BBC (Wednesday): Blair braced for hospital vote

[Jack Rabbit]

From the BBC Online
Dated Wednesday November 19 09:47 GMT (1:47 am PST)

Blair braced for hospital vote

Tony Blair is battling to avoid a damaging Commons defeat over his controversial plans for foundation hospitals.
Health Secretary John Reid has urged Labour MPs not to rebel and help the Tories to bring down the flagship piece of public service reform.
The prospect of a knife-edge vote at 1600 on Wednesday led to the recall of sports minister Richard Caborn from Australia so he can back the plans.
Former minister Frank Field predicted fellow rebels could win the day.

Could our British DUers please chime in here?

First of all, please explain foundation hospitals. This seems to be a radical change in the British national health care system, but it is still something short of complete privatization. Who benefits in this plan? Who loses?

Second, if this goes down, how serious of a defeat is it for Blair? It seems that all the source I've seen would regard it a pretty devastating, but no one is calling it a vote of confidence.

[rjbcar27]

1. It's a tough one.

foundation hospitals are a flagship policy of the Blair admin. They basically mean that certain big hospitals will have more autonomy when it comes to budget etc, more like a private hospital. This is meant to free them up to make their own decisions and make better use of the finances.

What it really means is that there will be a few mega hospitals dotted around the country and the rest will be to the same relatively poor current standard.

Not sure what will happen with the vote, the Lords have already thrown it out but I think the vote in the commons will pass, but only just.

[Spentastic]

2. No!

This is an excuse to PFI hospital provision even further.

It should be rejeceted.

[LibLabUK]

4. I agree.

"This is an excuse to PFI hospital provision even further."

PFI is probably the worst thing that has happened to the NHS, even worse than the introduction of the internal market.

I can't see how having hospitals tied into million pound contracts for decades saves the taxpayer money. Especially when they're selling off the valuable hospital sites. A prime example would be UCL's new building. The sale of the sites of the present UCL and Middlesex hospitals would have more than covered the cost of the new building and equipment.

[LibLabUK]

3. The BBC have a nice explanation.

Q& A on Foundation hospitals: http://news.bbc.co.uk/1/hi/uk_politics/3120878.stm

[Jack Rabbit]

5. Thank you

I know Britain has one of the older state-run health programs in the world. It has the usual advantages, such as anyone who needs a doctor can see one. The disadvantage, or so I've been told since I was in middle school, is that one may have to wait hours. An overhaul of the system wouldn't be a bad thing. However, that doesn't necessarily mean this is the best way to go about it.

Concerning the feature of the legislation that would allow hospitials to borrow money: would their be no oversight to their dealings? Would the government give the foundation hospitals the benefit of the doubt and step in only if mismanagement or corruption is obvious? This is public money we're talking about, isn't it?

I assume the Tories have their own ideas. I suppose these involve something more akin to privatization. Is that a good assumption?

If this plan is voted down, will the government came back with a new one? Is anybody in Labour who objects to foundation hospitals sounding any ideas about how problems with the British health care system can be fixed?

[LibLabUK]

6. To answer a couple of your questions.

"I assume the Tories have their own ideas. I suppose these involve something more akin to privatization. Is that a good assumption?"

Yes. That is their plan. They want an American system of private medical insurance for those that can afford it.

"The disadvantage, or so I've been told since I was in middle school, is that one may have to wait hours."

Depends. You have to remember that you only ever hear about the bad things happening to and in the NHS, good news doesn't sell papers, especially right-wing rags like the Daily Mail.

If you have an emergency and go to the Accident & Emergency department (ER) of your local hospital, you should be triaged quite promptly and your priority level set. You are then placed on a waiting list according to your priority level and you'll be seen as soon as staff become available. Obviously, the more serious your complaint the quicker you're seen. On the handful of occasions I've been seen in A&E I've not had to wait more than 4 hours.

This also holds true for non-emergency treatment, although waits of up to 18 months for minor surgery aren't unknown. Serious illnesses, such as cancers, are treated as soon as the resources allow. Afterall you can only treat a finite number of people a day, The wait is typically a matter of days or weeks (again depending on the type of treatment).

[Jack Rabbit]

7. Thank you

(The Tories) want an American system of private medical insurance for those that can afford it.

Anybody who thinks the American medical system is a good model needs a doctor, and I don't mean a surgeon.

[truthspeaker]

8. it works great for the rich

And that's all the Tories care about.

