UKC

Going to strike, again.

Donkeys led by lions.

In reply to Princess Bobina:

I'm sorry are you calling the doctors donkeys?!

In reply to Princess Bobina:

Eggs led by trumpets mate.

In reply to marsbar:

They are pushing the limit of public support, surely.

Even their own support is dropping.

In reply to Princess Bobina:



If the Junior Doctors are the donkey's, who are the metaphorical Lions?

In reply to Princess Bobina:

At times both the BMA and the Railway Unions seem to forget that the public is a better judge of what is in the public interest than they are.

In reply to Gone for good:

BMA.

They seem extraordinarily powerful.

In reply to m0unt41n:

Yep, I reckon the public have a fine grasp on what effect the contract being imposed is likely to have on front line services instead of just being annoyed about being inconvenienced.

In reply to Princess Bobina:


To be fair the BMA agreed a deal but the doctors voted against it. The BMA therefore had to keep fighting.
I suspect that the doctors may not be as clever at politics and judging public opinion as they are at doctoring.

In reply to Princess Bobina:


When the MP's cut their salary or stop having a massive pay hike every year then I might lose sympathy with the BMA. Up until then, the doctors have got my support.

In reply to Jim 1003:

The doctors keep saying this isn't about money.

In reply to Princess Bobina:
They have my support, I've not supported any other strike for a long, long time.

It ought to be about money, if someone wanted me to work more weekends than I had previously I'd want to be well compensated for it.

In reply to Princess Bobina:



You can't leave that just lion there

In reply to Princess Bobina: and what pray would you do Princess? Or do you think that whats offered is a super duper deal?

In reply to Postmanpat:



Yeah but what does the government (who know about politics) know about front line doctoring. F*&% all.

So Dr's might not understand politics. That doesn't mean they don't understand how to run the NHS better than the politicians that impose shit without thinking about anyone other than themselves.

In reply to m0unt41n:

That's a fairly controversial thing to say, I imagine the BMA have a fairly good idea of how the proposed changes will affect the service offered to the public, who will otherwise get the one-sided nonsense issued by Hunt's department (and it is utter nonsense).

In reply to Jim 1003:


MPs give generous rises to other deserving public sector workers. Just look at what Cameron did for his special advisers.

In reply to Princess Bobina:


I really don't think that's the case.

Are you Jeremy Hunt in disguise?

In reply to footwork:
>
Rather an odd post, since the issue I was addressing was not whether the government's policies are right but whether the doctors are likely to win their case, or more specifically to keep public opinion on their side.

Actually there's no real reason to think that junior doctors know how to run the NHS anymore than Wayne Rooney knows how to run FIFA. The doctors may have very valid input about the problems they face but managing one of the biggest organisations in the world is not one of the skills that they are taught a medical school.

Which is not to say that politicians can run it, but then again they don't. It is run by professional managers.

In reply to Postmanpat:

Princess is calling them donkeys and you are comparing them to Wayne Rooney. Not sure what is more insulting.

To study medicine requires commitment and very good grades. Stupid people don't get to become doctors. I'm sure most doctors could work out how to be managers really quite effectively if they put their mind to it.

In reply to marsbar:



Much as I generally find myself disagreeing with Postmanpat on politics threads, he really wasn't putting them down in any way.

In reply to marsbar:
>
Wayne Rooney is one of the finest practitioners of his profession in the country. Doctors shouldn't be insulted by the comparison unless they deliberately choose to misinterpret the comparison.

>
I'm sure they could but that is not the point. Indeed to infer that they are being described as stupid is exactly the opposite of the point.

The point is that they have neither the knowledge or the skillsets to manage a large organisation anymore than to be lawyers or history professors. They generally get a limited bottom up view of the organisation through specific issues or the specific environment which impact them but not of the broader, top down and budgetary issues which influence policy. It's quite unusual to meet a young ambitious intelligent person in any organisation who doesn't think they could run it better than the people who do. That doesn't mean they are right.

