wanderlust wrote:Yup -it was similar to denationalisation and yes it moved national services into the private sector and yes there was a fair few staff TUPEd (or whatever it's predecessor was called) from LAs to Trusts but the issues created were structural and unique to healthcare.
If you look at denationalising British Rail for example (which incidentally the current government is starting to renationalise!) the private companies contracted inherited the infrastructure, rolling stock and the staff (at a bargain basement price) so their focus and cost base was predominantly planned maintenance and replacement with a slowly expanding customer base.
The NHS costs however were focused on high tariff consumables (drugs) staff and what is effectively rent since the introduction of PFI by Major in 92. The NHS immediately lost it's large scale buying power - although this has more recently been partially replaced with private sector buyer groups - against a backdrop of rocketing drug prices and rapidly expanding customer base leaving it at the mercy of central government funding and private sector profiteering - which IMO is directly contradictory to the principles on which is was established and the principles that Britons of all political shades hold up to the rest of the world as being an example of societal inclusivity and national pride.
I have no problem with denationalisation where appropriate (and by that I mean where it makes sense to do so) but in the case of the NHS it made no economic sense and was in direct conflict with it's USP.
Point is that the NHS was kneecapped. Fine if society wishes to replace the NHS with a multiple tier health insurance scheme as per the USA but there is no overt political will to do that (although I've no doubt that some Tories, the private insurance sector and the Yanks in particular would love it)
We are left with a situation where the NHS is in desperate trouble and there is currently no palatable alternative - and a buyout of PFI and Trusts to renationalise is financially unconscionable.
Business is business but the NHS - like the Police force or the Army - wasn't created to be a business. Rail travel not so much.
Well I've no knowledge and expertise in the Health authorities but I have extensive in local government public sector services and although 'care' and 'protection' services (you can add the armed forces in the same category as the police service) one of the ethos's of the public sector is '
effective and efficient' provision which has always included the economic costs of services and the prioritisation of needs from finite resourcing (funding).
As service requirements have increased over the years - growing population and rising crime - budgets have not - funding only coming from taxation (local or national). People simply don't want to vote for higher taxation to pay for these needs.
Nationalised industries have always been seen to be financially inefficient and that has also been paralleled in traditional council service provision ie - refuse, homes for the elderly and other care provision services in the community, direct works (which include public highway and infra structure building). etc.
There's no question whether we like it or not that 'buying in' services rather than 'providing' services directly was cheaper - and can be clearly evidenced as to how many council in-house services failed to win their own contracts when submitted to compulsory competitive tendering.
Yes some companies deliberately tendered at a loss simply to win a share of the market (I would imagine this has happened in some of the rail franchises you obliquely reference to above in your post) but the bottom line is that all contracts are fixed term only and all have penalty clauses for failure to provide the contacted service awarded to them.
In respect of the NHS and police forces I expect they too have many services - particularly administrative and support services that can and have been put out to tender just has happened in the local council's.
At the end of the day the aim is to achieve the best value for money one is able to.
If the health service is as bad as you claim it to be following Thatcher's government reorganisation then why didn't the Labour government do something about them in their term of office between 1997 to 2010?
And need I remind you that it was under the Labour Administration that the PFI initiative really took off - they clearly thought that was the answer at the time!
I'm amazed that you are still wanting to fight battles that have been lost from twenty and thirty years or more ago - and even more surprised that you don't seemed to have understood the philosophy of why these things happened?
Your default setting clearly is hatred of everything the Tory party has done and ever will do.
You also seem to constantly bring into your reasoning that it is all a massive plot to allow America to 'buy and privatise' the NHS - without any reason to believe that is going to happen at all???
Certainly no party is ever going to win a general election in the near future with that on their manifesto.
Home
