Yes Polly, this is the point

Now there will be no fixed tariff, so private companies can undercut and cherry-pick easy work. That risks destabilising NHS services.

What can be done more cheaply by someone outside the NHS will and should be done by someone more cheaply, outside the NHS. That which cannot be done so (like, say, A&E) will not be done so.

In this manner we manage to get more health care for the money we are willing to spend on health care.

It is possible to get a tad more complex in this argument: that there are a lot of cross subsidies for example. Unbundling the NHS will make clear and apparent these cross subsidies. But then again, that\’s the point. We should always be working to make such subsidies explicit, not leaving them implicit in the design of a system.

For implicit subsidies have a tendency to become very damaging because, being implicit, they are not examined.

As an example I would give you the NHS national pay rates. These are, by definition, national, and mean that NHS pay in areas of low local wages is quite high compared to those local wages. Not too much of a problem, those Angels deserve good pay. But in areas of high local pay it means that those national wages are too low to attract the desired staff.

And yes, this does kill people:

These effects are not trivial: the results suggest that a
10% increase in the gap between the wages paid to NHS
nurses and those paid to women working in the private
sector locally raises the fatality rate among people
admitted with a heart attack by about 5%.

Only by unbundling the NHS will we be able to see these problems.

Unless, of course, you want to start arguing that equality of pay across the country is such an important issue that people should righteously die from a heart attack just because they live in an area of high pay?

3 thoughts on “Yes Polly, this is the point”

  1. A friend of mine (a fund manager who invests in evil private medical companies, amongst other things) was telling me about the difference between how pathology labs differ between Australia and the UK. In Australia, where most patients see doctors in private practice and public hospitals are much more free to buy services from outside providers, a lot of small companies providing pathology services have merged and taken over one another. So you have a couple of big companies with modern equipment, economies of scale, and incentives to cut costs and increase efficiency. In the UK, each hospital has its own small and often out of date lab without the same incentives. Therefore, getting tests done in Australia is cheaper and much faster, although the actual test is likely to be done further away from you. There was also a apparently a certain amount of drooling amongst the Australian companies about how much money they thought they could make if they were allowed to enter the British market on a competitive basis.

  2. I find it amazing that people talk about emergency and elective stuff as if they are so easily separable. It’s pretty dubious to pretend that you can hive off elective surgery from (say) a major teaching hospital and still run acute care in the same manner.

    But what do I know? I’m only a nurse

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