Emeritus Prof Christopher MayAnd, as warned (expected) Keir Starmer (and We Streeting) are expanding the amount of work the NHS hands off to the private sector as a way of 'dealing' with the NHS crisis... of course, this is a solution that looks at capacity (which of course needs to be expanded) rather than at the costs of provision.... to expand capacity by adding high-cost private contractors, may be a short-term sticking plaster but of course 'robs Peter to pay Paul'!
Donald RoyThis is what happens when they listen to #alanmilburn rather than #nigelcrisp - the official who had to deal with the consequences of #alanmilburn for the #nhs long after #milburn had left government. Sadly I find myself reminded of the comment about the restored Bourbon monarchy in France two centuries ago 'They have forgotten nothing and learned nothing' !
Yes, I've heard this before about Alan Milburn... he's also the Chancellor of Lancaster University & I'm not so sure he's been a good influence there either....
BashStKid@ChrisMayLA6 Well, quite. Everyone knows private hospitals don’t do intensive/er work, and the sector’s full of NHS staff doing extra shifts.
If this is going to be at all temporarily useful, there must be armtwisting to reduce charges and increase throughput *without* causing a consequent problem in the NHS. And not the thin end of the wedge.
If this is going to be at all temporarily useful, there must be armtwisting to reduce charges and increase throughput *without* causing a consequent problem in the NHS. And not the thin end of the wedge.
Exactly, otherwise (in that hackneyed phrase) its 'just rearranging deckchairs on the deck of the Titanic'!
WanWizard 🏴 🇳🇱@ChrisMayLA6 Nowhere,. ever, has outsourcing made things better and cheaper.
Cheaper usually means worse, if only because some of the money needs to be put aside for profits, bonuses and dividend payouts.
High costs and poor service in government is almost always caused by a combination of political meddling and people not caring about spending other peoples money (a specific breed of people that seems to be recruited for civil service and other government jobs).
Yup, my first academic job was on a business school project looking at outsourcing, and I reached exactly the same conclusion, even after I had accepted the logic of core-competences & gains from specialism - all the advantages that might be theorised were hoovered up into profits not enhanced anything!
Billy SmithAs Henry Ford said, "If you need a part, but just buy in the part from another company, you will pay for the machine to make the part, but you won't own it."
@ChrisMayLA6 I've worked for governments in IT projects on and off for over 20 years, and was a government advisor and consultant for 11. It has cost me my mental health.
The list of things wrong with a government organisation is long.
It starts with budgets, and the way they are allocated, which means it is impossible to plan anything long(er) term, as those things needs commitment from higher-up that the budget will be there.
@ChrisMayLA6
Then there's unwillingness to prioritize. Instead, they use what I call "salami tactics", and tell you there's a general cut of x%. One of my coworkers always used to say "ok, so which of the walls of the building shall we not build then?".
The costs of any project are what they are, you can't just cut x% and still do them all, you'll just end up with a long list of failures.
@ChrisMayLA6 Then there's the unwillingness to properly spend time (and money) to properly define and scope a project.
Instead, projects start without a clear plan, everything changes a million times along the way, making the cost of the projects spiral out of control (Scottish Ferries being a prime example).
And no fucks are usually given, as the money will come anyway, without haivng to put any effort in.
@ChrisMayLA6
When I started, my mentor used to say "pretend it is your money when you make spending descisions". Amongst the civil servants I worked with, you need to search for people with that attitude, most happily spend whatever budget is there, without much thought.
For some, the main focus is "spend it all", as when you don't, higher-up with think you don't need as much, and you'll get less budget the next year.
yes, the 'use it or lose it' is a frequent budgeting logic in large organisations; used to see it all the time at university (and as a middle manager adopted it myself, I'm afraid to say)
Agreed; the somali cuts (often presented as 'efficiency gains') are disproportionally difficult to resolve without warning project(s) or activities
MarjorieR@ChrisMayLA6 given many consultants (and nurses) already work in both the private and public sectors where is all this extra private provision for NHS patients going to come from?
The NHS workforce presumably.
The NHS workforce presumably.
Estarriol, Terrorist Dragon@marjolica @ChrisMayLA6 and if not already nhs, why not just hire them to the nhs.... oh yeah, no profit to donors.
Simon LucyAccording to Streeting at lunchtime that private providers have to source the resources needed but they can't reuse NHS staff and that's stipulated in the contracts.
When pushed on whether that means more foreign staff he said that's up to them and they could do that.
The implication is that foreign is wrong, but you can't train staff overnight.
There was also a lot on private providers sharing their training facilities with the NHS.
Hmmm..... tif they do go down the migrant health service staff route (doubling down on what the UK is already doing), it might alleviate an immediate crisis, but unless the UK also expands quickly training provision (and support for students), all that will happen is we will (once again) export a crisis to the developing world (this time to their domestic health services from whom we are stealing staff)!
(see earlier post)
Alex@rtnVFRmedia Suffolk UK@ChrisMayLA6 @simon_lucy @marjolica
I work in health and social care, getting staff from overseas doesn't happen overnight either (they all need to be cleared by Border Force etc, that takes time)
Kim Spence-Jones 🇬🇧😷@vfrmedia @ChrisMayLA6 @simon_lucy @marjolica
It also comes with all sorts of catches and caveats. The sponsoring firm has to get registered, and has to report if the foreign employee leaves or gets fired (and firing usually means deportation, so it’s a huge issue).For small firms it’s just not worth the hassle.
