Renew the party-on this blog

Can i suggest we copy an idea from Conservative Home? How abut we decide on a 100 policies to renew ourselves? The opposition blogs are doing it, and I think Labour needs to renew itself, so let's have people putting forward policies, debate them, then vote on the policy.




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Re: Renew the party-on this blog (#1)

What's the point? It will just be dominated by lefties proposing more tax, restrictions, nationalisation programmes and general crackpot schemes so none of it will come to fruition.

Re: Renew the party-on this blog (#2)

Thanks for that, I can see another thread disappearing into the realms of left v right slanging matches...

Re: Renew the party-on this blog (#3)

Well it's true - if this site was really reflective of the actual Labour membership, then it would be a good idea. But it's not - it's dominated by lefties and therefore it's a daft idea.

Re: Renew the party-on this blog (#4)

Hi, lefty here. See Brown got heckled tonight about Iraq and someone who dared to do so got roughed up and ejected from meeting.JR is right. What's the point?It's groundhog day.......

Re: Renew the party-on this blog (#5)

Yes, because I'm sure people who want to sever the union link and effectively dissolve the party are representative of the broader membership.

Re: Renew the party-on this blog (#8)

I'm not the one who fundamentally opposes what my party leadership does. I'm very content with the Labour party at the moment and have no desire to destroy it. You on the other hand...

With regards to severing the union link, you mock, but it will happen soon enough.

Re: Renew the party-on this blog (#9)

Once again, you oppose all the various policies overwhelmingly passed by Party Conference - policies which represent where most members of our movement are at the moment. I wouldn't be so hopeful about the dissolution of the party. Even uber-Blairites such as Hazel Blears and Alan Johnson are falling over themselves to defend the union link. Your position on this matter is far to the right of even the standardbearers of New Labour.

Re: Renew the party-on this blog (#29)

Only you wants to see the dissolution of the party - not me. Funnily enough both Blears and Johnson are running for deputy leader and guess what - the unions get a third of the vote, so do you not think they might be sucking up to the unions to get votes? Once elections are over, things change.

Re: Renew the party-on this blog (#23)

JR, you said Hattersley was a loony lefty, and Healey was too left wing, if that's evidence of this blog being full of lefties, then 95% of the PLP would be 'left-wing'

Re: Renew the party-on this blog (#30)

So you think 95% of the PLP are as left-wing as Roy Hattersley? Yeh right.

Re: Renew the party-on this blog (#32)

Well I don't think the party is left-wing as Roy 'the trot' Hattersley. What do you mean 'as left wing as Hatterlsey'?. He is not from the left of the party.

Re: Renew the party-on this blog (#33)

That post is all over the place, but the point is that 'the trot' is not from the left-wing of the party.

Re: Renew the party-on this blog (#35)

He's more left-wing than your average Labour member.

Re: Renew the party-on this blog (#36)

I'm beginning to lose all faith in mankind............

Re: Renew the party-on this blog (#6)

Will it not feature ideas, left and right, some of which - through discussion and debate - might find some consensus support, in the traditional way of a broad church? If you're right, JR, and it can't, then that would appear to be Blair's true legacy, and it's a sad one. I hope you're wrong.

Re: Renew the party-on this blog (#7)

Well, to be honest you're right. Blair's legacy has been to make the left's ideas completely unacceptable to most. That's a positive legacy.

Re: Renew the party-on this blog (#10)

So where does the right wing hang out, JR? Are there any?

Re: Renew the party-on this blog (#11)

Parliament, I think!

Re: Renew the party-on this blog (#19)

Oh yes....The politics of power.

Re: Renew the party-on this blog (#20)

The right wing hang out at the polling stations on election day.

Re: Renew the party-on this blog (#12)

ATTEMPT TO RESCUE THREAD FROM RIGHT VS. LEFT SLANGING MATCH:

Here's some ideas...

1. Fully elected House of Lords.

2. Some form of PR in local, Parliamentary and Lords (see above) elections.

3. English Parliament.

4. Push for massive investment in local, green power generation.

5. Real freedom for local health services - including a serious look at what targets can be scrapped.

How are those for starters.

Re: Renew the party-on this blog (#13)

GH is on the right of the Labour Party, I am on the left. JR is wrong: I completely agree with 1,2 and 4, would like to see a good deal more thought as to how an English Parliament would operate before I supported it and certainly agree with scrapping some targets, but am unsure about how 'real freedom' for local ealth services would operate. I'm well aware that the same standards and treatments do not apply in all areas, but I worry that Glasshouse's proposal would exacerbate rather than alleviate this.

