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NHS Propaganda. Drip, drip drip....

One aspect of the NHS I've never understood is that we are able to spend fortunes training up doctors and nurses and yet there is no minimum contract term at the end of it to put the NHS in the black.

It's normal practice in the armed forces AFAIK so why on earth are doctors not contracted to work for the NHS for say 5 years from the completion of their training? The same for nurses of course. I used to date a nurse being trained at St Marys and most of her year were looking to shift work in the US once they had their qualification.

Madness.

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Brian
You appear to have little or no knowledge on public procurement which is controlled by law imposed on us by both WTO and the EU. We cannot do what you want even if we wished to.

There is no" transferring of money to private pockets" which is what you keep claiming.

In a very brief nutshell, if there is a service such as cleaning, the authorities will identify a cost against a given service level.

The work can be put out to tender and even if a private company comes in with a lower price, the NHS is nearly always given the opportunity to match the price.

If they cannot or will not match the price, then the company offering the best value for money will usually get a 3 year contract.
The NHS staff are protected by TUPE and job losses are almost non existent. At the end of the three years, a new tender exercise is conducted and once again the NHS authority can apply to be included. If no supplier comes forward to tender, the work comes back to the NHS.

There is no transfer of funds, the NHS is still owned by the taxpayer and the service, which is always monitored by the NHS, is temporarily transferred for the three year period and the savings have to be identified by law and these are nearly always passed onto other budgets which allows more goods such as medicines to be bought.


Mick
Mostly correct Mick, but although the NHS entities also tender for contracts they certainly don't have the right to adjust their prices in the light of bids from private companies, that would be illegal.
 
Mostly correct Mick, but although the NHS entities also tender for contracts they certainly don't have the right to adjust their prices in the light of bids from private companies, that would be illegal.

Tony

WTO legislation is full of exclusion clauses.

I and my colleagues often visited Brussels to ask exception to various rules in the interest of economy and commercial interest.

For instance we were allowed to negotiate with the parent group (just once) to see if they would match the lowest price. It had to be a yes or no answer. We were allowed to do it.

Also we negotiated the right not to publish prices because it could have a detrimental effect on future tenders.

The main problem with the NHS was too many Trusts acting independently and doing their own thing.

The main issue, looking at the bigger picture is that selective outsoucing of strategic services and goods is beneficial and that seems to be a message that is being poorly communicated.

Like you I am inclined to just give up and walk away from this discussion but on the other hand by doing so we let ill informed prejudice rule supreme and then we fail our fellow citizens.

Regards

Mick
 
How is "the company offering the best value for money" determined?

Every company has to tender against a fixed specification. If one supplier can suggest something better, the specification is amended and sent out to everyone.

The main objective is that every potential supplier is quoting for exactly the same thing.

Once the prices are returned, the authority can negotiate according to the type of tender being issued. There is a thing called the award criteria which must be specified in the tender document and could weigh the selection decision based on predefined parameters. So for instance, price could have an importance of 30% allocated to it, delivery and logistic procedures could attract say 20%, proven ability to rectify non compliance issues could attract 10% and so on.

The main criticism that you imply is that the lowest price always wins, it rarely does because if the supplier with the lowest price also has to demonstrate the ability to run with continuous supply and with a proven track record of worthiness.

Therefore VFM has always been the main judging criteria.

Also in large government organisations you have many department involved in the selection process, so every interest such as quality v price is fully addressed.

Mick
 
Every company has to tender against a fixed specification. If one supplier can suggest something better, the specification is amended and sent out to everyone.

The main objective is that every potential supplier is quoting for exactly the same thing.

Once the prices are returned, the authority can negotiate according to the type of tender being issued. There is a thing called the award criteria which must be specified in the tender document and could weigh the selection decision based on predefined parameters. So for instance, price could have an importance of 30% allocated to it, delivery and logistic procedures could attract say 20%, proven ability to rectify non compliance issues could attract 10% and so on.

