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No, that's relatively new. 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 st

No, that's relatively new. 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.

stepbeek 4y ago
Yes! The UK has viewed private sector efficiency as axiomatic throughout my life. The New Statesmen has a good article on the systemic impact of such decisions in the current issue: https://magazine.newstatesman.com/2022/09/28/dieter-helm-capitalism-works-best-with-a-strong-state/content.html https://magazine.newstatesman.com/2022/09/28/dieter-helm-cap...
- nonrandomstring 4y ago
  Culminating with us more or less selling-out GCHQ to Amazon. A lot of voices are starting to frame this as national security. Regardless of political alliances and so-called "special relations" this is no longer about mere business. The frame of acquisitions, mergers, and contracts no longer adequately captures the risks. It's about where power lies and who actually runs a nation. If Huawei can be deemed a first-class threat, then so can Palantir, and this sort of revelation only makes that clearer.
boomskats 4y ago
Sadly, selling it off to private US social care firms will be deemed the only solution to our recently imposed budget deficit.
- oliwarner 4y ago
  Maybe, I don't think it'll happen quickly though. 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-launch-publicly-owned-energy-firm-keir-starmer-vows https://www.theguardian.com/politics/2022/sep/27/labour-will...
  - pessimizer 4y ago
    This is an extremely cynical and conspiratorial thought, but I wouldn't be surprised if the Conservatives haven't made a deal to hand the next elections over to Labour in return for helping them get rid of Boris, and with this interim sacrificial government of Truss to ram through a bunch of things that even Tories would think it would be political suicide to publicly support. Then Starmer can glide in, and do things that the Tories could never get away with doing, like privatizing healthcare. > 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. I doubt the PLP will ever show any serious effort to get this done. There's nothing they hate more than voting, and if there's any consistent policy from Labour it's that voting is an unfair commentary on things that average people are neither qualified nor deserving to discuss. They spend a significant amount of time as individuals trying to find people to remove the vote from.
VieEnCode 4y ago
This should be the top comment, but this place is full of Thiel Stans, hence their bemusement.
oliwarner 4y ago
If you're unaware of how tender breaks public services, here's an example. 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.
- wil421 4y ago
  How are you depreciating the MRI machine? Why is the year one cost so high? I would’ve expected the MRI machine to depreciate over a decade.
  - chalst 4y ago
    Depreciation is a term relevant to valuing assets and liabilities on the balance sheet and P&L accounts. oliwarner's figures are cashflow figures, a completely different kind of account, which is what you look to when asking how much financing is needed, a key factor in whether the purchase is given the go-ahead.
WastingMyTime89 4y ago
> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. 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.
- formerkrogemp 4y ago
  > 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. 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.
- linuxftw 4y ago
  Socialized medicine was always going to be unaffordable in the long term. If it wasn't a burden, then the 'cost cutting' measures probably wouldn't have been implemented. Having the government in charge of something means it's always going to be inefficient.
  - WastingMyTime89 4y ago
    > Socialized medicine was always going to be unaffordable in the long term. Why? Sorry but that’s horse shit. There is nothing preventing socialised medicine for working. It costs less per capita nowadays than it did when it was put in place and productivity skyrocketed since. The economic arguments were always the very privileged hiding their greed and contempt for the rest of us behind a fine veneer. I truly believe some of them even came to believe it to help themselves sleep at night. It doesn’t mean we all have to drink it.
Schroedingersat 4y ago
> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. 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.

stepbeek 4y ago

Yes! The UK has viewed private sector efficiency as axiomatic throughout my life. The New Statesmen has a good article on the systemic impact of such decisions in the current issue: https://magazine.newstatesman.com/2022/09/28/dieter-helm-capitalism-works-best-with-a-strong-state/content.html https://magazine.newstatesman.com/2022/09/28/dieter-helm-cap...

nonrandomstring 4y ago
Culminating with us more or less selling-out GCHQ to Amazon. A lot of voices are starting to frame this as national security. Regardless of political alliances and so-called "special relations" this is no longer about mere business. The frame of acquisitions, mergers, and contracts no longer adequately captures the risks. It's about where power lies and who actually runs a nation. If Huawei can be deemed a first-class threat, then so can Palantir, and this sort of revelation only makes that clearer.

boomskats 4y ago

Sadly, selling it off to private US social care firms will be deemed the only solution to our recently imposed budget deficit.

oliwarner 4y ago
Maybe, I don't think it'll happen quickly though. 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-launch-publicly-owned-energy-firm-keir-starmer-vows https://www.theguardian.com/politics/2022/sep/27/labour-will...
- pessimizer 4y ago
  This is an extremely cynical and conspiratorial thought, but I wouldn't be surprised if the Conservatives haven't made a deal to hand the next elections over to Labour in return for helping them get rid of Boris, and with this interim sacrificial government of Truss to ram through a bunch of things that even Tories would think it would be political suicide to publicly support. Then Starmer can glide in, and do things that the Tories could never get away with doing, like privatizing healthcare. > 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. I doubt the PLP will ever show any serious effort to get this done. There's nothing they hate more than voting, and if there's any consistent policy from Labour it's that voting is an unfair commentary on things that average people are neither qualified nor deserving to discuss. They spend a significant amount of time as individuals trying to find people to remove the vote from.

VieEnCode 4y ago

This should be the top comment, but this place is full of Thiel Stans, hence their bemusement.

oliwarner 4y ago

If you're unaware of how tender breaks public services, here's an example. 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.

wil421 4y ago
How are you depreciating the MRI machine? Why is the year one cost so high? I would’ve expected the MRI machine to depreciate over a decade.
- chalst 4y ago
  Depreciation is a term relevant to valuing assets and liabilities on the balance sheet and P&L accounts. oliwarner's figures are cashflow figures, a completely different kind of account, which is what you look to when asking how much financing is needed, a key factor in whether the purchase is given the go-ahead.

WastingMyTime89 4y ago

> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. 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.

formerkrogemp 4y ago
> 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. 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.
linuxftw 4y ago
Socialized medicine was always going to be unaffordable in the long term. If it wasn't a burden, then the 'cost cutting' measures probably wouldn't have been implemented. Having the government in charge of something means it's always going to be inefficient.
- WastingMyTime89 4y ago
  > Socialized medicine was always going to be unaffordable in the long term. Why? Sorry but that’s horse shit. There is nothing preventing socialised medicine for working. It costs less per capita nowadays than it did when it was put in place and productivity skyrocketed since. The economic arguments were always the very privileged hiding their greed and contempt for the rest of us behind a fine veneer. I truly believe some of them even came to believe it to help themselves sleep at night. It doesn’t mean we all have to drink it.

Schroedingersat 4y ago

> The NHS needs to stand up for itself and politicians need to start talking about 20y plans. 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.