Re: Renew the party-on this blog (#14)

1. Fully elected House of Lords.

Agreed.

2. Some form of PR in local, Parliamentary and Lords (see above) elections.

Some maybe yes. I think you could have a proportional system for the Lords (or whatever we end up calling it). And I quite like AV. Not sure about having too many systems (see recent Scottish confusion).

3. English Parliament.

Not keen on this. I agree with your reasons for going for it, but I'd rather we went for regional rather than national devolution. I know it's been kicked into the long grass a tad, but I'm still hopeful!

4. Push for massive investment in local, green power generation.

Good, yes.

5. Real freedom for local health services - including a serious look at what targets can be scrapped.

What does 'real freedom' mean? Who would be exercising that freedom, and who would they be accountable to?

How are those for starters?

Not bad.

Re: Renew the party-on this blog (#15)

I agree that Regional Assemblies are preferable to an English Parliament, but as they aren't going to happen any time soon, a Labour-implemented English Parliament is better than waiting for an (eventual) Tory government to create one on their terms - shutting us out forever. The West Lothian Question needs sorting out and locality working in an English Parliament could give us some of the regional representation needed. Eventually I would like to move to regional assemblies.

The real freedom I'm talking about is independent hospitals that recieve government money on the basis of money following the patient.

Re: Renew the party-on this blog (#16)

As an afterthought (for clarification) - I'm not talking about privatising hospitals.

Re: Renew the party-on this blog (#21)

Still not quite sure what you mean (but money following the patient sounds worryingly like money following the pupils which has a negative impact in education). Surely most people in most situations are going to go to their nearest hospital? I would like to see staff having a much greater say in hospital management, if that's the sort of thing you might advocate? If it's primarily a sort of marketisation with a further move towards hospitals competing against one another to get patients and therefore funding, I would be strongly opposed to such a move.

Re: Renew the party-on this blog (#22)

Sorry, yes - it's the latter ("hospitals competing against one another to get patients and therefore funding")

It doesn't matter that most people, in most situations are going to go to their nearest hospital. It's the fact that a certain percentage are willing to switch that forces Hospitals to compete for them and respond to the wishes of patients that is of real benefit.

That's why the "Only the Middle Class will exercise choice" is such a red herring. If two hospitals have to improve how they provide services X and Y to attract those middle class patients that ARE willing to switch to another hospital, everyone who uses services X and Y benefits - even those who wouldn't have dreamt of switching.

Re: Renew the party-on this blog (#26)

What do you do with the 'losing' hospitals?

Re: Renew the party-on this blog (#27)

Sack the managers and put them into special measures (the Hospitals that is, not the managers) :)

Once they're back on their feet again, set them loose.

Micromanaging the hospitals that have seriously underperformed is a much better idea than trying to micromanage them all. Plus, watching how people "vote with their feet" is a much better way of identifying which hospitals are underperforming than a complex list of targets which reflect local needs.

Re: Renew the party-on this blog (#39)

But putting into special measures just reduces patients' confidence in the hospital and reduces staff morale (if it follows the educational parallel). Also things have to go pretty wrong before special measures would be introduced. In the meantime there's a postcode lottery for the quality of your local hospital.

Re: Renew the party-on this blog (#41)

Yes, there would be a postcode lottery - that is true of any devolutionary measure.

But the point is that the competition would drive up standards across the board - they wouldn't all be the same standard as each other, but they would all be better than they are currently.

Re: Renew the party-on this blog (#43)

I don't actually think that's correct. Everyone's competing for the same cash; when one hospital gets it, it means another doesn't.

Re: Renew the party-on this blog (#45)

But the level of funding isn't the only factor determining the level of service.

If we've learnt anything from the last few years, it's that just putting the money in doesn't yield great results. Although we've had improvements in the Health Service, they're nowhere near what should have been expected from the huge investment the government has put in.

Its obvious to anyone that resources aren't being used efficiently and there's acres of room for improvement. Competition will create a constant drive for improvement.

Re: Renew the party-on this blog (#46)

I fear that the last few years serves to question this. I actually think that it has been the reform that has wasted the money. You have the bizarre scenario of hospitals getting into debt; hospitals bidding for pots of ring-fenced money that isn't actually what they need, but some money's better than none, and hospitals investing far too much money into management, consultation, etc. rather than front-line services.

