National Health Service? TINA?

[EliseNick]

FredClogs said:

Go on then, give me an example of something which has grown the economy, improved human life or understanding which didn't germinate with government spending or public money.

Go on, 1 example....

The car.

[sidicks]

FredClogs said:

sidicks said:

FredClogs said:

"Some government spending is good therefore more government spending of any kind is appropriate."

Logical fail...

Misquote fail.

And yet you previously denied the need to reduce anything that the NHS does or to reduce spending in other areas.

Seemingly therefore, in your view the only answer is more public spending...

[FredClogs]

maffski said:

FredClogs said:

Go on then, give me an example of something which has grown the economy, improved human life or understanding which didn't germinate with government spending or public money.

Go on, 1 example....

Anything that existed before modern government? How about farming.

We might have wondered off topic... But I'm going to speculate that organised "farming" was a response to serfdom and the demand created by centralised leadership, certainly the first guilds and markets and trade routes were supported and created by centralised government figures and monarchs.

Of course the first cavemen and neolithic men who planted seeds and fenced in chickens weren't getting any help from an establishment, or where they.

I've just watched season 3 of the walking dead, never assume we might not relive what the process actually was...

[Dixy]

The NHS is something as a country we should be immensely proud of and do our up-most to retain. However we should define better what it should or should not do.
It should keep people alive, when appropriate, it should keep people reasonably free from physical pain and it should keep people able to contribute to society.
For all extras they are a lifestyle choice and should be down to individuals to fund in their own way.

[sidicks]

Dixy said:

The NHS is something as a country we should be immensely proud of and do our up-most to retain. However we should define better what it should or should not do.
It should keep people alive, when appropriate, it should keep people reasonably free from physical pain and it should keep people able to contribute to society.
For all extras they are a lifestyle choice and should be down to individuals to fund in their own way.

[FredClogs]

EliseNick said:

FredClogs said:

Go on then, give me an example of something which has grown the economy, improved human life or understanding which didn't germinate with government spending or public money.

Go on, 1 example....

The car.

Wikipedia says...


"Ferdinand Verbiest, a member of a Jesuit mission in China, built the first steam-powered vehicle around 1672 as a toy for the Chinese Emperor."


The early years aside the real accelerator for the internal combustion engines development was WW1.

[mph1977]

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.

<snip>.

despite the overwhelming opinion from clinicians who are interested in the management of the organisation that the NHS works despite it's structures and that lay adminstrators have a vastly inflated opinion of their worth and utility ?

[FredClogs]

mph1977 said:

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.

<snip>.

despite the overwhelming opinion from clinicians who are interested in the management of the organisation that the NHS works despite it's structures and that lay adminstrators have a vastly inflated opinion of their worth and utility ?

Isn't the NHS led by clinicians these days? I though that was the plan in 2010 led by that Andrew Lansley fella, I have to admit I don't know much about it and it seems Jeremy Hunt wants to revert back to the NHS led by himself and a small cabal of his public school chums, but the Tory government of the last six years have been quite explicit about removing the excessive middle management in the NHS and handing it back to GPs and Doctors to run.

[Eric Mc]

EliseNick said:

FredClogs said:

Go on then, give me an example of something which has grown the economy, improved human life or understanding which didn't germinate with government spending or public money.

Go on, 1 example....

The car.

You might be surprised as to where much of the underlying technology for motor cars originally came from.

[andymadmak]

rscott said:

andymadmak said:

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:

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.

My sister works for a 'community initiative' not for profit company providing NHS services. In theory, this sort of organisation meet your 3 (very reasonable) aims . However, it fails on the second (and hence the 'profit' available for re-investment is reduced) as many of the staff in management/decision making roles are simply lacking in basic business sense - many are nursing staff who've moved upward into these roles without sufficient support or training .
For example. she's identified a simple change which would reduce costs of one aspect of the business by over £10,000 a year (a tweak to catering purchasing!) yet can't persuade them to even consider examining it, let alone trialling it.

Wow. That is a lot of money that could be spent on caring for patients! Does your sister know why they won't implement her findings? Because I think that understanding those reasons may lie at the heart of this debate. there may of course be a perfectly reasonable explanation but if it is just resistance to change or for ideological reasons then that is something that needs to be addressed. Either way it is gulp inducing to think of the numbers that could be involved if such inertia was widespread across the system

[Ridgemont]

Well the thread got derailed nicely with Fred's general knowledge quiz. Given that 'government' has been around in its modern form for a very short period of history, I'm sure its feasible to wibble on about swords, fishing rods, ploughs, cutlery what have you. If you have an activity consuming 35-40% of GDP, the chances are you will struggle to find something unaffected by it. Cause and effect however..

Back to the point at hand.

These are interesting.
http://www.bloomberg.com/infographics/2014-09-15/m...
Using life expectancy vs % of GDP as metrics its clear that the NHS is pretty much standard. It sits in a similar cluster to Italy, Spain, Portugal, Japan, Norway & Australia.

What's as interesting are those countries that have a lower % contribution and a higher life expectancy:
South Korea, Israel, Hong Kong, Singapore. They all appear to have either healthcare insurance, or charging models? Worst models appear unsurprisingly to be the US (for cost as %) and Russia (for life expectancy).

What possibly excites the more equitable minded of PHers is the equality of access:

https://pbs.twimg.com/media/B6k4jWhIYAEGSWU.png:la...

the UK has one of the most equitable care systems in the world, for better or worse.