In reply to Postmanpat:

Fair enough. I know less than nothing about football so all I know about Rooney is that he seems a bit dim. My misinterpretation entirely.

In reply to Postmanpat:

As much as I am against the "7 Day NHS" plan by Hunt, I agree that I think this could be a bad move form the public support point of view. However, I wanted to pick you up on this point:


Some junior doctors are final year Registrars. They are about to become consultants and WILL be running departments. My wife re-structured the on-call procedures and SHO/Reg rotas (they're not officially called this anymore I know) in order to make them legal/compliant in her her hospital. They have a better idea of how to run the service "on the ground" that you give them credit.

(I'm not claiming they could all run a trust but when it comes to shift patterns and covering wards, how many staff they need etc they are actually very switched on. Just don't let them control the money......)

In reply to Princess Bobina:

Do you have a proposal which could solve the dispute? (beyond "suck it up")

The doctors are striking because there are not enough of them (or any of the other departments) to provide care for non emergency patients at weekends. Hunt has no plans to train or recruit more doctors, therefore the existing doctors will have to work 7 days a week or weekday staffing levels will have to be cut.

And they definitely have my support.

In reply to galpinos:

>
Yes, I'm sure many experienced doctors are perfectly capable of running the department in which they work. Ultimately some of them, if they chose to, could develop the knowledge and skills to run a trust if they so chose. But this is not the same as saying that junior doctors understand best how to run the whole organisation.

In reply to Princess Bobina:

speaking as a member of the "inconvenienced" public, I support them all the way. Its not just about doctors contracts, its about a sustained attack on the NHS from the government.

In reply to Postmanpat:

now that is the most patronising response I've seen in some time. I doff my cap to you.

In reply to Postmanpat:
They dont run they organisation nor do they want to but they do want honesty about its funding and the implications on their patients.

They voted for industrial action as they still don't think the deal was right and that JH was talking seriously to fix the problems. Those I know say its still more about safety, fairness, recruitment and the big lie that the 7 day NHS is funded and a cost neutral JD contract has anything to do with implementing it. The goverment as ever wouldnt speak on radio 4 so an ex minister (hardly front line) was rolled out to say everything was fixed now except for the pay... so stupid and mendacious it beggars belief. JDs en masse are simply not a militant group by nature and even the conservative junior minister at the time of the original negotiations (Poulter) said a deal was available but lost on his side, so in my view this is one huge cock-up led by JH. If the public care about the NHS they better support the JDs' concerns on the tens of billions current funding gap. The 38 dgrees/ Guardian investigation shows that front line services are about to be seriously hit... hardly the efiiciency gains implied by the manifesto.

As for public support we will see. It won't be as good but its looking good enough for the moment and the last strike passed with pretty much no press issues beyond grumbling talking heads with no serious individual story.

In reply to Postmanpat:

From what I've seen, it's pretty much mandatory for all senior trainee doctors to take medical management courses, including learning how the whole organisation works. The ones which are interested in management are actively encouraged to undertake further training (I'm suspect that the doctors heavily involved in the BMA will be of this ilk).

Anyway having said that, we're not even talking about whether junior doctors are capable of running the whole of the NHS or not. I think as a group, junior doctors are capable of assessing how this new proposed (and soon to be imposed) contract will affect them, and it's implication on future recruitment, retention and service provision.

Also, what makes you think that Jeremy Hunt has the knowledge and skill-sets to run the organisation? From the evidence I've seen so far, he's not coming across as being particularly competent...

In reply to lummox:


There's nothing patronising about it at all. It's common sense. Do you think a thirty year old lawyer should run a major legal firm or a 30 year old lecturer run a university?

In reply to Short&Savage:


I was responding to Footwork's suggestion that they are better placed to run the NHS.

I'm no fan of JH but he doesn't "run the NHS". That is done by the NHS management which advises and informs him on policy.

In reply to Postmanpat:




In which case what do you think of the job that the NHS management is doing as a whole?