Re: Renew the party-on this blog (#49)

Isn't that hospital's own mismanagement though? And wouldn't competition encourage better management?

Re: Renew the party-on this blog (#57)

I don't think it is just mismanagement. I think it's the use of market principles and competition which has got hospital managers concentrating on issues of market-style management, and losing sight of their principle purpose.

Re: Renew the party-on this blog (#58)

"losing sight of their principle purpose."

Again - isn't that mismanagement?

Re: Renew the party-on this blog (#60)

Not so long as they keep the patients coming in.

Re: Renew the party-on this blog (#64)

Your point?

Re: Renew the party-on this blog (#74)

My point is that patient choice doesn't only follow quality of service.

Re: Renew the party-on this blog (#28)

Excuse a dreadful libertarian like me commenting here - I hope this isn't considered trolling. It's been suggested here that hospitals should be independent, but that this shouldn't mean privatisation. It's also been asked what should happen to failing hospitals, and who they are going to be accountable to. Surely, if the Labour party is really going to renew itself, it needs to question whether it needs to embrace the market. Can you really claim that services will be delivered better by the state? (My perennial question to anyone who says this is to ask them to name a service delivered by the state which is delivered effectively and efficiently). A private hospital would give you independence - there can be no doubt about that. I think all sides probably agree that central interference doesn't work. Accountability is surely far better when it is delivered directly between consumer and provider. What is "democratic accountability"? You get to provide a single vote out of what, 40 million?, on a basket of issues, every five years or so. This is a very, very weak form of accountability, surely? With a private hospital you are at least the only one with a vote and you get to cast that vote immediately. And failing hospitals? There is a ready made method for failing businesses to get recycled. They go into insolvency and if there is a demand for their services they get taken over by someone who is better at running them than the previous incumbents. "But what if nobody wants them?" I hear you ask. It's a fact of life, that at some point there is insufficient demand for a service. Would the money be better spent at another hospital. Perhaps the local population is declining - don't we need a rational way of deciding when to stop throwing money at the problem? The answer has to be privatisation. The question is, how to ensure access for the poor. (Please be nice).

Re: Renew the party-on this blog (#31)

Well, I think I'm probably one of the more classicly liberal Labour people over here, so I'll bite :)

I think most of what I've said in the last few posts implies that I would like to use patient choice to drive up standards. But marketisation doesn't neccessarily need to mean privatisation/commercialisation.

Why do you feel that we need to privatise the Hospitals to allow choice?

Re: Renew the party-on this blog (#37)

You don't need to privatise to allow choice. Choice will, to some extent at least, drive up standards as you rightly say. But if you want to revolutionise healthcare you need commercialisation. Let's say there's a brand new technology to treat some condition. It's very expensive. Its introduction will drastically reduce the number of staff involved in treating patients with this condition, allowing big ongoing savings to be made. This kind of investment and the kind of hard-nosed management required to drive will only happen with commercialisation. You need greedy capitalists to force through the job losses so that the cost savings are made and passed on to the consumer. A non-profit or a state-run operation will not do this.

Re: Renew the party-on this blog (#38)

Not sure you're selling this to a Labour audience...

Re: Renew the party-on this blog (#42)

"A non-profit or a state-run operation will not do this."

Why not? I've already said that hospitals would compete against each other for patients. If, by buying this equipment, they feel that they can use the savings to treat more patients in other departments (or treat them better), they will - in order to attract more.

Re: Renew the party-on this blog (#47)

Because firing people is very, very hard to do. Especially if they are your friends as well as your colleagues. Most people need a push to do this - which is what shareholders bring to a business. "Take the difficult decisions or I'll find someone who will" is the way it tends to be put. Without this commercial drive, non-profits and the public sector end up overmanned. That's why privatisation has always lead to job losses.

Re: Renew the party-on this blog (#50)

You can come back. ;o)

Re: Renew the party-on this blog (#52)

But I've already said - hospitals that fail to attract customers will be in receipt of less money, begin to fail, and have their management replaced.

So the same "Take the difficult decisions or I'll find someone who will" drive applies.

I agree with you on the need for competition - but you haven't said anything that would convinve me that the Health Service needs to be commercialised to create competition.

Re: Renew the party-on this blog (#77)

"You need greedy capitalists to force through the job losses so that the cost savings are made and passed on to the consumer."

