Runboard.com
Слава Україні!

runboard.com       Sign up (learn about it) | Sign in (lost password?)

 
Extropia DaSilva Profile
Live feed
Blog
Friends
Miscellaneous info

Moderator

Registered: 12-2017
Reply | Quote
The Truth of Jobs: Killing the NHS


THE TRUTH OF JOBS: KILLING THE NHS

Given capitalism's drive to seek out the most cost-effective commodities, it is perhaps not too surprising to find the private sector encroaching on the public sector. Let's take the NHS as an example. Given that it employs 1.2 million people, the National Health Service is one of the world's largest job creators. In fact, it is exceeded only by the Chinese People's Liberation Army, Indian Railways and Wal-mart. The nation's sick presents a huge money-making opportunity, as shown by those pharmaceutical companies that secure exclusive rights to some drug and then ramp up its price to many times the development costs, flogged to ‘consumers’ who have little choice but to pay the exorbitant prices.

But there is a problem, which is that the British public won't stand for the privatisation of the NHS because they appreciate the benefits of having healthcare funded by the tax payer and free at the point of use, rather than leaving the sick and vulnerable open to exploitation by competitive interests looking to get wealthier by whatever method they can get away with. Therefore, neoliberalism has had to resort to such tactics as privatisation of services within the NHS itself, the deliberate loading of unsustainable debt onto hospital balance sheets, and multiple and costly reorganisations that make hospitals so hard to run that the private sector has to move in to 'rescue' the situation.

PFI

The Private Finance Initiative or PFI is a good example of privatisation by stealth. This scheme allows the government to use private finance, hence its description as a form of 'public private partnership'. Using PFI brings certain advantages for government and business. Governments benefit because the majority of PFI debt does not appear in government debt or deficit figures. In other words, it's a way for governments to get into more debt while hiding the true extent of the deficit from the voters.

As for private interests, the benefit PFI confers on them consists of interest set at least twice the rate of gilt-based borrowing. Furthermore, its being a public private partnership means corporations get to circumvent one of the things that is supposed to make free-market capitalism the most generally advantageous of systems: Choice. Think about it. PFI is a way for the private sector to develop the infrastructure to deliver national services, paid for by the taxpayer. While you can choose to shop at Wal-mart you have far less choice over whether you pay taxes. Not only that, but the risk is also transferred to the taxpayer, since they’re the ones who ultimately shoulder the costs.

As Mendoza explained, PFIs "create a conspiracy of mutual self-interest between private service providers eager to create new markets in publicly run services, and successive governments seeking to put a gloss on spending figures".

An Obsession With Targets

When they came to power in 1997, New Labour modelled itself on the Clinton Administration. Like their US counterpart, New Labour gave power away to the banks and the markets. And they took the targets-based system that had been introduced by John Major and vastly expanded upon it- to the point where just about everyone from cabinet ministers down, and things that were previously considered unquantifiable- such as 'happiness'- became part of a huge mathematical system that was supposed to use targets to free public servants from bureaucratic control.

But what this targets-based system did was to provide an opportunity for cheats to succeed by finding sneaky ways of fulfilling their goals. For example, hospital managers were given targets to cut waiting lists, and they achieved this by ordering consultants to prioritise the easiest operations like bunions, over more complicated ones like cancer. When they were given targets to reduce the number of patients waiting on trolleys, management removed the wheels from some of the trollies, reclassified them as beds, and reclassified the corridors as wards. Again, this meant they could take those patients off the list and meet their targets. Obviously, those tactics were not doing much to increase the actual quality of medical care.

At first the government dismissed reports of cheating as a few bad eggs, but as more reports of fiddling the numbers came in, it became obvious that cheating had become endemic throughout the public services. Harvard Business School and others have shown that when goals are imposed on people, though intended to ensure peak performance, they often result in efforts to game the system without producing the underlying results the metric was supposed to be assessing. As Patrick Schilz, a professor of law, said:

"Your entire frame of reference will change and the dozens of quick decisions you make every day will reflect a set of values that embodies not what is right, but what you think you can get away with".