[LibLabUK]

9. No problem.

Maybe you can answer me a question.

How much does an average single 25-35 year old pay for healthcare in the US?

I currently pay £124/mo which at today's exchange rate is roughly $210. That's for Health, Disability and Unemployment Insurance and State Pension contribution. How does that compare to the US?

[haele]

10. You're actually getting more...

That's about how much the average non-union single 30 year old with a good benefits package in California payed out this year for medical, dental, visioncare, life insurance, and short/long term disability on a "before tax" basis - no matter how much the employee made. Unions do their own thing; I've heard where some union members pay much less than $200 a month for these benefits through the union rather through an employer.
Social Security, Medicare and a few other federal benefits are taxed under FICA, the national "pension and disability" fund, and is based off a percentage of taxable wages up to a certain ceiling. What most people end up seeing taken out is about 1% of their wages for every dollar up to about the wage limit of $85K a year.

Additional retirement other than SS - pensions, 401Ks, company stock, retirement investments, etc are either based on a percentage of the employees wages or salery if provided by the employer, or the employee must pay for any retirement on their own.

This year, a smart single worker who's making above livable wage in any area will find that there's usually an average of $350 a month going out to insure some sort of medical, life and wage insurance, and retirement.

A worker with a family will find him or herself paying out between $500 and $800 a month to protect the family.

At 44, with a spouse and and adding one child to my benefits package which includes all health, including Blue Cross PPO, vision and MetLife dental, $200K life insurance, disability, fully matched stock options and 401K at 5% of my salery before taxes, I'll paying out around $650 a month as of Jan 1, 2004 - which is considered CHEAP.
Before I got married two years ago, that same package cost me $217 a month.
If I was forced to make due with just COBRA, the federal medical and dental program for those who make above the poverty level of around $26K gross, is at least $350 a month for a single person and $900 if you add spouse and 1 child - and it covers far less than my current plan does.
So as a sole provider of a yearly family income gross of around $40K, I feel damn lucky to be shelling out just 1/3 of my monthly before tax gross to protect my family.
The benefits package I had with my last employer, with a family, I'd be paying around the same - 1/3 of my gross, but would not have had a quality medical, nor any dental or vision, nor would have had matched stock options.

Benefits packages in the US are strictly according to the contracts between employer and the service provider - or what the worker is able to afford on his or her own. That's why there's a health care and retirement crisis - so many Americans are undercovered or have no health or retirement other than what they pay into for FICA because they just don't make enough to invest in the insurance.
And it's not a matter of the average middle class manager not getting that big-assed TV or second SUV on credit to keep from falling short on his/her retirement investments; it's a matter of the average worker being able to invest between a quarter to one-third of a paycheck for adaquate health coverage and insurance even before paying the state and federal taxes for government provided infrastuctures.

Haele

[LibLabUK]

11. Wow!

Thank you for that comprehensive answer.

[T_i_B]

12. Why foundation hospitals are a bad idea

Former Health minister Frank Dobson explains all for starters

http://www.guardian.co.uk/comment/story/0,3604,913914,00.html

Why are so many people in the NHS, so many Labour party members and so many Labour MPs opposed to foundation hospitals? Why are the Tories drooling at the prospect? The answer to both these questions is the same. Foundation hospitals will reintroduce competition into the NHS, making it easier to break up and privatise. They are one of a flurry of government proposals that will undermine NHS integrity.

These proposals include planning for long-term dependency on private hospitals, paying them more per operation than the NHS gets and franchising out the management of "failing" hospitals and the ownership and management of new diagnosis and treatment centres. In his launch speech for Peter Mandelson's Progressive Governance conference, Tony Blair has called for a mixed economy in healthcare and, worse still, for "new forms of copayment" (which, in plain English, means new charges). Alan Milburn has decreed that NHS hospitals must compete with one another and the private sector. No wonder Labour people are glum.

Advocates of these ideas claim they are pragmatic - "away with ideology", they say, "what works is what counts". There are two problems with this. First, a few basic beliefs wouldn't go amiss. Second, there is no evidence that these competitive approaches work, and lots of evidence that they don't.

Few people object to the NHS using private hospitals to meet short-term pressures. But the government now plans to make the NHS permanently dependent on the private sector. They ignore what happened to long-term care of the elderly after the Tories transferred responsibility to the private sector. At first, the expansion of places in private residential and nursing homes was proclaimed a great success. Not any more. Private sector owners have found more profitable uses for their property, leaving elderly people, the NHS and local councils to cope with the consequences.