You made a typo Bishophill

shareholder/executives etc etc. But never consumer.

Re: Renew the party-on this blog (#78)

This isn't right. So long as you have more than one greedy capitalist in the market and reasonable anti-trust laws in place, they compete with each other and have to pass on cost savings to consumers. If they don't they lose market share to competitors who do.

Re: Renew the party-on this blog (#40)

Direct accountability between the 'consumer' and the 'provider' is the fundamental problematic concept with the market. Whether the money is following me (i.e. the government pays but where I go will influence which hospital gets the equivalent funding) or if I'm forced to pay for myself, I only have one hospital that is even vaguely accessable to me for the vast majority of possible ailments. And I drive a car and have a reasonably well-paid job. The idea that more than a tiny minority can offer this sort of market accountability is not realistic. Glass House says that efficiency born of competition will make the service better for everyone, but it might have precisely the opposite effect (if my hospital ends up heading for special measures) and I would have no power over that whatsoever. The focus of health policy must, therefore, be on making every hospital an excellent hospital, and differential funding is not the way to go about that.

Re: Renew the party-on this blog (#44)

You say that direct accountability between consumer and provider is a problem, and then go on to say that you only have a choice of one hospital. Firstly the choice of having a few big hospitals in large urban centres is something that the state has delivered for us under "democratic accountability". A private hospital operator would be less inclined to do this because it is so unpopular with patients. It would be a commercial gift to their rivals. I'm not saying that they would never close small hospitals, but the profit motive gives them a rational way of measuring the trade offs. Secondly, even where a private company has a local monopoly, it is incentivised to provide a good service because of the risk of a loss of reputation which would damage its brand and the value of the company. This kind of thing tends to get managers fired in the private sector.

Re: Renew the party-on this blog (#48)

But there's no sensible reason to have more than one hospital near where I live (not quite true - there's a good argument for keep small, local hospitals open for providing some services, although they are definitively inefficient) other than for them to compete against each other. There will be large sums of money wasted in the competition (advertising, management consultants, market research, etc.) which would be much better spent providing an excellent service in every hospital.

Re: Renew the party-on this blog (#51)

I'm sure the 'waste' of having multiple hospitals would be more than paid for by the fact that the hospitals would be some more more efficient due to competition.

Re: Renew the party-on this blog (#53)

Is this the sort of efficiency that bishophill is talking about (sacking people)? There's very little evidence to back this up. The internal market which the Tories brought in were hardly a great success (we tend to forget that abolishing it was a great early Blair achievement, because we've spent most of the time since Dobson was sacked bringing it back). Okay, I know the counter-argument about the Tory internal market is that it didn't go hand-in-hand with increased investment. But there's a very real danger that you put in increased investment and large parts of it never get to the front line and instead pay for the trappings of marketisation (as well as the dividends of various private providers that you bring into the system).

Re: Renew the party-on this blog (#56)

If there's overstaffing, then, yes people will need to be let go. Public services are there to serve the public, not provide jobs.

Of course, staff levels will no be allowed to lead to a drop in service standards and there will still be the need to keep up standards to retain patients. If a manager allows staff levels to fall below that point, the patients will soon up and move to another hospital that kept an appropriate level of staff/service.

Re: Renew the party-on this blog (#59)

there will still be the need to keep up standards to retain patients The problem with that is that it implies a trade-off: How far can we get away with cutting corners and reducing standards without losing patients? I know you would have lots of inspection and moderation, etc. to ensure that doesn't happen, but it ends up being another odd trade off: Apart from the fact that the inspection/regulation is expensive (but the expense doesn't appear in the local budget so we never know its impact on 'efficiency'), it also results in an increase in independence for management and senior decision-makers (despite the evidence that some of them use the independence rather poorly) and a decrease in independence for staff (despite the evidence that they are excellent).

Re: Renew the party-on this blog (#67)

Oops. "Absolutely" was in response to Glasshouse. If you have private hospitals you don't need inspectors. As soon as patient numbers fall slightly, managers in a private hospital will start to ask questions. Pretty soon their shareholders will be asking questions too. A hospital has huge fixed costs and so its profits are very sensitive to changes in patient numbers. Once they have asked the question, it should be relatively simple (a bit of market research perhaps) to find out that patients are leaving because staff levels are perceived as being too low.

