National Health Service? TINA?
Discussion
TINA. There Is No Alternative....
Or is there?
Whenever the subject of the NHS appears in the media it usually carries some reference to Tory attempts to privatise it or suggestions of a secret agenda for privatisation. The word private seems to be unmentionable in conjunction with NHS, but is this a sensible way discuss things? Is every debate to be based on carers nurses and doctors being the only human beings with a social conscience? Does being a Tory mean that you have ice water in your veins? Does being a Tory mean that you would happily watch the sick die in the gutter? Likewise does being a socialist give you a monopoly on caring about society? Or does being a socialist make you blind to the short comings of the public sector and rabid in your hatred of all things not micro managed by the State? What is the centre, sensible ground?
It's clear that:
Some politicians, of all colour rosettes but mostly those on the left, believe that the only way a "free at the point of use, for all" health service can be guaranteed for the future is to preserve it with the funding/control structures that it has today.
Some politicians, of all colour rosettes but mostly those on the right, think that a measure of private sector thinking would improve the efficiency of the system, thereby ensuring better patient outcomes and more bang for the tax payers buck.
But, it is an almost impossible debate to conduct. As soon as the private sector is mentioned it does appear to me that those on the left lose the power to make reasonable arguments, preferring instead to talk about the evils of profits and big business culture being incompatible with a caring society/NHS etc.
Likewise, many of us have had some utterly appalling experiences at the hands of a system that in some cases seems to care more for the hundreds of thousands that it employs than it does for the millions of people who need to use it, so our views may be considered to be skewed too.
One thing many do accept is that accountability, be it for clinical errors that lead to death or disability, be it for the huge sums of money that are clearly wasted every day within the system, or be it for the slapdash way in which many things are run/organised, appears to be completely non existent within the NHS. Oh sure, we get the lessons will be learned speeches when it all goes truly pear shaped, (Mid Staffs for example) but there is a real sense that nothing ever actually changes.
For many, the NHS epitomises both the very best and very worst about the public sector in the UK.
This thread is not about the rights and wrongs of what we have per se, but rather to set the question;
"If we were starting with a clean sheet of paper today, and we wanted to create a free at the point of use for all NHS that provided the best possible care in the most efficient and cost effective manner, what would we do?"
Now, Iit may be that the answer is "the same as what we have now" It may be that the answer is "some sort of insurance scheme with robust safety nets for the weakest and most vulnerable in our society" It may be that the answer is something completely new and radical.
I think that PH has a good mix of clever people of all political persuasions on here. I feel that that mix has the potential to think the unthinkable. What IS the answer?
Can we come up with a blueprint for a top notch 21st century health service that REALLY delivers for the UK?
Lets try to keep it civil and objective.
Or is there?
Whenever the subject of the NHS appears in the media it usually carries some reference to Tory attempts to privatise it or suggestions of a secret agenda for privatisation. The word private seems to be unmentionable in conjunction with NHS, but is this a sensible way discuss things? Is every debate to be based on carers nurses and doctors being the only human beings with a social conscience? Does being a Tory mean that you have ice water in your veins? Does being a Tory mean that you would happily watch the sick die in the gutter? Likewise does being a socialist give you a monopoly on caring about society? Or does being a socialist make you blind to the short comings of the public sector and rabid in your hatred of all things not micro managed by the State? What is the centre, sensible ground?
It's clear that:
Some politicians, of all colour rosettes but mostly those on the left, believe that the only way a "free at the point of use, for all" health service can be guaranteed for the future is to preserve it with the funding/control structures that it has today.
Some politicians, of all colour rosettes but mostly those on the right, think that a measure of private sector thinking would improve the efficiency of the system, thereby ensuring better patient outcomes and more bang for the tax payers buck.
But, it is an almost impossible debate to conduct. As soon as the private sector is mentioned it does appear to me that those on the left lose the power to make reasonable arguments, preferring instead to talk about the evils of profits and big business culture being incompatible with a caring society/NHS etc.
Likewise, many of us have had some utterly appalling experiences at the hands of a system that in some cases seems to care more for the hundreds of thousands that it employs than it does for the millions of people who need to use it, so our views may be considered to be skewed too.
One thing many do accept is that accountability, be it for clinical errors that lead to death or disability, be it for the huge sums of money that are clearly wasted every day within the system, or be it for the slapdash way in which many things are run/organised, appears to be completely non existent within the NHS. Oh sure, we get the lessons will be learned speeches when it all goes truly pear shaped, (Mid Staffs for example) but there is a real sense that nothing ever actually changes.
