Cocoa How have the mighty fallen OT. 732

Again, look at the suggested approaches for organisational status. I have not, at any point suggested that the alternative to centralised public sector NHS is for-profit private firms or the creation of a U.S. type system.

It is rather sad that people seem to think that there are only these two extreme alternatives.

I do think that the private, for-profit, sector has a part to play. One example is for people requiring elective or non urgent treatments on timescales that suit them and not those of the provider. Typically, these organisations don't set out to provide chronic care and the UK private insurance industry does not usually provide cover for it anyway. Either way, I do think that it is perfectly reasonable for those wishing to do so to choose care in this sector with part of the funding for a treatment coming from central government and part coming from the individual or his health insurance.

However, I have also repeatedly said that other additional options are charitable trust and not-for-profit organisations. These should operate on a break-even basis as NHS trusts are supposed to do. The big difference is that the relationship is an arms length one, with the government taken out of control in the way that it is today and that placed in the hands of the patients by virtue of their being able to select places run by such organisations, or not.

it really depends on the situation. If one does not have control over one's hours then it is reasonable to expect extra pay for extra work. However, the correct approach is to measure and remunerate by outcome. provided that the outcome is agreed up front and the remuneration to match, there is no question of coercion.

There are non-elective treatments and procedures but which are not immediately critical in nature. One might consider cosmetic surgery to be elective, but not a hip replacement.

Yes there is. It's simply rather different in nature. Obviously in case of emergency circumstances are different. However, it is not the case that going to the nearest hospital is the correct procedure. The point is to go to the nearest *suitable* one for the situation.

There is no reason why hospitals established under any organisational regime should not offer emergency cover for a certain set of situations - one could even mandate it as part of their license to operate. A&E departments are full of people with trivial injuries and there is certainly a market for certain types of A&E service in the private sector. There would also be the possibility for specialist trauma centres of excellence able to handle the more difficult cases.

Of course there is. There is private sector education in addition to the state sector.

That's a simple one. Abandon comprehensive education and return to a system of selection based on suitability. This is done in many other countries in the state sector and works perfectly well. It really is time to end the socialist experiments of the 40s, 50s and 60s.

That is the natural way of things. I see no reason to attempt social engineering to support the untenable.

Once again. Nobody said anything about private firms as being the only alternative to central control.

Making it a market issue is the *only* way to solve the problem. The challenge is defining what the market is and the rules therein. My suggestion is that that should be in the hands of the customers - in this case the patients.

Sigh..... I can understand why you feel comfortable in the public sector.

The point is that management consultants should not have been hired in the first place. If the people in the management positions are not competent at knowing what to do or are unwilling to make decisions or put their careers on the line over them, then they should not be in the job in the first place. That is why the ever-present sword of Damocles is so important.

I suppose so. It just saddens me to see case after case of bureaucracy and incompetence that I am paying for when there is really no need for it.