This is a pretty amazing detail view:

http://www.qualitywatch.org.uk/indicator/internati...

It looks at all sorts of mortality rates by illness type.
What's fascinating, tying the comparison countries mentioned above, the UK is performing pretty badly around things like stroke and cancer survival. Arguably with better focus on high mortality treatment and tech, significant uplifts in survival rates could be achieved.

[mph1977]

FredClogs said:

Isn't the NHS led by clinicians these days? I though that was the plan in 2010 led by that Andrew Lansley fella, I have to admit I don't know much about it and it seems Jeremy Hunt wants to revert back to the NHS led by himself and a small cabal of his public school chums, but the Tory government of the last six years have been quite explicit about removing the excessive middle management in the NHS and handing it back to GPs and Doctors to run.

you are confusing commissioning which with the CCGs is much more clinician led , with the actual management of providers ...

[handpaper]

FredClogs said:

First bicycle drawings were attributed to a student of Leonardo Da Vinci at the time he was living and working under the patronage of the pope in the vatican.

Wikipedia says...

"The first verifiable claim for a practically used bicycle belongs to German Baron Karl von Drais, a civil servant to the Grand Duke of Baden in Germany."

Public servant invents wooden horse... The headlines would have read...

By that logic, are you claiming Einstein's Relativity Theories also, given that he was working in the patent office at the time?

IMO, unless there's a war on, and sometimes even then (Frank Whittle, Barnes Wallace), Government is only capable of impeding and preventing technological development. Railways and canals needed permissions and rights-of-way from Parliament; they were funded by public subscription and conceived by private bodies.

I agree with the earlier posters who suggested some level of patient contribution; it might be worth comparing missed GP appointments with those at dentists, who do charge for NHS treatment.

[Camoradi]

Has anyone asked Fred Clogs? He might know.

[crankedup]

andymadmak said:

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:

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 !

1. Makes for a comforting thought 'all profits reinvested'. This is an unlikely scenario imo with the 'not for profit' organisation principals to young and unproven to be eligible for such major contracts.

2. As above.

3. Problem is the human hand, whether we call them private or public its locally the medics that make a good service better, if they have the support in term of finance and management.

My insurance or no medical care drift is. a genuine consideration based upon real world experience. Only certain health care is 'free of charge' in France, much requires payment and the need to be insured or face a monster bill unaided. It is this situation that will, imo, pose the most threat to our current service. Once the creep effect starts its very difficult to stop.

[ATG]

NHS efficiency is actually pretty good when you compare it to other developed countries. The one developed country that sticks out like a sore thumb for being staggeringly inefficient is the USA.

If genuine market forces apply to some economic activity, then let them rip. Patients' demand for diagnosis and treatment don't even vaguely conform to that, and financing a large part through insurance also fails to bring useful market forces into play.

We already have a hybrid state/private system in the UK. I can use the health insurance I get via my employer to get seen by a specialist a bit quicker for non-life threatening stuff, and to upgrade the "hotel" side of medical care. That seems like a fairly sensible balance.

If a hospital, trust, regional health authority can put some services it needs out to competitive tender, then that seems entirely sensible to me. That'd be a good way to bring the benefits of competition into play.

Having some type of means-tested claw back might be worth considering to encourage patients to value the services they are accessing and to discourage frivolous use of the NHS or failing to turn up for appointments. But this kind of scheme can become an expensive bureaucratic mess, so not obvious that the benefit would out weigh the cost.

Edited by ATG on Wednesday 4th May 13:48

[FredClogs]

handpaper said:

FredClogs said:

First bicycle drawings were attributed to a student of Leonardo Da Vinci at the time he was living and working under the patronage of the pope in the vatican.

Wikipedia says...

"The first verifiable claim for a practically used bicycle belongs to German Baron Karl von Drais, a civil servant to the Grand Duke of Baden in Germany."

Public servant invents wooden horse... The headlines would have read...

By that logic, are you claiming Einstein's Relativity Theories also, given that he was working in the patent office at the time?

IMO, unless there's a war on, and sometimes even then (Frank Whittle, Barnes Wallace), Government is only capable of impeding and preventing technological development. Railways and canals needed permissions and rights-of-way from Parliament; they were funded by public subscription and conceived by private bodies.

I agree with the earlier posters who suggested some level of patient contribution; it might be worth comparing missed GP appointments with those at dentists, who do charge for NHS treatment.

From the Manhattan project to the various teaching posts and early work in the patent office virtually all of Einsteins career, and much of the research still going on into his work is funded by public money, as is a huge amount of science in all areas.

[sidicks]

ATG said:

Having some type of means-tested claw back might be worth considering to encourage patients to value the services they are accessing and to discourage frivolous use of the NHS or failing to turn up for appointments. But this kind of scheme can become an expensive bureaucratic mess, so not obvious that the benefit would out weigh the cost.

Means-tested?

I suggest that the people who aren't turning up for appointments are far more likely to be the ones that are on welfare, than the ones earning a living who struggle to get appointments in the first place...

[Smiler.]

Camoradi said:

Has anyone asked Fred Clogs? He might know.

He's got no idea, absolutely nunn.

[sidicks]

FredClogs said:

From the Manhattan project to the various teaching posts and early work in the patent office virtually all of Einsteins career, and much of the research still going on into his work is funded by public money, as is a huge amount of science in all areas.

Which is not to say that with lower taxes it could not or would not be done by the private sector, after all, where does the money come from in the first place?