For many, the NHS epitomises both the very best and very worst about the public sector in the UK.
This thread is not about the rights and wrongs of what we have per se, but rather to set the question;
"If we were starting with a clean sheet of paper today, and we wanted to create a free at the point of use for all NHS that provided the best possible care in the most efficient and cost effective manner, what would we do?"
Now, Iit may be that the answer is "the same as what we have now" It may be that the answer is "some sort of insurance scheme with robust safety nets for the weakest and most vulnerable in our society" It may be that the answer is something completely new and radical.
I think that PH has a good mix of clever people of all political persuasions on here. I feel that that mix has the potential to think the unthinkable. What IS the answer?
Can we come up with a blueprint for a top notch 21st century health service that REALLY delivers for the UK?
Lets try to keep it civil and objective.
Eric Mc said:
It's a bit like "How can we achieve world peace?"
Blimey. As hard as that? Really?Joking aside, if we really do think it's impossible to come up with a better way then I fear for the future of the NHS. It's like a black hole that is voracious in its appetite for money and people. There will never ever be enough resource to feed it so that it burps contentedly
The NHS performs perfectly adequately for what it costs.
If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
andymadmak said:
Blimey. As hard as that? Really?
Joking aside, if we really do think it's impossible to come up with a better way then I fear for the future of the NHS. It's like a black hole that is voracious in its appetite for money and people. There will never ever be enough resource to feed it so that it burps contentedly
I still think the answer is "No".Joking aside, if we really do think it's impossible to come up with a better way then I fear for the future of the NHS. It's like a black hole that is voracious in its appetite for money and people. There will never ever be enough resource to feed it so that it burps contentedly
The media always highlights its failings so we get a very skewed view of it as filtered through the news or political point scoring.
In reality - on balance - it actually works well. All my encounters with it have been, on the whole, positive.
FredClogs said:
The NHS performs perfectly adequately for what it costs.
If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
I'd agree, except to say that it performs extremely well for what it costs, rather than merely adequately.If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
As you say, the issue isn't what each treatment costs - it's the number of treatments required!
The first place to start, in my view, is with no-shows. People not turning up is costing getting on for £1Bn per annum!
Free at the point of consumption isn't necessarily a bad thing, but people who don't even make it to the point of consumption should be charged! Maybe next time a patient rocks up at their doctor, they're given an appointment card similar to an Oyster card. This could have 3 free appointment slots on it, and if you turn up for your appointment, then the slot gets returned to the card. Fail to turn up for an appointment, and you lose the slot. Fail 3 times, and you have to top it back up at £25 per slot before you can book another appointment. I'm sure it wouldn't cost too much - and certainly far less than £1Bn per annum - to add it into the Oyster network itself to allow people to top it up.
Easier, of course, would just be to say "you're going to be charged £25 per appointment, which will be refunded on the day", but that's just going to have people moaning about excluding the under-privileged from the healthcare system.
My principle reason and concern regarding any possible privatisation of our NHS is : (long pause for effect)
suitability of service directly associated with 'making people healthy again'.
The army of bean counters ensuring profit margins and the effect this may have on the service.
The extraordinary range of skill demands each driving for profit not perfection.
Concern that the service will drift into insurance related access only.
Just a few considerations and of course each can be easily countered perhaps.
suitability of service directly associated with 'making people healthy again'.
The army of bean counters ensuring profit margins and the effect this may have on the service.
The extraordinary range of skill demands each driving for profit not perfection.
Concern that the service will drift into insurance related access only.
Just a few considerations and of course each can be easily countered perhaps.
FredClogs said:
The NHS performs perfectly adequately for what it costs.
If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
In which case, we either have to cut back on what it does - which areas would you propose cease to be covered - or we have to seriously cut back spending on other public services - which ares would you propose receive less funding (education, welfare, defence)?If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
FredClogs said:
The NHS performs perfectly adequately for what it costs.
If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
I bet you all of those figures would reduce if there was a charge placed for each visit.If you want a better health service you'll have to pay more for it.
Any organisation with 60million customers, 1.3 million staff and a £110b turnover is going to have areas it could improve, of course, maybe we could start with the customers...
10% of NHS spending is directly related to diabetes the majority of which is self inflicted type 2 obesity related.
1 in 5 primary school children are overweight
700,000 alchohol related visits to UK A&E last year.
