that fact that people disagree means nothing and should be ignored as people disagree all the times about anything and everything.
The NHS used to own its radiography suites. It used to own its land and buildings. It used to hire doctors and nurses and support staff directly.
But because of a [also recent] forced-tender system, and high breakthrough prices on in-housing projects, it was deemed "cheaper" to let private providers burden the upfront costs of equipment, land and building management, and short contract management.
Shock, horror! Letting "interface companies" extract profit makes services more expensive, and now we're paying more, it's even less affordable to talk about major public capital investment to bring these critical, primary services back in-house.
The NHS needs to stand up for itself and politicians need to start talking about 20y plans. Making ends meet today isn't enough. Giving up, adding insurance companies to the mix won't do anything but make it even more expensive.
Hospital needs a new MRI suite. To them, this would cost £2m for the machine, £400k for the room, and £500/h in running cost, £1.4m/year. The first 5 years costs are: £3.8m, £1.4m, £1.4m, £1.4m, £1.4m, ...
But which trust has £4m in their back pocket for y1 cost? Even if they did, it's a large project so has to go out to tender. A capital-investment-backed provider comes back with a flat cost of £2m/year. They might have the additional cost of land but many of these [currently, right now in many hospitals] operate in containers in the carpark. At £2m, they break-even after Y4 and produce £600k a year profit from Y5 for another 11 years. NHS loses £6.6m over 15 years.
And it's not that simple because their £2m bid will be interesting but there'll another for £1.5m at half-duty that will sell operational time to private providers, even direct-to-public (increasingly popular in the UK) at massive markups. They'll break even in Y3. Possibly even quicker if the hospital realises it needs full duty and pays triple-rate to book the machine out.
So the NHS picks a private provider. They make a 5 year saving, and take an 11 year beasting. And at the end of it, or even halfway through it when they discover they need even more capacity, they find out that their old suite is now a support ward. Or managers have moved in, or it's just fallen down. The cost to build a new suite isn't the £2.4m it would have been, it's £4m. To get so assuming we would now need two machines, it's an £8m y1 cost to bring this back in-house.
The long-term budgetary flexibility required to go back to running your own services is staggering and something that is very hard to sell to people not looking at TCO.
Also, since I’m from the US, your example reminds me of Bobby Bonilla Day, jeered at as an awful deal for the sports team but in reality a fair present value exchange for forgoing a large short-term contract. (I realize unit specific numbers are just an example.) Fun recap, analysis and interview: https://www.npr.org/2021/06/25/1010404697/bobby-bonilla-day
To cap it off, when the mother asks if the child is a boy or a girl, Graham Chapman responds, "it's a bit early to start putting roles on it".
If you are serious, I have bad news for you. The situation is going exactly as expected. That’s the traditional Tory plan. Defund, complain it doesn’t work now that it doesn’t have money then make private.
British voters can only blame themselves. Between Brexit and decades of voting for the worst of the Tory, if they were less stupid, their country situation wouldn’t be so bad.
> British voters can only blame themselves. Between Brexit and decades of voting for the worst of the Tory, if they were less stupid, their country situation wouldn’t be so bad.
I've yet to see, in decades of Tory rule, much but decline, neglect, and scandal. Tax cuts and service cuts. That's all everyone needs apparently. Unfortunately, labor seems so incompetent at gaining power that it seems almost like a "managed opposition." Maybe I'm being too generous to their electorate as well. The UK is a tourism attraction at this point, a historical relic found in a curio shop or flea market. Or soon will be at its current clip.
I've no illusions about the electorate but the Tories have spent their time distilling the party down to the extreme right wing element and that's —frankly— shown us all what a bunch of idiots they are. I can't remember a less electable bunch. https://twitter.com/UKPoliticalPics/status/15765728049624760...
Having the government in charge of something means it's always going to be inefficient.
Nobody wants US healthcare, not even the US; to willingly introduce it here would be instant political suicide. That gives me hope.
And Conservatives have screwed things so hard in the past 12 years, I think there's genuine appetite for public investment. The current Labour party isn't the government it very nearly could have been in 2017 but if their recently energy policy[1] is anything to go by, they're not afraid of borrowing to invest in long term savings.
Energy is a great example. If we could become independent of oil and not just swap that for lithium/cobalt dependencies, that probably is worth the outlay. Healthcare falls into a similar bracket.
The added bonus is that if Labour gets a PR-like voting system implemented, it might be harder for any one (or two) parties to dominate politics and we could focus on goal-orientated politics. Maybe.
1: https://www.theguardian.com/politics/2022/sep/27/labour-will...
There's a 20 year plan.
Make sure the private system that replaces it after spending 20 years looting it is as profitable as possible.
There have been various contortions along the road; initially, the plan was that all GP surgeries would be required to upload patient data to the (shareable) national collection. The government partially backed down, allowing patients to opt out of that kind of sharing. A separate opt-out was required for data concerning hospital treatment. Both required patients to acquire and submit a paper form; there was no opt-out website.
Then they changed the structure of the sharing system a little, rendering prior opt-outs moot; you had to opt-out again.
You'd think the government would be able to make a lot of money out of this data; but one of the scandalous early deals they made was to sell the data of a million patients to the Society of Actuaries. For £3,000. Actuaries work for insurance companies; and insurance companies would dearly love to get their hands on people's health data. But £3,000?
Now Palantir's core business is collecting data. It isn't a medical company. Corellating "anonymised" data is what they do. They are hostile to privacy, and they are famously secretive.
There are people in government who want to privatize the NHS completely. Unfortunately for them, the NHS is probably the most popular institution in the UK; so they salami-slice. Various NHS services are privatized by stealth; the last CT scan I had was conducted in a van in the hospital carpark, run by some US health conglomerate. Various testing services have been fully privatized, with the original NHS services shut down.
So there are two threads behind this story: the creeping privatisation of NHS services, and the involvement of this creepy company in handling patient data.
Sweden walked this same path and is deeply deeply suffering the privatisation.
Doctors are nowhere to be seen, waiting times are absolutely impossible to work with. You basically have to beg to see a doctor and even then they will likely decline you unless you’re in pain.
It’s ridiculous. It can be directly attributed to the privatisation of the underlying services.
I believe the mechanism you're advocating for is generally referred to as a dictatorship.
