunately, that isn't the case in the model of the semi-privatised NHS. The private companies don't have to impress us, the service users. They have to satisfy the NHS/government managers contracting them, by meeting clinical and cost-effectiveness. We don't have a choice who we're seen by - we fall ill, and end up seeing whichever company is contracted in the area to provide that service. We don't choose who to go with, just whether to be treated or don't receive any treatment at all.

Jake said...

I'm assuming that this article is a point of view about the cuts which have been declared concerning the LAS. Sadly, from what I've noticed anyway, the amount of ridiculous 999 calls that are received are quite amazing - and although I don't think that the ambulance service should be privatised, I do think that people who misuse the service should be fined, at the very least. The fire service are already doing this with lift breakdown callouts (Call 3 times in a certain period of time, and the building gets a fine - as these buildings should have maintainance guys to fix this), and I'm pretty sure the police are doing something similar.

Somehow I think that by having the threat of a fine every time 999 is called, it may make people think twice before calling - and those who understand and know that it is a real emergency wouldn't hesitate. Sometimes all it takes is someone to think twice before calling, and wondering whether it actually warrants a yellow van with blue lights.

My girlfriend also pointed out a while back, that when we were little, we were taught how to call 999 in Primary school. However, we were taught just how to call 999 - and nothing else really. Although this is fine for young children, I can't help but think that perhaps the public needs to be educated a little more about what an medical emergency actually is. It's fine for children to call 999 if something's happening to their parents and they're worried, but it's entirely another thing for an adult with a scraped finger to call an ambulance, as opposed to getting in his/her car and driving up to A+E themselves - or even just applying a plaster.

I suppose I may just be echoing a little what you have said already, but it is my opinion nonetheless.

Major said...

What proportion of your bogus calls come from "taxpayer" types? The welfare classes will go right on calling 999 when they have a cold. You can send them as many bills as they like, they simply won't pay - safe in the knowledge that you can't cut off service for non-payment.

Xf said...

actually, you'd be surprised at the mix of 'classes' that call for almost no reason. But when it comes to alcohol and drugs - most 999 callers are not of the 'welfare class' you speak about.

Fines would be more effective on this category of caller I think. Worth a try anyway.

Xf said...


Thanks for that; maybe we should be looking a more competition-based model, without any Government interference because that is the problem - the more Whitehall gets involved with its performance levels and targets, the less inclined the population are to think in terms of quality.

Anonymous said...

If you start a new commercial operation where service is key, it is actually quite profitable [for long enough to make it worthwhile] to deliver a service to your customers, a return to your shareholders all at the expense of your employees. After a while the business model tends to become unstable.
At first I do not expect employees of these new sectors of industry will be well looked after, nor would I expect them to be more committed to the welfare of their patients. Their primary concerns would be the targets they are set.
After a while I am sure that somewhat more reasonable circumstances would evolve.
I would like to be neither a patient nor an employee of one of these new services whilst this balance is finding the level.
I do not see that paying people so little that the government subsidises the low wages with "Tax Credits" and "state pensions" that in effect goes to shareholders pockets is a terrific move forward in terms of either a health service or the leadership of a Nation.

Peter said...

I agree there are a lot of absolute rubbish 9'ers and I agree there has to be tough measures possibly including fines to try to help remedy the situation.

I do take absolute disagreement with your pro-privitisation arguments. Whilst I am in favour of competition generally I just can't see it working in the health service.

I fear some Health care provider will submit the cheapest bid and then provide a 'mixed' level of care to people who can really not choose elsewhere.

I don't think the privitisation of the railways or the buses were a success (I pay a lot more, don't feel more 'customer satisfied' and have no real choice)

Privitisation has perhaps worked in some cases but in my view it only really works when the individual (as opposed to the person submitting bids for the contract to the government)has a real choice. I just don't see that in this case, I just see the dismantlement of an abused system by an ideologically driven campaign by certain interested parties.

Xf said...


It wasn't a PRO argument; and I wasn't talking about the entire system. I was talking about certain aspects of it - private companies, for example, could take over the ambulatory needs of the drunken masses and charge them a fee for their recovery.

In any case, whichever way you look at this system, there is no happy ending. There isn't the money or the will to make it better. The public will continue to abuse something that they perceive is 'free'. Some of the people working in it will continue to use it for their own gain and not to the benefit of the tax payer.

Fiz said...

My daughter as a two year old once a
accidentally rang 999 from a friend's
non-corded phone. I went hot and cold with horror when I heard this voice saying "Emergency services, how can I help you?" She was very nice when I explained, but I wish my friend hadn't left the phone where my daughter could get at it!

Xf said...


This is never a problem... the call takers are trained to deal with accidental calls. The problem with silent calls, however, is that they initiate a response... just in case.

Peter said...

Sorry Stuart, thought you were talking in favour of privatising the whole Ambulance service.
I don't see why we couldn't have a private firm say with a version of the Booze Bus.
In my ambulance service certain journeys are contracted out to companies anyways. PTS in the main, and they charge a lot but it's a possibility.

It does make you despair at some of the abuse of our system, we both have stories of people who use us as a taxi service and it is really difficult to see what we could do, and to have a government with enough mental fortitude to crack down on the service abusers.

I'm going a little off topic as it is an issue close to my heart because it a) costs the taxpayers a lot of money and b) contributes to the earlier retirement of staff. The last point is lost on many, I feel.

Fiz said...

My daughter does not read your blog, Stuart, but the other day she said that she thought that all hospitals serving the drunk should have their wages or ss money garnished to pay for their waste of public time. I think a drunk bus is a very good idea!