Re: Renew the party-on this blog (#71)

I agree. But a hospital doesn't have to be private for that mechanism to work - it just needs to be be independently run and have money from government follow the patient.

Re: Renew the party-on this blog (#70)

But there IS a trade off - and there always will be.

We currently put Xbn into the Health Service - why not put X+1bn in? I'm sure it would improve something. The government decides what is an appropriate level of funding - that's a trade off.

Re: Renew the party-on this blog (#73)

Yes but that's a trade-off with other spending commitments across the range of government, and isn't made by those actually providing the services. There shouldn't be any incentive to cut corners in a hospital (there is some now, because of the marketisation that has already taken place).

Re: Renew the party-on this blog (#65)

Absolutely.

Re: Renew the party-on this blog (#61)

The internal market was, of course, not a proper market. The commercial imperative wasn't present, because all the hospitals were still state owned. The internal market is basically what glasshouse was proposing at the start of this thread - ie money following the patient around a fully state-owned system of hospitals. Yes, you might make the hospitals more independent, but that just gets us back from where we are now to where we were at the end of the 1990s when, as you rightly observe, the system was not obviously better than it is now. Your point about investment not hitting the front line is another good reason for having commercialisation rather than internal markets. I don't think the dividends point is right. A business pays a dividend when it has too much capital and wants to return some to shareholders (who will invest it somewhere more profitable). Where there is high demand (and therefore high profits) there is no point in paying a dividend - why not reinvest it and make more money?

Re: Renew the party-on this blog (#63)

I realise that; I was debating Glass at the time (this is a rather complex three-wayer!) But aren't your shareholders going to want to get some money from this venture? Why would commercialisation ensure that the money hit the front line? It seems just as likely that it'll get soaked up in management and market strategies as with the faux internal market.

Re: Renew the party-on this blog (#69)

I'm finding it hard to follow myself! Don't forget that the shareholders can get value from a business as both capital (increase in share price) or as income (dividends). Fast growing businesses tend not to pay dividends because the capital is growing fast already - there is no point in trying to reallocate it elsewhere. If the shareholder wants to realise some value, he can sell the shares. You can never really ensure that investment hits the front line, but commercialisation represents your most likely way of achieving this. If you go to your shareholder and ask for £1m to buy a NMR scanner or something like that, they will expect to see a return in terms of increased profit. If you fritter it away on management consultants/ advertising/ corporate awaydays/ pay rises they aren't going to see this, and it's unlikely to be a good career move on your part.

Re: Renew the party-on this blog (#72)

Obviously we're kind of talking on a theoretical, hypothetical level because I'm absolutely fundamentally committed to free healthcare. I actually think both you and Glass are proposing something which no genuine commercial enterprise would do. If you actually privatised the NHS (I don't mean a piecemeal creation of a faux market but just sold it) the last thing a private company would do would have all their branches competing against each other. They'd go for McDonaldisation: every 'branch' of the NHS offering the identical services and local managers essentially doing human resources, regulation and cashing up. I'm not proposing that as a model by any means (!!!) but I think you have to ask different questions from the ones you are asking. This is more to Glass than to you because, as a libertarian of the right, you are presumably ideologically opposed to state ownership. But rather than try and create processes that you think could work like similar processes in the private sector and you believe will produce desirable outcomes, why not just ascertain what those desirable outcomes would be and put them in place? There are well-funded, over-subscribed schools that are, in many ways not good schools (though the market sees them as excellent). The same would be true of hospitals. There would be no market incentive for my local hospital to have excellent services for all areas: much more sensible to specialise in certain areas and attract patients from around the country. But that leaves local people bereft of some services that they may require. Do organisations seek excellence because the alternative is going bust (or going into special measures) or because that's what they exist to do? Just how much of a motivator is the market?

Re: Renew the party-on this blog (#80)

Why did nobody answer this? I was enjoying it! (Haven't debated right libertarians since I was stoodent!)

