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EDUCATION AND DEBATE: Nicholas Timmins Use of private health care in the NHS BMJ 2005; 331: 1141-1142 [Full text]

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bring private health care into the nhs

brian ormondroyd   (11 November 2005)

reforms and private providers

ben dean   (12 November 2005)

Where does the surgical training fit into all of this?

Nagarajan Muthukumar   (13 November 2005)

Surgical training within the future NHS

Sashidhar Yeluri   (15 November 2005)

bring private health care into the nhs 11 November 2005
brian ormondroyd, retired teacher bd23 2 uw Send response to journal: Re: bring private health care into the nhs	my father worked actively in the 1940's to bring health provision into the public domain - the NHS. now we see all manner of health provision being hived off to private companies - companies the aim of which is to maximise profit and not for the benefit of the vast majority of patients. only a planned, efficiently and democratically run NHS can give the whole of the british people the health service that they need. the cash is there for bombs why not switch to hospital beds? Competing interests: None declared
reforms and private providers 12 November 2005
ben dean, dr sho australia, nambour Send response to journal: Re: reforms and private providers	The argument I have is simple but I believe it cuts to the heart of why current government policy is wasting a great deal of taxpayers money in trying to expand the private sector. Free heatlhcare for all is fundamentally flawed as an ldeolgical concept, if the heathcare is going to be of a good standard and also if the system is going to be able to survive sustainably. The NHS is an example of this and simply has not been able to cope with demand. There are many reasons behind this, many can be explained by looking at the problem in terms of pressures on each individual patient/consumer of healthcare. Dependence and excessive expectation are both problems that have worsened over time in the NHS, these result from there being no cost to the individual for using the service provided. The goverments recent reforms do not address the fundmanental problem, that is the pressures on the individual. The reforms have enabled the private sector to expand and make huge profits by cherry picking the most lucrative work, at the expense of the NHS which has lost a great deal of revenue and at the expense of the taxpayer who has had to pay for it. There are still not pressures on the individual to stop using an overburdened service. The buzzword of 'choice' is also nothing more than political chat and is a paradox in a collectivist system (1). The principle behind introducing market forces is not ideoligically unsound, however the reforms have not addressed this in the correct manner. They have all been via 'top down' intervention. If the NHS is to survive then the government needs to admit free healthcare for all is simply unsustainable. The way to recovery involves charging the consumer for using the services provided. This does not mean the poor would not be assisted, they could be helped in a means tested manner. Until this is done endless funds will be poured into the pit of NHS reform with little reward. The 'bottom up' approach is the only way to progress, and until the individuals have to bear a cost for using the system then no progress will be made. It doesn't actually matter whether the healthcare system is run privately or publically, the key principle is that the consumer must pay for using the service. I have heard enough hollow talk from politicians and it is about time they admitted ' if you want something good then you will have to pay for it '. Good heathcare does not come cheap, especially when a large amount of funds is wasted on endless reforms that do not address the core problems. Yours, Dr Benjamin Dean 1. A Oliver and J G Evans. The paradox of promoting choice in a collectivist system. J Med Ethics 2005 31: 187 Competing interests: None declared
Where does the surgical training fit into all of this? 13 November 2005
Nagarajan Muthukumar, Specialist Registrar in Trauma & Orthopaedics Leeds General Infirmary, Great George Street, Leeds, LS1 3EX Send response to journal: Re: Where does the surgical training fit into all of this?	I read with interest the article by Timmins1 on the rapid changes in health care provision in the United Kingdom and its effect on the National Health Service (NHS). Yeluri et al2 have pointed out the effect of introduction of the European Working Time Directive (EWTD) on training. The present day trainee is likely to be disadvantaged on the following counts 1. A possible 25% drop in training opportunities as a result of the changes in working patterns resulting from EWTD. 2. A reduction in the number of patients who represent the best training opportunities (those with straightforward pathologies and lower anaesthetic risk) as they are being contracted out to the Independent Sector Treatment Centres. 3. Timmins1 has raised the possibility of NHS hospital closures as a result of changes in health care economics and changes. This might suggest that when the trainee finally does manage to complete his/her training there is a likelihood that the demand for their services, at least in the NHS, might decline. I do not think there is anything that can be done about the first predicament apart from ensuring optimal utilisation of the time that is available for training. One way to address the second point would be to incorporate a training commitment clause at the time of drawing up contracts with the treatment centres. With regards to the third scenario, one can only hope that the job crisis that is affecting the junior doctors at the moment does not hound them even after they have completed their training. 1.Timmins N. The NHS revolution: health care in the market place. Use of private health care in the NHS. BMJ 2005;331:1141-1142 (12 November) 2. Yeluri S, Dadayal G. Junior doctor’s shift and sleep deprivation. No easy solution exists. BMJ 2005; 331:514 (3 September) Competing interests: None declared
Surgical training within the future NHS 15 November 2005
Sashidhar Yeluri, SHO- Leeds BST Rotation St. James's University Hospital, Leeds Send response to journal: Re: Surgical training within the future NHS	I must congratulate the author for a very balanced and unbiased article. It has, however, highighted some very complex issues. The philosophy behind the NHS is noble and ofcourse generates envy. Nowhere in the world can people expect a world class service for free. NHS is probably the only exception to the saying, Nothing good ever comes free. Closure of NHS hospitals, as suggested in this article, seems the likely course in the foreseeable future and means an end to this noble philosophy. Also important to note is the fact that NHS allows patients access to probably the best doctors in the world, and allows doctors access to probably the best training in the world. No wonder you see doctors pouring in from all over the world for training. Shortcomings do exist and I agree that waiting list is an important issue. While it is important for ministers to deliver the goods, it is equally important to draw the line somewhere. The answer should lie in expanding the NHS services in the future. I am sure ways can be worked out for the same. Transferring health services to the private treatment centres is the least of the answers. While it may seem the most viable service alternative in the short term, it may not be the best option for the future. The least we can do is to transform holistic health care to simple service provisions. Implications also exist for training as pointed out in earlier letters. Training in the UK is already being eroded by the implementation of the EWTD. Add to that the impact of privatisation. It is a huge loss to training. A loss of 500000 procedures in the near future is a big big loss. I am not quite sure if we can boast of continuing to produce world class doctors in the future. By the way, once all the NHS hospitals are closed, dont forget to close the medical schools as well. That will be a huge saving . We can send a few interested students to train abroad and ofcourse to work abroad. There will be no vacancies on the independent treatment centres should these doctors wish to return. I will be interested to read the remainder of the article this week. Competing interests: None declared