Cocoa How have the mighty fallen OT. 730

Of course it won't, which is precisely why this silly nonsense of having a "national" service together with all that goes with it in terms of "postcode lotteries"

It can never be uniformly the same. There will always be people and places with more or less than another so there is no point in attempting to do the impossible.

For that matter, the balance of funding and emphasis on different ailments is going to be completely different depending on the economic and geographical situation of an area anyway.

Precisely. Local accountability and empowerment. Reward for success as determined by clinical outcomes and the feedback of patients (the customers). Correction, but ultimately discipline and dismissal for lack of performance without reasonable excuse.

Above all, freedom for central interference.

There is nothing morally bankrupt about not making a profit, which is why I included charitable trusts and not-for-profit methods of organisation as a sensible alternative to a centralised system.

It's not morally bankrupt if a person chooses to do so of their own free will and is appropriately rewarded (not necessarily completely financially) for it. It becomes morally bankrupt when an organisation expects this of its employees as a necessary pre-requisite to operate, uses moral blackmail to attract back former employees and then engenders an atbreastude that its (paying) customers should be grateful for what they get.

That's your choice, though.

I wasn't advocating a U.S. system at all. All I have said is

- that the concept of centralised *delivery* of healthcare should be abandoned

- that management and operation of healthcare should be localised and fully accountable against clinical standards and with the feedback of customers.

- that funding is pbutted to healthcare organisations via the patients (customers) and not via central handout. This is by far the best way of promoting all of the above. If an organisation doesn't perform, patients shop elsewhere. They can then strive to fix their problems, or have management replaced.

I already have. Several times.

Nobody said anything about 1000s of tiny providers either. Local organisations would be quite at liberty to form alliances with others in areas of their choice to provide expertise as required.

You have got to be joking. The state education system is not that far behind healthcare in terms of declining standards and value for money.

It is both. The main issue is lack of accountability. That is simply not achieved until people's livelihoods are threatened on the one end and they are rewarded on the other.

The public sector ( as consbreastuted by central government) is simply not a viable vehicle for achieving either.

Of course not. The Band Aid argument. This is the result of wasting money on firms of management consultants, (who basically are people who don't know what they are doing telling people who neither know what they are doing and-or who are willing to make decisions) how to run a business. So the mantra of the moment gets proposed.

A typical one is to outsource non-core activities - i.e. hospitals are in the business of making people well, not cleaning bogs. Of course, it failed to realise that one is a necessary pre-requisite of the other. It still didn't fix the problem because one has incompetent public sector "managers" attempting to put in place contracts and run them that are beyond their ability to do. This was why the management consultants were hired in the first place. When it all goes breasts up, the management consultants can be blamed rather than those really responsible getting the sack.

None of this has to do with whether or not cleaning is privatised. Private hospitals use firms of private cleaners perfectly successfully as witnessed by low infection rates. Therefore, one has to look elsewhere, and the blame laid squarely at the door of those responsible for drafting, agreeing and running the contracts.

No it isn't. See earlier.

It could be a great deal better for the same money, and IMHO it is very poor value based on my own experiences. I will accept that I expect pretty high standards. However that is much more about atbreastude than money.

There I would agree with you. But I would not willingly (i.e. not through the compulsion of tax) invest in the public sector to do this under the current centralised arrangements. 50 years to get this right is way more than long enough.