In any case, this thread started about junior doctors going on strike. It's actually a bit of a side discussing 'who runs the NHS' isn't it?

In reply to Princess Bobina:

If you can imagine a dinosaur with rose tinted glasses, that is what the great british public are when it comes to health care provisioning in the UK. How did the NHS become such a holy cow that noone dares to try to bring health care in line with the level provided in most of the rest of Europe ? Partly, I suppose, because the same dinosaurs always vote for lower taxes.

In reply to Short&Savage:

>
Mixed

>
As I said, it was a response to a post. That post seemed to suggest that doctors knew more about how to run the NHS than the government and its advisors and that their arguments were therefore right. I don't accept that premise and therefore don't accept it as a reason for accepting the doctors' position. There may be other reasons why the doctors are right of course.

In reply to Postmanpat:



I think it was your suggestion that junior doctors have no clue about how the organisations works that irked.
Also, seeing that your opinion of NHS mangement isn't particularly high, presumably you don't hold their opinion in such high regards either?

In reply to Postmanpat:


But.... I wasn't saying that. This contract is about how to best provide a service on the wards. I'd say they are very well placed how to deliver the best service. Not how to fund it etc but how to staff it, which is the main issue with the "7 day NHS" contract.

In reply to Short&Savage:

>
I didn't say that they had "no clue". I said that had a limited perspective. Rather different.


Not especially, but quite possibly the organisation is simply so big and cumbersome it is almost impossible to manage.

In reply to galpinos:

No, but footwork was.

To go back to the rather clumsy football analogy. No doubt Wayne Rooney could tell the gaffer that the squad needs more strength in depth, a new keeper and a centre half, better squad rotation to keep everyone at peak performance, some extra support staff and less intensive training on Mondays.
He might well be right but he might not understand or be able to solve the difficulties, roadblocks and budgetary restraints to getting there.

In reply to Postmanpat:
Its a characteristic in any organisation or company that most employees consider that they can run the organisation/company better than the current management. There is the odd exception, usually smaller companies.

I find it annoying when people say they can do better. The simple answer is then take on the responsibility and do it.There is usally an opening or opportunity somewhere for an employee, especially in an organisation like the NHS to be able to demonstrate their capability to perform well.Whether they want to is the real test.

In reply to Princess Bobina: there is of course the assumption being made that the contract changes proposed are designed to improve the quality of patent care, and that careful researcher was done to support them rather than cheap point scoring/politici.

So while the junior doktorar may or may not know how to run a department neither may Jeremy Hunt, but he'll do stuff anyway.

In reply to Trevers:

In reality it is called politics. The public vote in (well sort of given our system) a government and charge them with governing. They should get rid of them if they do not like them.

The electorate has somehow decided that it doesn't want to pay for a fully functioning NHS so instead we have a shambles of under funded service.

That is obvious to everyone, so it doesn't need the Junior Doctors to deliberately make it worse merely to make everyone listen to them. The train unions are the same about their claim for safety.

The BMA should try to convince the public but not by making things worse. If they cant make the public listen then they should shut up and do their job not threaten people using the arrogant excuse that they are only doing it for the publics benefit even if the public may not agree.

In reply to Princess Bobina:
It would also be interesting to see how many people would be willing to accept a decrease in their quality of working conditions to satisfy what seems to be a pretty arbitrary political decision. Postmanpat ?

In reply to m0unt41n:
I'm sorry but it's not obvious to the voting public. We've got to the point now where taxes are generally considered to be theft, not the price we pay for order and public services. So people resent paying taxes, they resent people who are perceived to pay less tax than them and vote for governments that promise to lower their taxes, regardless of what that means for the funding of public services.

The government line is that these services are simply unsustainable. They are, not inherently, but because of under-funding and worsening working conditions causing staffing shortages. The funding would be readily available under a more progressive tax system.

Do you really think the BMA should just step aside and allow the government to erode the service it's clients provide? Strikes make people take notice. They're supposed to cause hardship. I only hope that this strike enjoys the high levels of support the previous ones have.