The main criticism that you imply is that the lowest price always wins, it rarely does because if the supplier with the lowest price also has to demonstrate the ability to run with continuous supply and with a proven track record of worthiness.

Therefore VFM has always been the main judging criteria.

Also in large government organisations you have many department involved in the selection process, so every interest such as quality v price is fully addressed.

Mick
In fact I wasn't implying anything. I tend to say exactly what I mean. If I already had the view the lowest bid always wins I would have said so. As it happens I've never taken that view. I'm interested how vfm is established before the service has happened.
 
The main problem with the NHS was too many Trusts acting independently and doing their own thing.



Regards

Mick
Very true Mick. Added to this is the fact that, in many cases, the tender evaluators don't understand enough about the services being tendered to make an informed decision. Sometimes, only two questions are asked; can the tenderers supply the required service? and two, then who's the cheapest? Fortunately the wiser Trusts involve the right people in the tender evaluation process most of the time.
 
Again Mick. It was a simple straightforward question.

If the system takes into account service levels as well as cost, why are the majority of health care trusts failing on that level given the amount of private sector contracts in place?

It really just requires a simple answer.

I think Tony has answered that and I thank him for taking the time to offer an insight.

As suspected, the focus of those teams responsible for making the decisions is not always in the right place from a services POV.

That's clearly the case in a lot of trusts and in a love of tender situations and this is resulting in a failing health service. The answer is to have these teams switch focus but do they have the financial room to do so?
 
As suspected, the focus of those teams responsible for making the decisions is not always in the right place from a services POV.

That's clearly the case in a lot of trusts and in a love of tender situations and this is resulting in a failing health service. The answer is to have these teams switch focus but do they have the financial room to do so?

The problem seems to be when you screw down the pricing to such an extent and allow any idiotic company to put in a tender, plus pay legions of highly paid PFI contractors (like Mick) who know everything about price, but nothing whatsoever about the actual profession out of the budget you end up with an end result that the real professionals, the people we actually need to do the work, don't want to work for, so they leave en masse. The key problem with the NHS today is that it is hemorrhaging highly (and expensively) trained staff. Everything else is a secondary concern. Anyone with even the slightest hint of management acumen should be able to see that!
 
The problem seems to be when you screw down the pricing to such an extent and allow any idiotic company to put in a tender, plus pay legions of highly paid PFI contractors (like Mick) who know everything about price, but nothing whatsoever about the actual profession out of the budget you end up with an end result that the real professionals, the people we actually need to do the work, don't want to work for, so they leave en masse. The key problem with the NHS today is that it is hemorrhaging highly (and expensively) trained staff. Everything else is a secondary concern. Anyone with even the slightest hint of management acumen should be able to see that!
Firstly, they're by no means "idiotic" companies. Neither do they know nothing whatsoever about the professions they represent.

More of the usual misinformed rhetoric. That's me out of here.
 
Firstly, they're by no means "idiotic" companies. Neither do they know nothing whatsoever about the professions they represent.

More of the usual misinformed rhetoric. That's me out of here.

Just before you take the generic lost argument flounce perhaps you'd care to indicate why you think the NHS is hemorrhaging it's highly trained staff under current government policy? Can't be anything to do with contracts, outsourcing, pricing etc, surely?!
 
Just before you take the generic lost argument flounce perhaps you'd care to indicate why you think the NHS is hemorrhaging it's highly trained staff under current government policy? Can't be anything to do with contracts, outsourcing, pricing etc, surely?!

I could imagine that being the political football that the NHS is for the parties and the big changes in management etc that each new government seems to like to introduce, it must get pretty demotivating.
 
Firstly, they're by no means "idiotic" companies. Neither do they know nothing whatsoever about the professions they represent.

More of the usual misinformed rhetoric. That's me out of here.

It seems to me you're concentrating on a small number of these small companies you mentioned earlier and I'm sure they're fine, however that isn't what people are talking about.