There's not much wrong with the principle, practice or cost of the NHS in comparison to other nations.
sidicks said:
In which case, we either have to cut back on what it does - which areas would you propose cease to be covered - or we have to seriously cut back spending on other public services - which ares would you propose receive less funding (education, welfare, defence)?
We don't have to cut any more spending, we have to raise the amount of public money spent on the areas with which it can be seen to raise the countries prosperity and increase the size and efficiency of our economy. Keeping people healthy and alive (in all but the end of life scenario) should be of positive economic value, not a cost - surely? As would spending money on better infrastructure, education and policing.FredClogs said:
We don't have to cut any more spending, we have to raise the amount of public money spent on the areas with which it can be seen to raise the countries prosperity and increase the size and efficiency of our economy. Keeping people healthy and alive (in all but the end of life scenario) should be of positive economic value, not a cost - surely? As would spending money on better infrastructure, education and policing.
Simply not feasible.I think everyone likes to piss and moan about the NHS and yes it does have its failings but its still a world class setup.
My little idea is £10 per GP visit for working age adults. This would also cover prescription costs if needed. Results are a bit of wonga for the NHS and less idiots seeing a gp over a headache or cold.
I personally wouldnt mind paying that,my GP is brilliant. If i ring up at 8am i can be seen within the hour most days.
Now A+E is a mess but not sure where i would go with that, needs a bit of a think.
My little idea is £10 per GP visit for working age adults. This would also cover prescription costs if needed. Results are a bit of wonga for the NHS and less idiots seeing a gp over a headache or cold.
I personally wouldnt mind paying that,my GP is brilliant. If i ring up at 8am i can be seen within the hour most days.
Now A+E is a mess but not sure where i would go with that, needs a bit of a think.
sidicks said:
Simply not feasible.
With respect, that's b
ks.Everything that ever made money, created a job or increased scientific understanding in western society anyway started with tax payers money and government spending. They even rescued the banking sector not too long ago. The government don't need to spend less they just need to be more aggressive in claiming a stake in the money they invest in the economy and country as a whole instead of dishing it out under the table as if government spending is something dirty to be ashamed of.
crankedup said:
My principle reason and concern regarding any possible privatisation of our NHS is : (long pause for effect)
suitability of service directly associated with 'making people healthy again'.
The army of bean counters ensuring profit margins and the effect this may have on the service.
The extraordinary range of skill demands each driving for profit not perfection.
Concern that the service will drift into insurance related access only.
Just a few considerations and of course each can be easily countered perhaps.
Some interesting points there Cranky. Let me ask you, would you object to the idea of a profit motive if:suitability of service directly associated with 'making people healthy again'.
The army of bean counters ensuring profit margins and the effect this may have on the service.
The extraordinary range of skill demands each driving for profit not perfection.
Concern that the service will drift into insurance related access only.
Just a few considerations and of course each can be easily countered perhaps.
1. ALL "profits" were to be reinvested in the system (i.e. no dividends to shareholders or such like)
2. The basic emphasis was on securing value for money and efficiency with the resources available rather than returning a profit
3. That the patient and his/her requirements for a healthy life were the focus of the system.
Its interesting that some posters are mentioning a refundable charge for appointments. I can easily see how this would dramatically cut the number of no shows (thereby significantly improving efficiency and reducing waiting times/costs) - in business it is generally understood that free stuff (especially services) is generally undervalued by recipients, whereas stuff that is charged for tends to be valued more. It's that human nature thing. Do people unintentionally "abuse the service" because as far as they are concerned it costs them nowt and is always available for even the most minor stuff? I think that perhaps some people do exactly that.
Fred Clogs belief that there will always be enough money for the NHS so long as we grow the economy fast enough is a bit simplistic. The NHS already gets real terms increases in funding, and it's STILL not enough. Moreover, how do we cope in times of downturn? Gordon did not abolish boom and bust, so we have to face the fact that provision of healthcare needs to continue even at bust times. We cannot have a situation whereby its only the rich who can afford to get sick !
FredClogs said:
sidicks said:
Simply not feasible.
With respect, that's bks.Everything that ever made money, created a job or increased scientific understanding in western society anyway started with tax payers money and government spending. They even rescued the banking sector not too long ago. The government don't need to spend less they just need to be more aggressive in claiming a stake in the money they invest in the economy and country as a whole instead of dishing it out under the table as if government spending is something dirty to be ashamed of.
Seriously? Everything? Just have a think about that for a moment pleaseGassing Station | News, Politics & Economics | Top of Page | What's New | My Stuff