Re: Renew the party-on this blog (#84)

Sorry, missed that one. I'm not sure if you're misunderstanding me. I'm not suggesting that the NHS should be privatised as a whole. That would just create a monopoly. It would need to be broken up - I would have thought the hospitals should be sold off individually, possibly to their staff. This would maximise the competition. The scenario you describe - of hospitals McDonalds-ising themselves is plausible. This is one way that businesses get to be efficient - ie standardisation. There may well be scope for this in healthcare, but I think it may be limited by the fact that you are dealing with individuals, each of whose requirements will be different. Let's assume though that McDonaldisation does happen, and a hospital finds that it is struggling to make its margins on a particular serice. Firstly it will raise its prices. This asks the question of consumers - do you want to pay more to have the service delivered locally or would you rather go further afield to get it cheaper? If people refuse to pay, then yes the service will be closed, but we know that this is because they would rather travel than pay more. The simple answer to putting in equivalent processes/outcomes in a state-owned hospital is that it's been tried and it doesn't work. It needs the commercial imperative to ensure that costs are kept down, that resources go to where they are needed most. etc. You are right about many schools being oversubscribed when they are not actually particularly good. Schools are also singing politicians' tune rather than that of consumers. This makes them, on the whole, pretty poor. Parents will try hard to get their children into the least bad school, hence the oversubscription, but it would be far better if they were privatised and forced to respond to market demands. The answer to your question of what makes an organisation strive for excellence is "both" - for a company at least. ie there is a fear of insolvency and the fact that a company exists to make money. I think this is one of the reasons that state ownership fails - because it only has fear of "special measures" to drive it, and special measures are rarely terminal. For a company manager, just missing a profit target can be terminal for ones career at that organisation. If you end up insolvent, it can be terminal for your career full stop.

Re: Renew the party-on this blog (#85)

It's funny really because I entirely agree with you that putting in place faux market structures in the public sector doesn't work. But disagree with you about absolutely everything else!!!

I did realise that you were suggesting selling hospitals seperately, because you want to create a market: it's always amused me how much state intervention maintaining markets actually involves! I was taking a hypothetical possibility (which it all is for me, as I don't really see much role for the market in ANY situation, let alone healthcare!) whereby the NHS suddenly becomes a private company. I really don't think that they'd see any commercial benefit in breaking up the organisation into competing parts: I appreciate that is more of an argument against the internal market idea than your idea.

The problem is that I don't think a hospital should exist to make money. (I don't think a supermarket should exist to make money either, but there you go!) And I'm not convinced that the imperative to make money actually goes hand in hand with an imperative to improve a service. Improving a service is ONE way to make money, but there are plenty of others (including degrading the service).

What would you do about the healthcare of those unable to pay for it, then? Libertarians of old used to say that we'd all be a lot happier to pay to charity if we weren't paying so much tax, so we'd help keep charity hospitals afloat. Is that your view?

Re: Renew the party-on this blog (#86)

The problem with saying "I don't believe hospitals should exist to make money" is that you are dispensing with the only effective way of knowing if you are providing the services people want. In terms of paying for healthcare, I think politicians need to take a long hard look at Singapore-style compulsory provident funds. Essentially you have a bank account with money set aside for healthcare. You can't use it for anything else. If you can't afford to put money in it, the state fills it for you. It has the advantage of creating a direct producer-consumer link, avoiding the problems with state-run and insurance-based systems, where a middleman with different incentives in place gets in the way.

Re: Renew the party-on this blog (#87)

I honestly think that markets are a hugely INEFFECTIVE way of finding out if organisations (public or private) are providing the services that people want. Take the post office I live next door to, for instance. People want it very badly. It would close down tomorrow were it subject to real market forces. Now I realise you would argue that it would either transform in such a way as to make money, or it would close down and it would be no bad thing. But for me there IS an alternative to that choice. Something can be both valuable and uneconomic. To stick with hospitals: there is no market advantage in a hospital ensuring that there are signs in braille on all the corridors, or that they provide a good advocacy service for patients who - for whatever reason - find it hard to articulate their needs. The market incentive would be to spend that money that is reserved for a small minority of your potential 'customers' on something that the majority would favour and therefore value (such as broadband internet in the wards). If a hospital didn't have those things, how would a market help? Okay, so long as they could afford it, and were fully aware of the choices they had, they could go to a different hospital (so long as they had those things, but there wouldn't really be any market advantage in it for them either), but much more likely is that they will accept a substandard service because there is no real choice. Also markets distort costs. The price mechanism will be determined by what people will pay for and how much they will pay for it. Why offer cheap ulcer operations, when MOST of your customers for that are businessmen who'll pay top whack? If you can't provide some treatments at a cost that will ensure a profit and people will still pay, the market answer is to cut it and concentrate on more profitable services, isn't it? People get frustrated enough as it is about the often finance-led decisions of NICE. The point is 'uneconomic' services in a hospital may not be unpopular, they just may be rare or complex, or effect minorities.