It also comes with all sorts of catches and caveats. The sponsoring firm has to get registered, and has to report if the foreign employee leaves or gets fired (and firing usually means deportation, so it’s a huge issue).For small firms it’s just not worth the hassle.
@KimSJ @ChrisMayLA6 @simon_lucy @marjolica
I set up all the Sharepoints and other resources for the staff files, the admin staff have to spend so much time checking documents etc and the Home Office audits these every so often (including checking up even on staff who have left)
@KimSJ @vfrmedia @ChrisMayLA6 @marjolica
But it still happens and if it's made a priority then controls are eased.
As in the last part of the post he also talked about training.
Time will tell.
@simon_lucy @marjolica @ChrisMayLA6
This could descend into farce. Sounds like Streeting has set the private sector an impossible challenge. Their only option is going to be ‘no bid’. Egg on Streeting’s face when his ‘solution’ turns out to be a bust?
This could descend into farce. Sounds like Streeting has set the private sector an impossible challenge. Their only option is going to be ‘no bid’. Egg on Streeting’s face when his ‘solution’ turns out to be a bust?
Passenger@KimSJ @simon_lucy @marjolica @ChrisMayLA6
My money is on him privately backing down and allowing them to hire NHS staff via some loophole rather than see the privatisation fail, even if he continues to bluster publicly.
@passenger @KimSJ @simon_lucy @marjolica
Yes, that sounds all too plausible - he'll claim to be 'prgamatic'
beemoh@passenger @KimSJ @simon_lucy @marjolica @ChrisMayLA6 I don't see how the 'reuse' thing is even plausible- if someone leaves the NHS are they now unemployable?
I think the loophole-cum-objective here is to get staff to leave the NHS and become fully employed by either the private firm or an agency, then claim the NHS is failing due to it not having the staff left.
@beemoh @passenger @KimSJ @marjolica @ChrisMayLA6
Well conspiracy theories apart. He specifically said that the contracts disallow poaching NHS Staff, so they can't approach or hire current NHS Staff.
Consultants with existing arrangements are no doubt excluded.
You can distrust all you like but sometimes what they say is their intention.
Alternatively how do you address lack of resources otherwise?
@simon_lucy @passenger @KimSJ @marjolica @ChrisMayLA6 You can cry conspiracy theory all you like, but sometimes criticism of a bad idea is because an idea is bad and should be criticised.
How is this going to be enforced? How do you demonstrate that NHS Worker X hasn't just seen the recruitment ad for the private firm in passing and applied of their own accord? Or after they left for unrelated reasons, will they still be told they're not allowed to work for the private firm?
@beemoh @passenger @KimSJ @marjolica @ChrisMayLA6
As I understand it the hiring company or agency will filter them out. That's not to say they couldn't hire someone to not work on NHS cases but that's a bit outré.
The supply contract determines who can and can't be hired.
I'd suggest listening to the interview on yesterday's BBC Radio 4 Today Programme.
@beemoh @passenger @KimSJ @simon_lucy @ChrisMayLA6 so no more staff and the private companies creaming off profits.
How does that solve the waiting list problem?
Of course the private companies claim that they are more efficient, but in practice what that means is that (1) they only take the easy cases, leaving the more complicated and expensive to treat cases to the NHS and (2) if they can't handle an issue with one of the easy cases they just shunt them off to the NHS to sort out.
How does that solve the waiting list problem?
Of course the private companies claim that they are more efficient, but in practice what that means is that (1) they only take the easy cases, leaving the more complicated and expensive to treat cases to the NHS and (2) if they can't handle an issue with one of the easy cases they just shunt them off to the NHS to sort out.
@marjolica @beemoh @passenger @KimSJ @ChrisMayLA6
I'd recommend fishing out the interview with Streeting on Radio 4 Today yesterday morning.
@marjolica @beemoh @passenger @KimSJ @simon_lucy
Yes, the final point is key; they continue to use the NHS as a backstop, adding to the potential crisis/emergency cases needing to be treated
@marjolica @beemoh @passenger @KimSJ @simon_lucy @ChrisMayLA6
This is what #nigelcrisp discovered rather painfully in the middle 2000s and why later on #andyburnham told #nhs commissioners to look first at public providers .
@KimSJ @marjolica @ChrisMayLA6
I think he said contracts were either made or in the process of being made.
It's fine to wait and see whether it is achieved but ridiculing it is pretty pointless.
MJ Ray@KimSJ @simon_lucy @marjolica @ChrisMayLA6 there's always going to be some private sector chancer willing to bid very high if they think they might be the only bid, so "expensive bids that would all fail" is more likely than "no bid". The main question is whether the person inviting bids realises they would all fail, or if they're foolish enough to pick a winner that then fails and puts egg on many faces?
@mjr @simon_lucy @marjolica @ChrisMayLA6
This is going to be ripe for FoI requests and journalistic revelations!
This is going to be ripe for FoI requests and journalistic revelations!