Quote:
Originally Posted by ethariel
Agreed, HOWEVER if you leave the Civil Service to manage anything you know it's going to either fail or come online 10 years late, out of date and 5x over budget.
The ONLY way to make it work is have a Private Company run it and be able to make a profit based on performance - Privatised healthcare.
If it's run by the government or civil service they have absolutely no incentive to make it work as all they have to do is hold thier hand out for more funding every time they need it, a 'Private' company does not have that luxury.
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I strongly disagree that it has to be private to make it work. That's just an over-simplification of what's involved
For starters, why does it have to be a for-profit organisation? There's plenty of successful not-for-profit entities out there that don't have the blank-cheque backing that you seem to suggest the public sector does.
Another problem with your concept is that a private firm facing financial diffculties can just go bankrupt and stop delivering the service when the going gets tough. The priority will become to balance the books (maintaining profitability first), not to deliver the healthcare: The reaction will be to compromise delivery, make excuses, but keep the shareholders happy! Have you not seen the recent energy sector examples? Or perhaps some of the not-too-distant events in the rail industry? Replicating events that have happened there wouldn't be good in a national healthcare situation.
What metrics would you put in place to be able to gauge the 'performance' of these private healthcare providers, given the uncertain and variable nature of the demand for their services? How would you price the contracts? E.g., what unit price for an A&E department on a Saturday night to give a, say, 2 hour wait time SLA?
And a public sector proposal doesn't get funding that easily, especially 'extra' funding once initial approvals have been given. Have you ever had to deal with public sector governance? Competition is very intense for a share of the public purse. The numbers are big but so is the scale of the works and it's still not an infinitely deep pot. Often the reason things end up 'over-budget' is because they were (maybe deliberately) badly estimated in the first place to secure the initial green light by getting over an arbitrary 'expect to pay' hurdle - dealing with the politics of 'you won't please everyone' so it inevitably becomes a compromise situation with much pushing of problems into the future rather than facing failure now. We've become quite a selfish society - Everybody seems to want things cheap in this country and no-one wants to pay for anyone except themselves.
I'm not saying the public sector is wonderfully brilliant at all it does, far from it, but suggesting the private sector is dramatically better in all cases isn't accurate either. It's horses for courses. The scale, complexity and uncertainty associated with many public sector requirements would panic many a private sector Director. 'Joe Public' is a hellish Chairman of the Board!
So, whether private or public, distill it all down and there still needs to be a balance between the cost to be incurred and the funding available. Too often it's just badly out of balance, with one side or the other being inaccurately calculated (for a variety of reasons, some good, some not so good). Then the games begin!