Re: Renew the party-on this blog (#88)

I actually agree with you that something can be valuable and uneconomic. Your post office is a case in point. My business uses the post office in our village a great deal. It would probably close if it were exposed to market forces (and let's face it, it will probably close anyway). The service is valuable to me and to many others in the village, but this doesn't (IMHO) give me the right to demand that others who don't value it so much subsidise it in order that it can stay open. I don't agree about braille signs in hospitals. By making it more likely that blind people would use that hospital, it would potentially increase profits. Obviously the business is going to make a cost/benefit calculation, but the cost is relatively low so I see no obvious reason why they wouldn't do this. The same applies to advocacy services. If the government still didn't think so, they might choose to increase the value of the provident fund for some categories of people so as to make them more attractive to providers. I don't understand your point about money reserved for minorities etc. The money is in the hand of the individual patient - it's reserved for them. Or are you talking about investment decisions? When you talk about money being reserved for certain things, this is very much the way the public sector works. Private companies don't have reserved funds like this. They make investment decisions based on estimates of the returns available and direct funds to where they are needed most (ie are most profitable). If they have lots of things which require funding (ie will be profitable) they go to the markets and ask for more capital - "we can make a 20% return per annum return by attracting blind patients - would you like to invest?". You offer cheap ulcer operations so as to undercut your competitors. The incentive is clear. Providing complex and/or rare treatments is an issue which faces both state-run and private hospitals. Both have to deal with the fact that funds are limited. The market mechanism will not make this go away but does provide a rational way of dealing with it. If you have provident funds it's reasonably fair too. What we have under the NHS is people going without treatment because the budget for the year has been spent - you don't get treated because you became ill at the wrong time of year. This will not happen under a market, because funds are following the patient.

Re: Renew the party-on this blog (#89)

Sorry 'reserved for' was just lazy phraseology. What I meant was you could either spend your limited resources in such a way as to help a small minority of your 'customers' who are unlikely to transfer their business elsewhere, or you can spend it on something to secure the business of the majority of your 'customers' (such as the rather flippant example I suggested!) Of course you could borrow for either (and I assume Glass would say you could do that in the public sector too, even though I find the concept abhorrent!) but you're unlikely to get much return on your investment from the former, even if blind people decided to boycott the hospital (which I don't suppose they would)!

Re: Renew the party-on this blog (#54)

Yes, but I've already explained that having a single private hospital will give a better outcome than a single public one because of the need to retain brand value. Also the profit motive gives a rational way to trade off the extra costs of small hospitals against the benefits consumers see in them. I don't think it's fair to characterise advertising and market research as waste. Having informed consumers and providers is, after all, a requirement for a reasonably efficient market to work. How is a hospital to know how to provide the services consumers want, without asking them what it is they want? Would you like your physiotherapy in the evenings or during office hours? Would you pay more to have it during the evenings? Why would a rapacious capitalist pay a management consultant for work that didn't bring value to the business? Twenty years ago senior management in large companies used to use consultants to hide behind, but I don't think shareholders let them get away with it much any more.

Re: Renew the party-on this blog (#55)

Although I don't like the term 'brand value' when applied to public services, I think the NHS has a much better 'brand value' than any private healthcare organisation that I'm aware of. I'm sure managers get value of some sort from market consultants, etc. but I'm not sure that patients do.

Re: Renew the party-on this blog (#62)

I disagree, but that's not the point. If the NHS mucks up an operation the ensuing scandal doesn't damage its brand (such as it is), because it is publicly owned. There are no shareholders firing directors for causing a loss of value, there is no share price plunging. The NHS can shrug its shoulders and move on because patients have nowhere else to go. Even if we have funds following the patients, people who are dissatisfied can still only go to another branch of the same business (Chief executive P Hewitt).

Re: Renew the party-on this blog (#66)

The emphasis should be on ensuring the best service, not necessarily having the best appearances and indulging in PR sackings.

Re: Renew the party-on this blog (#68)

Not sure what you mean. The best service is the one that the patients want. What do you mean by "best appearances"? I haven't said anything about PR sackings. People need to be laid off where they are no longer required, so as to free up funds for areas where they ARE required. To do this for PR purposes would be madness.

Re: Renew the party-on this blog (#75)

Sacking to protect 'brand value' is essentially a PR sacking.