This endemic cheating turned what had been intended as a rational system for boosting efficiency, into a weird world in which people were confronted with numbers and simply didn't know whether to trust them or not. New Labour responded by adding even more mathematical levels of management, devising complex systems of auditing in order to monitor workers and make sure targets were being correctly fulfilled. The effect of all this was to turn what had been intended as a system of liberation into powerful new forms of control.

The Cost

The taxpayer will be expected to pay back £301 billion over the next 25 years. While this will be an extremely profitable venture for the likes of HSBC (the bank has a controlling stake in 27 PFI projects and is the outright owner of 3 NHS hospitals) it's not providing good value to the taxpayer. We are likely to see changes such as those that affected Stanford Hospital, which underwent drastic cuts in staffing levels, all in the name of making savings.

The hospital launched something called the 'Clinical Floors Project' that configured the management of patients by floor rather than by ward. Because of this change, in floor two of Stanford Hospital just three nurses were expected to cover two wards containing forty patients. The hospital then decided it could save a further £594,000 if it shed a further 21 nursing positions and amalgamate surgical wards into surgical floors, a decision that lead to overstretched and untrained junior staff looking after patients. And there were yet further cuts, when the Hospital Management Board decided to lay off a further 52 nursing staff, even though a review had determined that the hospital was understaffed by 27 posts. Perhaps unsurprisingly, the mortality rate was up to 45% higher than the Health Care Commons standard mortality rates

Private’s Alright For the Rich...

Now, I am sure that privately-run healthcare provides top-quality service for the affluent. But we should never forget that all businesses within the capitalist system have an agenda above that of providing top-quality service. A hospital run by the private sector does not exist primarily to provide care; it exists to make profit for its owners. The more affluent members of society have the wealth and power to ensure standards of quality are kept at tip-top levels. But what about the poorer members? They have little choice but to accept the bare minimum level of care, because if they cannot look after themselves and cannot rely on their family (perhaps because they are too busy wage labouring to provide adequate care) then they have little choice other than to accept whatever is on offer. This makes them ripe for exploitation by firms seeking to maximise profits by reducing costs. At the same time, staff working in such places are likely to be so overworked and underpaid they cannot provide adequate care and may seem to act with what is lack of compassion for the patients. The ability to provide care for those who most need it is therefore often sacrificed in the name of profit, the only real purpose of any capitalist venture.

These reasons, combined with those in the previous essay, are the explanation for why it is hard to find rewarding work providing care under capitalism.

REFERENCES

“Austerity” by Kerry-Ann Mendoza

“Why We Work” by Eric Schwartz
1/21/2018, 2:10 am Link to this post PM Extropia DaSilva Blog
 
greendocnowciv Profile
Live feed
Blog
Friends
Miscellaneous info



Registered: 11-2017
Reply | Quote
Re: The Truth of Jobs: Killing the NHS


Private is very good, but so intensive with expensively paid nurses.

Can we replace any of those expensive nurses by using OS's of loving grace? It doesnt have to take all that long, either. The pessimists used to say hundreds of years or never, but the believers in sooner are growing.

Until AI is ready for the big step, we already have a half-step described by you, Exty, in the old KAI Forums.

The Jennifer Unit taken from Amazon Warehouse/fulfillment Centers and given to Suzy and Sam basic level care-person.

The three nurses per 40 to 50 patients from the article supervise a bunch of low-paid Suzy and Sams along with a clever AI that does two broad things.

One, it tracks that medical medication orders and plans are followed, and two, it tracks the interactions of the Susies and Sams with the patients and each other.

The least loving are noted and replaced with more loving over time. The system would give loving care and better quality care. Lots of what the nurses do is tracking and checking those medical orders.

We basically do that in US Navy Hospitals, using staffing of people instead of levels of AI to make sure Nurse orders are carried out professionally and respectfully by junior medical techs for a ward. Regardless of how many Nurses are there, they only make a few periodic visits to talk to this patient or that.

Enlisted managers do that many times, ensuring that patients are being treated well by keeping the junior techs working hard.

AI would make the same system, which the Brit NHS in the example was shooting for, possible.
1/21/2018, 8:37 am Link to this post PM greendocnowciv Blog
 


Add a reply





You are not logged in (login)
Back To Top