In reply to Trevers:


And when that doesn't work, what then?

In reply to neilh:


Are they claiming they know how to run the entire organisation better or just their particular role?
Personally I find it annoying when people confuse competence with being a manager. Its something my industry sometimes deals with better separating out the people/financial management roles from the actual roles which need specialist domain knowledge and then balances the two so that you dont get a technical expert who loaths paperwork having to do that instead of what they are good at or a accountant trying to make technical resourcing decisions.

In reply to Trevers:

Its a tricky debate.The big downside to what you say is people's experience of the NHS.Its very mixed.To portray it as permanently in a state of collapse does not really stack up.You see too many tv shots of state of the art services and my own familys experience of it is mixed from outstanding to okish. the Ok ish part is on treatment for the elderly, the outstanding is the rest ( even my Gp service is good). My last visit to A & E was 2 months ago and we were in and out within an hour on a Sunday evening.

So when people say to me its getting worse, I reply - well I am sorry- but in my experience its not. Even for my elderly parents I have seen improvements with better links between hospital and social services.

I know there are alot of issues and there are some horror stories.

But to flood it with money, not sure that stacks up.

In reply to neilh:


Errr, don't think the junior doctors (or the BMA) have ever said they can run the NHS better. They are 'merely' saying that the new working contract proposed is crap (for them and the general public).

In reply to marsbar:



Seems an odd poster and the tory party have been trolling the web, so you might not be that far off the mark.

Visited my brother in law in hospital yesterday and all the nurses and doctors were running around like blue arsed flies, although apparently they were significantly quieter than they had been the previous day.

In reply to neilh:


Anecdotal experiences aren't good enough to make policy decisions on. Nationally, various indicators (e.g. A+E waiting time, ambulance response times, cancer treatment delays, etc.) shows that the organisation is struggling.



Exactly how much in terms of percentage GDP should we spend on health then? Up to Norwegian level? Brazilian level? North Korean level?? At the end of the day, historically and to some extent presently the UK haven't paid very much in proportion to GDP for health compared to other industrialised nations have they.

In reply to Short&Savage:

>
And other countries finance it in a different way, don't they. So why don't we take a leaf out of their book?

In reply to Short&Savage:

It was in reply to an earlier post when somebody said they could run it better. Nothing allong the line s of what you are saying.

In reply to Short&Savage:

What is the satisfaction rate with the NHS - something in the region of 85%- I cannot remember the exact number.

If the rates was less than 50% i would agree. But its not-- the majority of people are generally OK with it.

This is one of the paradoxes.

I am not saying there are no issues. But to rubbish the NHS on funding and say " open the purse strings and give us access to the money tree" does not stack up.

In reply to Postmanpat:


Dunno.
What does that give us?
Will an alternate financing model actually cut our costs or raise them?

In reply to KevinD:




Perhaps we should have an open and public debate about it?

In reply to neilh:

TV shows are pure Disney. Extra staff drafted in while it's being shot, more senior staff on the shop floor, amazing time the staff have to spend with each patient reflecting on their personal 'health journey's - it doesn't do justice to the conditions a majority of staff have to work under nor the volume of work with the increasing onslaught of elderly ill people and or expectant mothers using maternity services.

D

In reply to Postmanpat:

Which is not to say that politicians can run it, but then again they don't. It is run by professional managers.

If only! I’ve spent my whole working life in the NHS clinically. Never climbed the greasy pole, frankly not interested. For many years I’ve been union rep and sit on many collaborative panels which help such a large organisation function. One of these roles sets the pay scale for new jobs with the Trust. I can confidently say that there has been a significant increase in middle and senior management. The Trust would dispute this claiming there is a 52/48 percent split between clinical and non-clinical staff. However, many of these roles essential characteristics demand membership of professional bodies which in turn require that clinical hours and validated updates. This is smoke and mirrors with registrants doing the absolutely bare minimum of clinical hours and having management tasks classed as meeting the requirements of registration. If you’re ever unlucky enough be in hospital and one of these management types is setting about a procedure on you tell them to get lost. They probably went into management because they were rubbish nurses or doctors.