Re: Renew the party-on this blog (#76)

If somebody makes a mess of an operation, he damages the company's brand value. He's being fired for making a mess of the operation though. You surely don't think he should stay on having made a mess of the operation AND damaged the value of the shareholders' business?

Re: Renew the party-on this blog (#79)

Just one observation about 'brand value'. If a council (I can't imagine it would be significantly different with hospitals - it is the same argument) wants higher levels of 'customer satisfaction', the way to get them is not by investing in providing higher quality services, but by spending more on 'communications'. This is arguably a sad fact, but is born out in all the studies. Obviously, the amount spent on spin is not the only factor, but any council looking to increase its brand value at the lowest cost starts by spending more on PR people. Quite apart from the fact that the private sector obviously and demonstrably doesn't work in the way that bishophill appears to think it does, the implication of the above is that hospitals competing with each other are incentivised to invest more money in PR and spin. Is that really going to be the way to improve quality of care?

Re: Renew the party-on this blog (#83)

Don Your point about councils investing in spin is correct. It is quite plausible that a council (or the government) could persuade sufficient of the electorate that it is doing a sufficiently good job of providing healthcare in order to secure re-election. The same scenario emphatically doesn't apply to private operators because they have a fundamentally different relationship with consumers. Only the individual affected gets to vote on whether the service provided is adequate or not. If your hip replacement takes too long, you have the option to go elsewhere. No amount of PR is going to persuade you to wait, is it?

Re: Renew the party-on this blog (#17)

"1. Fully elected House of Lords." Agree - or abolish it entirely. "2. Some form of PR in local, Parliamentary and Lords (see above) elections." Possibly - I'm opposed to undiluted PR but sympathetic to AV. Undiluted PR, of course, would break the constituency-party link; allow the party to impose lists of its preferred candidates; and create unrepresentative coalitions that no-one actually voted for. "3. English Parliament." Strongly opposed. England represents about 85% of the British population as things stand. Such a parliament would effectively be the same as the one that currently exists in Westminster, except for excluding the relatively very small Scottish and Welsh minority populations. It would also only foster nationalism right across the country. I advocate a federal system with a network of regional assemblies right across the country. Obviously my preferred solution is a federal republic but I accept that we're far away from that as things stand! "4. Push for massive investment in local, green power generation." Agreed "5. Real freedom for local health services - including a serious look at what targets can be scrapped." I'd need to know what "real freedom" meant. If it means more fragmentation and marketisation, as well as effectively removing democratic accountability over health services, then obviously I'd be opposed. "How are those for starters." Surprisingly good!

Re: Renew the party-on this blog (#18)

Why surprisingly? :-)

Re: Renew the party-on this blog (#34)

not sure if i am in support of a system that uses numbers rather thatn crosses for the ballot paper. Use MMP if we want to keept the constituency link, but provide proportionality. Reforming the Lords, absoloutely.

Re: Renew the party-on this blog (#24)

Campaign Finance Reform. The right already hate me for being a 'lefty', so I think the 'lefties' will now outcast me. I propose we cap donations to Political Parties. No State Funding, (why should taxpayer's money go to paying the BNP?) just cap donations, as I believe large donations mean politicians can spend all their money on advertising, instead of engaging with voters.

Re: Renew the party-on this blog (#25)

Why not cap spending then? The problem with capping donations is that - at least in the case of proposals so far - it doesn't discriminate between large individual donations and large collective donations (i.e. lots of small, democratic donations, that people have the choice to opt out of, put together from an organisation). So capping spending makes more sense to me, for precisely the reasons you give.

Re: Renew the party-on this blog (#81)

I personally think it would make more of a powerful statement, if someone was only able to donate £50, but a CEO was only able to donate £50 (i don't know what the spending cap should be, just a suggestion)

Re: Renew the party-on this blog (#82)

I don't think you're going to avoid state funding if you limit it to £50... The truth is that the suggested limits for donations are still actually very high for most people, but through trade unions we have the ability - in union with our comrades - to donate large amounts, and therefore unionised workers are as strong as wealthy individuals in the political system, so long as they act in union. Which I think is rather neat.

Basing funding on limited donations means that the party with the most rich supporters will get more money (you need lots of wealthy people rather just a couple of handy millionaires!) If you limit what they can spend - that has an enormous impact. You can have as many millionaires supporting you as you like, if it gives you no campaigning advantage.