Bye Bye NHS

[multitool]

The argument Streeting is putting forward is that there is an immediate issue of long-waiting lists for NHS treatment leading to huge wealth inequalities for the reasons you mention. It isn't just about surgeons, but about theatre space, and bed space. (see also crisis in social care leading to bed blocking).

He is arguing that the less well off should not be denied treatment because of 'principles'. He has a point here because in the short-term throwing money at the NHS will not help people on waiting lists now, and if you are one of them and your life is being shortened, or threatened by lack of health care you would likely not refuse treatment provided by the private sector. Indeed, those that can afford to go private are increasingly having to do so.

This is very different from the argument that private health care is better because it offers greater efficiency etc etc. That is the Tory argument, and as far as I can see is not the argument Streeting is making. And it is not an argument for changing the funding model for UK health care.

 

[BoldonLad]

There are a few things being missed here.

Wes Streeting has received tens of thousands of pounds in donations from donors linked to, mainly US, private healthcare firms. He's opposed pay and funding demands from NHS medical staff, like the Tories, and has now seemingly encouraged more privatisation of the NHS, like the Tories.

Private healthcare firms are not bleeding heart liberals. Like all private firms in any industry, they're in the business of making profits for themselves, shareholders and offshore tax accountants. They will charge as much as they can get away with and do as little as possible for it. They'll be no checks and balances as, let's be honest here, the UK Gov, regardless of flavour, don't do checks and balances when it comes to taxpayers cash.

Why not just use the money that will go to these private firms and invest it directly into the NHS? Previous Labour Governments did that successfully.

Also, he writes this is in The Sun. The Sun is read by mainly working class people. He's banging on about 'Middle Class Lefties.' Are Labour going to carry on the politics of division that we've had for the past 14 or so years? Them vs Us? It's also quite insulting to think that working class people will blindly accept privatisation of the NHS.

Middle class people are going private as they have no choice, especially with a 7.4 million waiting list, and they are able to afford it, not that they really want to pay for private care. Also, they earn larger salaries and pay more tax so if you ask these 'Middle Class Lefties' if they would like to go private or use the NHS, that they pay for, then I'm sure the answer will be NHS every time.

Remind me again of the difference between the two main parties?

Invest? interesting word

 

[icowden]

Why not just use the money that will go to these private firms and invest it directly into the NHS? Previous Labour Governments did that successfully.

Because of this:-
https://www.independent.co.uk/news/health/doctors-nhs-private-sector-safety-b2011941.html

If you let private healthcare take all the routine ops, you start to lose qualified professional specialists as there are no longer routine ops for them to perform in order to gain training, or maintain current skills.

 

[icowden]

I think the issue with the NHS is that it has ceilings, and thus staff are not incentivised*. Hence the moonlighting.

This is a major issue and cost for the NHS IMHO. I offered to work for the NHS multiple times as an employee, but every time would have involved a significant income drop. Instead they preferred to pay a project company to pay an agency to pay me via a Ltd company to work for them, so overall paying probably close to double what it would have cost to pay direct wages, but because that wage would put me at a senior director level, they wouldn't do that.

This gets echoed throughout the health service. Hunt meant the cap to ensure that Nurses didn't all disappear to agencies who were able to get them much higher salaries, but due to his incompetence it applies to the whole NHS. IT people, Managers, highly skilled Consultants etc. it's particularly draining on the administrative side where the NHS is competing with market rates for the same people and many Trusts cannot afford to have competent IT staff employed full time, but can afford to get them via a project outsourced to a third party.

This was further reinforced by IR35 rules changes which meant that contractors would no longer work directly for Trusts, but only via a project model. The NHS would save a fortune if it could set salaries properly.

 

[BoldonLad]

This is a major issue and cost for the NHS IMHO. I offered to work for the NHS multiple times as an employee, but every time would have involved a significant income drop. Instead they preferred to pay a project company to pay an agency to pay me via a Ltd company to work for them, so overall paying probably close to double what it would have cost to pay direct wages, but because that wage would put me at a senior director level, they wouldn't do that.

This gets echoed throughout the health service. Hunt meant the cap to ensure that Nurses didn't all disappear to agencies who were able to get them much higher salaries, but due to his incompetence it applies to the whole NHS. IT people, Managers, highly skilled Consultants etc. it's particularly draining on the administrative side where the NHS is competing with market rates for the same people and many Trusts cannot afford to have competent IT staff employed full time, but can afford to get them via a project outsourced to a third party.

This was further reinforced by IR35 rules changes which meant that contractors would no longer work directly for Trusts, but only via a project model. The NHS would save a fortune if it could set salaries properly.

There is more to the cost of employing someone than their Salary. Ltd Company contractors or temps, do not incur Employer pension liabilities, sick pay, holiday pay. In addition, if you decide to “offload” a Ltd Company Contractor, there are no redundancy or unfair dismissal considerations.

