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So...what? Is the NHS just not reducing its spending when moving services over to contractors or private peeps?
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Well. It is different in different situations. But what often happens is, political and business interests collide and a scheme gets under way which goes drastically wrong and needs rescuing to avoid somethng catostrophic happening, or where the relationship between the state sector and the business sector skews all the advantage to the business sector. PFI hospitals gave a quick fix solution to the problem of out of date (from years of underfunding) or inadequate hospital facilities, but whereas the old buildings were ownwed by the NHS, the new buildings, built partially with government funding, end up as the property of the company. Effectively we pay a large percentage of the building costs and then lease the building from the private body.
Attempts to plug the service gaps (again, caused by years of underfunding) by bringing in third party organisations (so for instance a particular type of testing may be done by a private firm, with their own private staff. This has been trialled in some areas using, I think, a South African company, with their own staff). Another way of plugging service gaps is to utilise current Private medical facilities (such as Bupa hospitals). Naturally this costs more.
Thing is, the doctors who work at Bupa, also work in NHS hospitals, and have been trained by the NHS. Not all work carried out in private hospitals is private medicine.....not all work carried out in the NHS hospitals is social medicine. The lines have become confused. An attempt to meld a universal social medicince system has resulted in a massive culture clash within medical provision.
The whole thing has been further complicated by the drive to 'decentralise' medicine, resulting in "Primary Care Trusts". These essentialy run medical provision in some areas. Problem is, as with the Police and Fire services, these areas are larger than any single authority. My local authority and two others are covered by our Primary Care Trust. We as an authority, have our targets and mission statement on health, involving building a partnership with various bodies, including the PCT. They have their targets and mission statements and they are supposed to achieve that in partnership with each of the authorities. These partnerships don't always run smoothly. Because Councils are represented to the trust but have no democratic powers over it, there is very little democratic accountability.
At the point that they broke everything up into this decentralised system, they also broke the funding up, so that Trusts operate their own seperate budgets. This has led to some serious problems in terms of universality in the services which are available in any ne area.
It's better than it was ten years ago, in many ways. Service levels are better, waiting times are lower and most people, though they'll express an opinion that the NHS is going down hill, will if asked say that their own personal experience of it has been fine. But...with the amount of money we've poured into it we should have fixed it a damn sight more than we have. It was broken when we got hold of it...and we've fixed a lot of stuff, but we're busy unbolting some fairly important components along the way.