In reply to Postmanpat:


After the success of the last political debate I cant see what could possibly go wrong.

In reply to KevinD:

I wasn't suggesting referendum, just that we stop treating it as a rsacred cow and start treating it as a service, and question the fundamentals of how it should be delivered and financed.

In reply to Postmanpat:


What are those fundamentals. Since about the only one intact from the last few years is the free at point of care. Outside of that there has been massive change in the name of the religion of free markets.

In reply to KevinD:
>
Funding primarily: hypothecated tax, state insurance, co-payments etc. But also a more honest and open discussion of delivery.

In reply to pebbles:


If the inconvenience means the treatment for you or your family being postponed, prolonging some painful condition, and you see cheerful young doctors demonstrating on tv, would you still be supportive?

In reply to Dauphin:

I was not talking tv shows . i was talking about shots from news programmes etc.I take your point on tv shows.

The elderly issue is better dealt with by merging with social services, certainly based on personal experience where this is being done it seems to work. Having been in a meeting all morning with 4 ( yes that is 4) qualifed nurses( 2 from NHS and 2 from social services) to discuss future provision for my mum opened my eyes as to why this need to be done. What a waste of resources.

At least that issue is being moved forward.

In reply to marsbar:

Im not sure about that. Ive had three misdiagnosed conditions including one potentially cancerous. I also have a lot of professional medical experience and have seen many bad practices. Im happy to explain if required although the consultants will be anonymised to protect the guilty.

And lets not forget that drs aren't doing this to be altruistic. Many do it for the kudos, salary, private practice and medico-legal work.

In reply to neilh:

No one sensible is saying we should flood the NHS with money. The 7 day issue is in fact a classic waste of money (prety much all the research shows it would be more efficient to spend the money elsewhere). In the meantime the NHS is one of the worst state funded health services as a fraction of GDP spending in the big countries of the western world. Its not well funded nor inefficient by by any sensible measure. Hunt is trying to square a circle and run a service he knows he hasn't funded to the right level. Its a big lie.

In reply to neilh:

Absolutely agree with you re merged budgets and management of elderly care services, but it's 2016 it should of occurred 20 years ago and in many if not most areas of the country it doesn't happen. Embarrassing to part of such an ineffectual shit show tbh.

D

In reply to Jim Hamilton:

yes. do you really think people supporting the doctors dont realise that possibility? Its worth enduring some temporary inconvenience now to preserve the NHS for the future. And the 'cheerful young doctors' are very aware of the issue and seem very concerned to make sure people still receive urgent treatment.

In reply to Postmanpat:


Personally, I don't think there's any problem per se in discussing possibilities for alternative models of health care funding. However, despite all the inefficiencies that exist in the NHS (being the gigantic organisation that it is), I think it's a fallacy that just by switching to say an insurance based model, that things would magically be a lot more efficient:

http://www.commonwealthfund.org/publications/in-theliterature/2014/sep/hosp...

Basically, by making it partly or wholly an insurance based system, this inherently introduces another layer of admin costs which the NHS (a free at point of provision service) doesn't have to deal with. Either way, we can't escape the fact that modern medicine is expensive.

In reply to Princess Bobina:

They have my support.

If the government want to deliver on their 7 day NHS pledge (and I'm not saying they should) then they should fund and staff it adequately. Of course I don't for one second believe that's what they actually want out of this train wreck of a negotiation.
jk

In reply to Offwidth:

how does that match with the other claim by everybody in the nhs seems to claim that compared £ for £ the NHS is far better value than the US model?

I suspect every politican knows that its not funded to the right level where it would be perfect.

But I always take issue with the view- " its the worst".

As I have said my own experience is far from it.

In reply to neilh:


>
The US model is a red herring because it excludes so many people (and is expensive). The European models are far more realistic alternatives.