 

[Rusty Nails]

There is more to the cost of employing someone than their Salary. Ltd Company contractors or temps, do not incur Employer pension liabilities, sick pay, holiday pay. In addition, if you decide to “offload” a Ltd Company Contractor, there are no redundancy or unfair dismissal considerations.

@icowden says that his total cost to the NHS as a contractor was almost double that of a similarly responsible direct employee. Obviously it depends on the company but from what I have read on-costs for employees are estimated as between 30 and 40% of salary/wage costs. I am happy to accept his figures based on his experience.

Some nationalised organisations have found it looks better if they can show they are controlling their employee numbers...even if they are substituting them elsewhere in the (cooked) books.

 

[BoldonLad]

@icowden says that his total cost to the NHS as a contractor was almost double that of a similarly responsible direct employee. Obviously it depends on the company but from what I have read on-costs for employees are estimated as between 30 and 40% of salary/wage costs. I am happy to accept his figures based on his experience.

Some nationalised organisations have found it looks better if they can show they are controlling their employee numbers...even if they are substituting them elsewhere in the (cooked) books.

As I said, there is more than simply the "on-costs", but, accept away.

 

[icowden]

There is more to the cost of employing someone than their Salary. Ltd Company contractors or temps, do not incur Employer pension liabilities, sick pay, holiday pay. In addition, if you decide to “offload” a Ltd Company Contractor, there are no redundancy or unfair dismissal considerations.

That's true but it doesn't work out. There are around 252 working days in a year. Lets take off 30 days for holiday. That leaves 222 days.
A Band 8a tops out at about £61k with full London weighting.

A contractor working on an IT project in a senior role at 8a sort of level is currently being offered around £500 a day. That's £116k but of course that doesn't include the agencies 20%, so we need to add on £23,200. The contractor because of IR35 isn't going to go direct, they will be employed by a project which will probably include at least a 20% profit margin on the staff. So without doing all the complex maths lets call it another 20%.

That IT Contractor is now costing (per annum) £162,400 of which almost £50k is going to the companies rather than the contractor. It's also three times that £61k salary and any learning or knowledge leaves at the end of the project.

To me, that doesn't feel like value for money. Of course if you offered an 8d the contractor might go employed (or even an 8b), but that's one or two bands below the COO and CEO type roles. Not a standard senior rank and file role.

And bear in mind that that £500 a day rate is what I'm currently hearing offered for NHS work, not private sector - expect at least £750 private sector, double if it's banking. I've settled for the reliability of employment elsewhere and once you take off taxes and overheads you don't earn the full £116k - a lot of that goes back to HM Gov, so an 8b to 8d would be enough to recruit similar talent.

But the fact remains, it is not cheaper to pay for IT through a Project.

 

[BoldonLad]

That's true but it doesn't work out. There are around 252 working days in a year. Lets take off 30 days for holiday. That leaves 222 days.
A Band 8a tops out at about £61k with full London weighting.

A contractor working on an IT project in a senior role at 8a sort of level is currently being offered around £500 a day. That's £116k but of course that doesn't include the agencies 20%, so we need to add on £23,200. The contractor because of IR35 isn't going to go direct, they will be employed by a project which will probably include at least a 20% profit margin on the staff. So without doing all the complex maths lets call it another 20%.

That IT Contractor is now costing (per annum) £162,400 of which almost £50k is going to the companies rather than the contractor. It's also three times that £61k salary and any learning or knowledge leaves at the end of the project.

To me, that doesn't feel like value for money. Of course if you offered an 8d the contractor might go employed (or even an 8b), but that's one or two bands below the COO and CEO type roles. Not a standard senior rank and file role.

And bear in mind that that £500 a day rate is what I'm currently hearing offered for NHS work, not private sector - expect at least £750 private sector, double if it's banking. I've settled for the reliability of employment elsewhere and once you take off taxes and overheads you don't earn the full £116k - a lot of that goes back to HM Gov, so an 8b to 8d would be enough to recruit similar talent.

But the fact remains, it is not cheaper to pay for IT through a Project.

I thought your argument was shortage of staff, and, that Contractors would become available as staff, if salary rates matched Contract rates? So, a Salary of £116k would not cut it. Plus, of course, Contractors choose to be Contractors for a variety of reasons, at least I did.

 

[icowden]

I thought your argument was shortage of staff, and, that Contractors would become available as staff, if salary rates matched Contract rates? So, a Salary of £116k would not cut it. Plus, of course, Contractors choose to be Contractors for a variety of reasons, at least I did.