Here again is the link I posted earlier to the Guardian report on how large sums are being diverted/wasted.

How can any of this be a good thing?

Why are trained people apparently leaving in their droves?

I still haven't found how much money is spent on the whole tendering process and where it goes. Do you have these figures?
 
Just before you take the generic lost argument flounce perhaps you'd care to indicate why you think the NHS is hemorrhaging it's highly trained staff under current government policy? Can't be anything to do with contracts, outsourcing, pricing etc, surely?!
Why do you think it's a "flounce"? And why on earth do you think I've lost an argument here, when all I've tried to do is explain how the contracting system works, and I'm constantly frustrated by these misinfomed interjections which prevent any sort of intelligent discussion. OK, it's all a filthy Tory plot if that makes you happy (ignoring the role the Labour party, and all governments of whatever flavour, in messing with the NHS). I'm just fed up to the back teeth with it.
 
Why do you think it's a "flounce"? And why on earth do you think I've lost an argument here, when all I've tried to do is explain how the contracting system works, and I'm constantly frustrated by these misinfomed interjections which prevent any sort of intelligent discussion. OK, it's all a filthy Tory plot if that makes you happy (ignoring the role the Labour party, and all governments of whatever flavour, in messing with the NHS). I'm just fed up to the back teeth with it.
Examples of misinformed interjections?

Any comment on The Guardian article I linked to twice now, or is it a misinformed interjection preventing an intelligent discussion?
 
Tony,

I think those who doubt that the system is as well conceived and operated as your posts seem to suggest are those who have experienced a failing NHS and are looking for the primary reasons behind those failures.

We are coming at this from the POV that the NHS is indeed failing. We are not asking whether they are but why they are. Looking at the big picture from the outside, we spend less on our healthcare system in the UK than they do in other leading EU states, and the results with regards to survival rates and life expectancy are poorer.

One side comes at this problem by suggesting that efficiency and cost cutting will improve this state of affairs and the other side suggests that the former will help but the latter will be a hindrance. If the latter forms the main motivation when trusts are engaged in the tender process with outside agencies then it is surely not overly surprising that the issues continue to worsen?

From a purely personal point of view, any large operation in the UK that is answerable to it's shareholders is increasingly profits focussed and driven and with the readily available supply of cheap labour is not the sort of operation I want in charge of my familiy's healthcare. I simply do not think that free market economics has a place in the wellfare of the nation.
 
Free market economics doesn't have a place in anything that is essential. For example, we apparently have huge energy costs in the UK compared to most of Europe. It's not difficult to work out why.

Much of the privatisation of essentials by the tories needs to be reversed imo.
 
I've read every post on this thread and really can't muster up the energy to get involved.
I no longer work in the NHS and despite it giving me a very good standard of living over 35 years and a damn good pension, I really have little to say about a system which could be so good but just appears to be deteriorating month by month.
Someone really has to answer how we replace retiring medical staff because at the end of the day you cannot run a good system with just nurses and ancillary staff.
Perhaps someone should ask why so many medics want to retire and why so many young doctors want to emigrate within a year or two of qualifying.

I could on but I have no answers other than to say private companies working contracted by the NHS will never be a good long term solution because their shareholders demand profit whilst the government continually screw down the price. That coupled with a reducing medical workforce can only mean a reduced service.
Simon, two things: Firstly, if I have got this right, you were a GP. As the vast majority of GPs are private businesses contracted to the NHS, paying themselves from the profits and exacting a pension from the sale of their share in the business, I think you have a bit of a cheek in disparaging other private providers, whatever the merits of that form of provision.

Secondly, I struggle to give any credence to the opinions of someone who has 'doctor' as part of his user name. I'm sorry but it just looks like someone who defines themselves by the importance they place in the number of years they spent in remembering lists. Perhaps I should call myself FirstDegreeSecond DegreeFellowshipSimeon. But I don't. I did proper degrees.
 


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