On of the key problems is that the NHS has become so politicised. Its existence along Statist lines central of the Labour mythology and its recreation along different lines is central to the Tory philosophy. I really can't imagine the Germans making their mixed provision health service central to the opening ceremony of a German olympics. IT would just be regrded as weird.

In reply to Postmanpat:

In Germany I once sat waiting with an 11 year old in a & e whilst a colleague had to go back and get the childs passport and supporting documentation before they would treat her.Opened my eyes at the time to people drawing comparisons with the NHS. People would be outraged if this happened here.And yet in Germany it appeared to be normal.From the nursing staff upward nobody batted an eyelid.

In reply to Postmanpat:


True, but it's the Doctors who have to do the shifts isn't it?


I'm not convinced the public, still don't support the doctors.

In reply to neilh:

You do realise the US health system iis more expensive in state expenditure per capita than the NHS (before a cent of insurance income is received)? .... its by far the worst value for money major health system in the world but with the best treatment (if you are rich enough to afford the insurance for it). Most Eurpean countries even without the insurance income spend more per capita than the UK: we are behind where we probably should be in terms of state funding for health.

This isn't about 'perfect' funding (its hard see what that even means) it's about possible levels of realistic funding in given scenarios . JH is claiming we must have a 7 day NHS on numbers no sensible commentators think is even close to being possible. He started dealing with this Gordian knot by picking a fight with a group not even relevant to the sharp end of resolving those funding problems. Its all a big lie and bonkers in terms of tactics. The potential differences in cost of resolving this dispute are financially small for the NHS (but big politically) compared to the projected annual 20 billion funding gap. Thee issues are also big for JDs and for good liberal evidenced based reasons (not left wing militancy): recruitment is being impacted seriously even now so from a market perspective the pay and conditions combination looks wrong; the 7 day week promise forcing most of the projected NHS funding gap needs facing down or services will collapse; important equality issues are still not fully resolved.

In reply to Offwidth:

Yes I am only too aware of the US system.

Take on board your other comments.

So what do you propose on the funding gap?

In reply to Offwidth:

Spot on with that analysis, offwidth.

Spend on health care as a proportion of GDP is set to fall to below 7% by 2020 (or was when Osborne was chancellor). Comparable countries (Germany, France, Australia) spend around 10%. Even Greece spends more than 7%.

An unprecedented experiment is being attempted by the government- is it even possible to deliver acceptable health care to a population in a developed country on 7% of GDP?

The answer is clearly no, yet it that is what is being planned. The NHS is being set up to fail. The industrial relations dispute with junior doctors, inexplicable taken at face value, needs to be viewed in that context.

In reply to no_more_scotch_eggs:


I'd have clicked like but it seems rather inappropriate.
jk

In reply to no_more_scotch_eggs:


>
What really stands out if you look at the numbers is the low % of GDP accounted for by private spending on health. Of the 34 countries monitored by the King's Fund only five spend less as a proportion than the UK. For several countries eg.Norway, NZ, Greece, Portugal and Canada private spending accounts for pretty much all the difference in overall health spending/GDP and for others such as France it accounts for a very significant proportion of the difference.

The UK comes in at about 10th of the 34 in terms of government spending on health/GDP ahead of eg. Australia,Spain, Finland, Italy,Canada and Switzerland.

Incidentally health spending/GDP only reached 7% in the UK in 2007. As late as 2004 it was only 6% and in 2000 it was 5% so it's hardly an "unprecedented experiment". What the numbers imply is the unsustainability of spending growth continuing at these levels without some serious attention to how it is funded.

(Numbers are rounded and some taken from charts)

In reply to Postmanpat:

But that private spending all has to come from the same source in the end; either we pay through taxes, or some form of insurance premiums, but we have to pay somehow.

I am unconvinced that greatly increasing the private sector contribution to the UK health sector is a necessary step at this stage; far from being inefficient, the NHS performs well on international benchmarking in this area. It performs less well on some outcome measures, which is an serious shortcoming- but before abandoning the model, I'd argue that funding it properly should be tried first, as that nmay resolve the outcomes problem.