And here is fellow Wednesdayite Roy Hattersley with more. Expect the vote to pass though. "new" labour MP's are not known for standing up to their paymasters. :grr:

http://www.guardian.co.uk/comment/story/0,3604,1084663,00.html

No matter how rational the argument or how strong the evidence, New Labour always accuses its critics of defending outdated ideas and discredited ideology. Name-calling is usually an alternative to thought. But the irony of the government's health service reforms creates a temptation which is too strong to resist. The idea behind the creation of foundation trusts is both hopelessly old-fashioned and mindlessly ideological. It is based on the myth that competition - the panacea for all 19th-century economic ills - invariably improves performance and that it will somehow encourage, shame or coerce bad hospitals into doing better.

If foundation trusts are created on the periphery of the NHS, a minority may enjoy even higher standards than three-star status already provides. But the rest will receive a lower level of care - certainly in comparison with what the foundation trusts can offer and probably even in absolute terms.

That is the reality of the four financial advantages which are to be bestowed on foundation trusts. They will be allowed to keep moneys raised from selling land and assets, retain surpluses from one year to the next, borrow from the private sector and largely determine their own pay rates. That means that one James Plaskitt MP may be able to justify the content (if not the sycophantic tone) of his request to the prime minister that a foundation trust be created in his constituency. It is the MPs for adjoining seats who should be alarmed. They should be alarmed about the staff levels in their non-foundation hospitals. The objection to flexible pay rates is not the usual trade union concern about wage levels being reduced in the independent sector. Quite the opposite. The danger - indeed the near certainty - is that a foundation trust, short of theatre and intensive care nurses (in some areas the commonest cause of cancelled surgery) will simply increase salaries and poach from the surrounding hospitals. Who can blame them? But they will be offered the chance to improve at the expense of other hospitals.

The same strange principle - taking from the hospital with the greatest problems in order to give to those where the imperative to improve is least - will widen the divide between the best and worst. In the past, income from asset sales has been pooled and distributed to hospitals with the most need for more resources. That rule will still apply in general. But the foundation trusts will keep all they can get, no matter how great their income from other sources. The losers will be the hospitals which are deprived access to the market and a share in the trusts' windfall income.

[T_i_B]

13. Why PFI is a fraud

See the book Captive State by George Monbiot for more.

http://www.spectator.co.uk/article.php3?table=old§ion=current&issue=2002-03-09&id=1646

Because the private finance initiative mobilises private capital, ministers have argued, it allows the government to start more schemes than it would otherwise be able to commission. Private companies provide the money for public infrastructure the state can’t afford, and the government pays it back over a number of years. Because the private sector is more efficient, they insist, PFI schemes offer better value for money than public funding. And because private companies, rather than the government, provide the capital, the money spent on new projects does not contribute to the public sector borrowing requirement.

The reality is that PFI, or ‘public private partnership’ as the government now prefers to call it, is a scam. It works for neither socialists nor free marketeers, as it offers neither effective public provision nor business efficiencies. Far from introducing market disciplines, it has become an official licence to fleece the taxpayer. Far from reducing the public sector borrowing requirement, PFI is, as the Accounting Standards Board has noted, simply ‘an off-balance sheet fiddle’. Most alarmingly, the ministers I have spoken to simply do not understand how it works.

The first of the problems Labour has failed to grasp is the process by which the private investors are chosen. The government announces a new scheme, companies make their bids, and the government selects the bid which appears to offer best value for money. The chosen consortium is named the ‘preferred bidder’, and the government starts to negotiate the contract.

The consortium then has the government over a barrel. In theory, the contract is still open to competition. In practice, preferred bidders have been deselected only, as far as I can discover, in two of the hundreds of PFI schemes the government has launched. Once the consortium has its foot in the door, it can raise its price and reduce its services. Costs which weren’t envisaged before will emerge. The likely inflation of labour and materials will be priced as generously as possible. In some cases, I have found, companies have simply slipped extra figures into the spreadsheets. Most importantly, value for money in PFI contracts is a function of the extent to which the projects’ risks are transferred to the private sector. Because the government is hopelessly outclassed in negotiations, companies routinely transfer most of the key risks back to the taxpayer. As a result, PFI, from the corporate point of view, is a far better deal than privatisation. The consortia get the assets but not the liabilities. In some cases, they carry no greater risk than ordinary contractors for the public sector, but they are rewarded as if they were the most reckless entrepreneurs