E10 Rifle wrote:

QUOTE:
Does that mean that health staff pay rates and the like vary a lot? And does that also potentially make what the state is paying out more costly and harder to manage than a less marketised system?

The variation in doctor's pay varies from specialty to specialty. The Government, with input from health providers) sets a standard scale of payments for each type of service. Surgeons make more than GPs - how much more depends in part on how many surgeries they feel like doing. Anaesthesiologists are so stupidly well-paid that most of them only work 6 months a year.

Nurses - well, nurses tend not to work in clinics, only in hospitals. They're unionized and within each province their hourly rates don't vary much.

I think where pay tends to vary is among people like lab techs and office assistants. What an admin assistant would be paid in a clinic is (I suspect) quite a bit less than what they'd be paid in a hospital. On ancillary services like laundry and food, there are persistent battles (though less so now than when the country as really skint fifteen years ago) about whether these should be contracted out to other agencies. For the most part they are not - not food, anyway (there was an experiment in Manitoba that really didn't go too well).

QUOTE:
I'm saying that the organisation that buys healthcare for you shouldn't be the same organisation that provides it.

That sounds a bit like a market-based solution to me to be honest. And anyway, we've had a purchaser-provider split in the NHS for the past 15-odd years, and increasing marketisation, with PFI and commissioning/provision from private sector sources. Are you sure that the things you want aren't already in fact the cause of the problems you cite?

Problems in the NHS have multiplied once bringing in a new level of NHS Trust bureaucracy got their noses in the trough.

No, because the internal market was introduced without any structural reform. So it's essentially an accounting exercise.

And let's be fair to Labour – waiting times have come down since they came in. But, with a health budget finally approaching the European average, we still have waiting lists.

But quoting you from the previous page:

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It's clear the NHS requires better management and for standards to improve - I don't think anyone here's questioned that. But if "politicians" are removed from managing the health service, to whom should that responsibility fall, and to whom would they be accountable?

Therein lies the problem. If a chief executive wants to hire better managers – many of which will be in the private sector – he can't do it, because someone like you would also advocate national pay scales. Neither does he have the freedom to manage all of his budget. He might be providing operations cheaper than a hospital down the road, with better clinical outcomes, but there are few incentives to do that either. Plus there's the Department of Health, the NHS trust and the primary care trust sticking their noses in.

I'm not advocating no political involvement in health, but why should civil servants and politicians be managing hospitals and primary care? And why do other socialists in Europe have no ideological objections to a mixture of healthcare provision and funding, but you do?

Of course the idea that better managers will make the difference, will be found in the private sector, and will need to be paid more - all that is common sense, and nothing whatsoever to do with any kind of ideology, no siree bob.

But would you scrap national pay scales so that they could be hired?

No

So how do you square that circle?

If it costs more money to tempt good managers out of the private sector than the national pay scale allows you to pay them, how do you increase the overall quality of management?

Sorry, Stumpy, did you think I was being straightforward rather than sarky? Apologies if so.

I don't subscribe to your better management ideology.

Is it a trick question? I mean, the obvious answer seems to be "increase the national pay scale", but I may be missing something.

(It certainly seems a less hard problem than squaring the circle, which is impossible.)

What TonTon said, as well. The idea that the "private sector" is brim-full of "good managers" whose "skills" are "transferable" into a completely unrelated field that runs on a public service ethos--well, show me some evidence that any of that is the case.

Word. Also, when senior management types from the private sector have been recruited on top whack to manage public services, they've been known to bring along a fair bit of 'ideology' themselves. Dare one say, that's probably why successive governments have been so keen to recruit them in the first place.

So if current managers aren't up to the job and private sector managers aren't up to the job, how do you suggest management is improved across the NHS?

Personally I wouldn't presume to say that either current managers or hypothetical future ones aren't up to the job. What's important is the nature of the job, and whether the politicians who set the terms of the job are up to the, er, are up to scratch.