I'd also argue that if you put this to the electorate- if you want a proper health service, you either pay for it though tax rises, or you pay for it through other means, and you may well pay more that way- people may actually accept it.

At least that would be more honest than what we actually have- a pretence that we can extend the scope of our health service, and increase quality, sufficient to meet need and expectation, on a resource base restricted to a greater extent than any developed country has ever attempted.

In reply to Postmanpat:
http://www.nuffieldtrust.org.uk/data-and-charts/uk-health-spending-share-gdp

Just seen your edit- please can you link to source, I don't agree with the numbers- to my understanding spend as % of GDP rose under labour to around 9-10%, and has been falling ever since

Edit: yes, here is a graph showing UK spend as percentage of GDP on health since 1995, referenced again EU & OECD averages. For some reason my phone pastes the link at the start of this post.

It shows that the figure has never been as low as 5%; it was just under 7% at the end of the Major administration, and was 8% in 2004, climbing above 9% thereafter.

So, not unprecedented, no. But 2020 is not going to be 1996. The demographics and in particular the number of frail elderly with multiple long term conditions are very different. It didn't work in 1996, and it's really, really not going to work in 2020.

The NHS will have 'failed'. And people will demand, something must be done. ..

In reply to no_more_scotch_eggs:

It did break 8% but the point I was making that this was only quite recently ie.2008. Clearing the costs of healthcare have risen even since then but Offwidth made it sound like 7% was returning to prehistory.

http://www.economicshelp.org/wp-content/uploads/2016/08/health-care-spendin...

The OECD figures has it peaking in 2009 at 8.9%. There are other figures (world bank?) which have have it higher I think.

In reply to no_more_scotch_eggs:

>
My point is that it is not being put to the electorate. It is one of those topics that politicians regard as so incendiary as to be out of bounds so they pretend that we can muddle through, or that there is a magic money tree or that we can improve efficiency to solve the problem.
None of these things are likely true.

In reply to Postmanpat:
Very different figures! Not sure I can believe them- would like to see the original source.

Edit: tried to track down the source of your links figures; sorry to play the ad hom card, but if I have to choose between the Nuffield trust and an unreferenced chart in a blog by an economics teacher, Im going with the Nuffield. ....

In reply to Postmanpat:



No disagreement with this

I will think the NHS model is the most efficient and equitable one, and can have better outcomes; but all alternatives should be explicitly on the table.

In reply to no_more_scotch_eggs:

They are slightly odd although the Kings fund has the same series. It appears to be the OECD series http://www.nuffieldtrust.org.uk/nhs-numbers-0 (chart labelled "Share of GDP spent on healthcare among OECD countries 2000-2013") so maybe adjusted to meet international criteria?

The ONS numbers are higher.

Worth pointing out that the blip up in 2008-9 was as much about GDP falling as spending rising.

In reply to Postmanpat:

Yes very confusing. Your newer link gives a figure for 2004 of 7.4%; thats from the Nuffield trust, but is lower than the 8.0% in the link I gave, from the same organisation. Both are higher than the approx 6.2% in the opaquely sourced graph the blog you linked gave

In the end, I think this is focusing on detail at the expense of the bigger picture. The demands on the health and social care system are growing rapidly every year, as the number of frail elderly increase. Spend on health and social care is being reduced, as a proportion of GDP year on year for the next 4 years.

That is not going to end well; and I find it impossible to believe that those responsible are not fully aware of this.

In reply to Postmanpat:

Ps its not me that's disliking all your posts, pat...

In reply to no_more_scotch_eggs:


It's not me either. I've been 'like'-ing his last few posts.....

In reply to no_more_scotch_eggs:


Don't worry. I think I've got a stalker. I feel lonely and ignored when he or she doesn't turn up

In reply to no_more_scotch_eggs:


For what it's worth, the economics blog uses the chart twice and the second time sources it to the King's fund. The latter does use this chart but doesn't say where the underlying data comes from (not that I can be bothered to find, anyway!)

