David Osland (at the other place) offers a wonderfully concise critique of the utilisation of the private sector to deliver public goods....
'We're told pensions are 'unsustainable', the Post Office is 'unsustainable' & now that the NHS is 'unsustainable'. They were all entirely sustainable before the private sector starting looting the public sector'!
Yup, that's about it....
@ChrisMayLA6 The logic seems straightforward to me. Take the NHS as an example. An NHS which uses more and more private resource will not cost us less as we still have to pay for everything we currently pay for but we also have to stump up for profits. As shown by water infrastructure, private big business is way more interested in bonuses than it is in investing in the business. So an NHS with more privatisation will cost more and get worse.
Whilst I am not in any way in favour of the privatization of healthcare services, the current privatization drive may nevertheless result in the massive slimming down of the hugely overweight bureaucracy currently absorbing a disproportionate percentage of the NHS budget!
I would like to think so. From what I have heard, many of the the problems stem from Edwina Currie's tenure at the Dept for Health. She considered that the NHS was "undermanaged" and insisted on everyone having a 'manager' on their backs to tick boxes to make sure they had done their jobs. Around that time I did some work for the NHS and one of my contacts who had formerly been a useful troubleshooter and extra pair of hands where needed, spent his days, in his own words, filling in forms and ticking boxes! He said that in the past, they had confidence in people doing their jobs conscientiously but since Edwina Currie introduced her reforms, everyone has to be managed by someone to make sure they carry out their duties properly! My current contacts in the NHS are scathing about the quality of people in the lower, dare I say 'largely unnecessary', tiers of management.
@Paulos_the_fog @ChrisMayLA6 A disproportionate percentage of the NHS budget is spent on servicing PFI debt. Yet another example of private sector taking from the NHS. Am not at all convinced anything will improve with yet more private involvement.
@Paulos_the_fog @IndyRichard @ChrisMayLA6 Managers make up just less than 3% of NHS workforce. Recent research by Institute for Public Policy Research suggested that the healthcare sector is under-managed, and this increases the burden of bureaucracy that falls on frontline professionals.
@Lassielmr @Paulos_the_fog @IndyRichard
Thanks, a little counter-intuitive, but I'm sure that's right - so then the Q. is what sort of management is actually taking place - clinical administration, or the required admin to make the 'internal market' work?
@ChrisMayLA6 @Lassielmr @Paulos_the_fog @IndyRichard My partner is a consultant doctor in an NHS hospital. The amount of work she does that is not based on her 6 years of studying the human body followed by 6 years of specialising in a specific disease but rather dealing with specialised management work makes me think the NHS could use more managers so the doctors can focus on delivering healthcare.
@ChrisMayLA6 @Paulos_the_fog @IndyRichard senior and middle managers, specialist managers in areas like finance, procurement and human resources, estates and clinicians who take on part time or ‘hybrid’ management roles (such as clinical directors). The number of managers in the NHS has fallen in recent years. Administrators (clinician support) don’t manage. Nurse managers are not classified as Managers.
@Lassielmr @Paulos_the_fog @IndyRichard @ChrisMayLA6 Excellent so all those middle managers universities don't need could move into the NHS and solve two problems at once.
@Lassielmr @IndyRichard @ChrisMayLA6
I believe you will find that many 'managers' are classed as administrators rather than specifically as managers. In one case of which I am aware, a guy developing Excel spreadsheets for various purposes in a hospital was officially on the payroll as a nurse to help keep the balance between medical staff and others tipped on the medical side!
The best way to deal with bureaucracy is not to employ more pen-pushers to avoid frontline staff being burdened with it but to slash the bloody bureaucracy at least 50% of which is most likely totally unnecessary!
As a software engineer, I have done development work both for the NHS and for many other large organisations that are household names.
@Paulos_the_fog @Lassielmr @IndyRichard @ChrisMayLA6 my solution is simple, lose all middle managers and 1/3rd of senior managers. Frees up money without altering care.
If he was on the payroll as a nurse, he needed an NMC registration, or they were breaking far more than just a staffing levels bit.
@Thebratdragon @Lassielmr @IndyRichard @ChrisMayLA6
The guy was a nurse and a quite talented amateur programmer, so he was trained, qualified and registered as a nurse but wasn't actually doing that. When the hospital where he worked discovered his talents with Excel and VBA, they put him to work doing that instead of nursing as that was a more pressing need.
The story has a sad ending for the NHS, at least; the last I heard of him, he had been head-hunted via the grape-vine by a firm in the City of London where Excel skills are in huge demand, where he was earning around 5 times what a nurse is paid and eventually was put in charge of the Excel team at the asset management company where he worked on £250,000 a year.
@Paulos_the_fog @Lassielmr @IndyRichard @ChrisMayLA6 good for him, sad for patients.
@Paulos_the_fog @IndyRichard
Hmmm... well, as I understand it, the bloated bureaucracy is directly linked to putting in places & maintaining the conditions for an 'internal market' in the NHS.... my guess is like US healthcare, more 'privitaisation' will result in more managers not less....