Contract rates don't have to match salary rates, salary rates they are typically at least 25% lower. That headline income of £116k includes £22k of corporation tax for a start, leaving £94k. Then you have company pension payment, overheads, insurance, equipment costs etc. Paid out "Salary" from that would likely be around 80k to 90k. It also doesn't include fallow periods between contracts, sick leave, paternity or maternity leave, compassionate leave etc, so a salaried job at 80 to 85k would attract a contractor on £500 a day rate even though the headline rate is much higher.

 

[farfromtheland]

This post is pretty typical of your output.

It is conflating two completely different things: provision of services and method of funding.

Increased use of private sector for the supply of medical services does not mean that end users will be charged. It means that, in theory, waiting lists will shorten. Streeting has already said that he is open to increased use of private health care for precisely this reason, and it is fairly obvious as to why.

Funding is a different matter. If memory serves there was an investigation in the Lords six or seven years ago into different options available. These are funding from general taxation (UK), a social insurance fund (France etc) or private health insurance (USA, Switzerland etc). The outcome was that all of the systems have advantages and disadvantages and neither of the other two offered any material advantages over the system we have.

This is why Labour does not plan to change the funding system and sees the possible movement to.be in a reform of how the money is spent.

In the short term, the huge waiting lists cannot be reduced without employing more staff. But the supply of staff is not there, hence the view to using capacity within the private sector.

In my local hospital there is an unstated triage at A&E that sends patients either to the hospital's actual consultant-run casualty ward or to the contracted 'urgent care' service that in my case fobbed me off with going elsewhere to book blood tests with at least a 2 week wait and then getting an emergency ambulance sent to my house in the middle of the night when the results came in.

This was not capacity within the private sector, it's a company set up precisely to cream off the 'easy' work - only in this case it turned out quite uneasy.

I now face a contracted physiotherapy service that has just terminated it's contract with the hydrotherapy service. Unfortunately I need hydrotherapy.

The list goes on.

It's not value for money! it's taking the decision-making away from medical staff and giving it to an asset stripping algorithm with tame typists. Labour brought in the NHS internal market and the Private Finance property scams. Wes Streeting is a toe wag.

 

[BoldonLad]

Contract rates don't have to match salary rates, salary rates they are typically at least 25% lower. That headline income of £116k includes £22k of corporation tax for a start, leaving £94k. Then you have company pension payment, overheads, insurance, equipment costs etc. Paid out "Salary" from that would likely be around 80k to 90k. It also doesn't include fallow periods between contracts, sick leave, paternity or maternity leave, compassionate leave etc, so a salaried job at 80 to 85k would attract a contractor on £500 a day rate even though the headline rate is much higher.

This is a major issue and cost for the NHS IMHO. I offered to work for the NHS multiple times as an employee, but every time would have involved a significant income drop. Instead they preferred to pay a project company to pay an agency to pay me via a Ltd company to work for them, so overall paying probably close to double what it would have cost to pay direct wages, but because that wage would put me at a senior director level, they wouldn't do that.

This gets echoed throughout the health service. Hunt meant the cap to ensure that Nurses didn't all disappear to agencies who were able to get them much higher salaries, but due to his incompetence it applies to the whole NHS. IT people, Managers, highly skilled Consultants etc. it's particularly draining on the administrative side where the NHS is competing with market rates for the same people and many Trusts cannot afford to have competent IT staff employed full time, but can afford to get them via a project outsourced to a third party.

This was further reinforced by IR35 rules changes which meant that contractors would no longer work directly for Trusts, but only via a project model. The NHS would save a fortune if it could set salaries properly.

Interesting, but, are you arguing for the Contractor, or, for the "poor" NHS?.

As for the "leave" etc, this exactly what I said earlier.

 

[icowden]

Interesting, but, are you arguing for the Contractor, or, for the "poor" NHS?.
As for the "leave" etc, this exactly what I said earlier.

A bit of both but mostly the NHS. I enjoyed working with the NHS, and I enjoyed working for the NHS before I accidentally fell into consultancy work, but the fact is that I know multiple talented people who left the NHS to return as contractors because the salary was incredibly uncompetitive. As a tax payer, I don't want to be funding Deloitte and multiple agencies unnecessarily. A centralised controlled pay scale only works if there isn't more, significantly better paid private sector work. Teachers don't all leave to return as contractors because the vast majority of jobs are government jobs.

The rule was brought in to control Nursing as Agencies were able to get Nurses better salaries that they could actually live on.

 

[cookiemonster]

Not just Streeting, but Herr Starmer as well. Can we be sure that this private involvement is just short term? No-one gives 175K to any politician without some kind of return.

https://www.thenational.scot/news/2...akes-175k-donors-linked-private-health-firms/

 

[multitool]

It depends what the 'links' are.
The hedge fund manager may have 'links' to all sorts of things.

Unfortunately, the Labour party has to get its funds from somewhere if it is to compete with the vastly better funded Conservative machine, especially considering the Conservatives have just removed the cap on party electoral spend. Ah...you didnt know about that...I see.