In reply to no_more_scotch_eggs:

In other European countries they seem to have a mix of public/private.Germany was talked about earlier as an example.Is there anywhere in Europe which funds healthcare like we do out of general taxation with comparable sized economies/populations? Small countries like Norway, Finland or economic basket cases like Greece need not apply.

In reply to Postmanpat:
You are a naughty man. I made no comment on the decline let alone move to prehistory; even if I do think it is important to hold the government to account on how much they spend on health compared to other nations (and on overall cost to look to the good in Europe rather than the very bad in the US for lessons). My main issue is with a massive funding gap that the government refuse to own up to and that I think is the real cause behind this dispute. It will all end in tears as the public and the marginal tory MPs that represent them simply won't take the planned cuts in service that are starting to leak.

The UK public are clear they want the NHS so talk of insurance systems are for the moment immaterial. I just want something that is honest, evidence based and works at the levels of expenditure most other nations achieve (given government boasting about what a powerful economy we have, it should be more but I'll settle with par).

That answers part of Neil's question... for the rest of it: integrate social care into the NHS immediately as the failing interface costs the NHS and social care a fortune (more billions saved and much happier old folk); dump this false market than Landsley brought and costs a few billion a year; forget the 7 day NHS and spend money where the experts think it will do the most good; look seriously at recruitment planning... I'm not sure we don't have a disaster heading our way on NHS staff training in several important areas and the smaller past mistakes have led to too way much money being burnt on agency staff and locums. Just letting the NHS run with less political interference would also be good but that's maybe a step too far in the what's possible stakes.

On the dislike stalkers, carry them with pride (even though the children think they smite in secret, data is stored and UKC knows who they are) your comments here are very welcome from me even when you put words in my mouth (an opportunity to take them out again).

In reply to Offwidth:

What I do not really understand as a big picture issue is that if merging social care with the nhs is going to save billions where does the extra £20 billlion in underfunding come from. Is that with or without this merger of the two services?Out of interest do you know.

The funding gap was highlighted at the last election from what I remember. NHS England correctly caused a stir by highlighting it to all the parties.

In reply to neilh:
The gap is between the level of funding estimated by various independant organisations to run a 7 day NHS and the funds currently allocated. The government have a magic efficiency savings number that no serious health commentator believes and according to the FOI information from 38 Degrees looks like bringing in some significant reorganisations very soon (like small A&E closures in sensitive constituencies)

Google Roy Lilley for numerous fun articles on this (he is very anti-strike and critical of the lack of public joined up thinking on health funding so no socialist patsy). He is loosely linked with the Kings Fund (one of those organisations that did the sums). His solutions rely on a magic bullets too... bypassing the reality of the stike by dumping national bargaining and expecting people to be treated better on pay and that good stuff in management will work spread and thrive (and not end up as rare beacons or get stopped by politicans).

Merging Social care is being tested in Manchester and seems to be showing signs of savings and better services already. Its not part of the funding gap as its not planned across the UK yet. Social care is one of two big forgotten and growing costs on the UK middle classes (the other being all the private work, usually on insurance, as people get nervous about waiting times)

In reply to Offwidth:





Well, maybe "prehistory" was my own interpretation of your words.

The point I would make is that there is dishonesty and disingenuousness on all sides. Labour won't acknowledge the scale of tax rises implied if it is to be funded up to peer group levels purely by the State (especially if all there other areas of increased spending are added), and the Tories won't acknowledge that it is underfunded. My second point is, as I said, that compared to our peers the obvious difference in not so much in State spending on healthcare but in private spending, and that is not acknowledged.

Regarding the the public's commitment to the NHS; perhaps this is because the points of above and the alternative funding and provision arrangements are regarded as "off limits" by politicians. So except for geeks like us they are seldom discussed.

Secondly, whilst they might have a deep commitment to healthcare being available to all, preferably free at the point of service, I don't accept that finding other ways of funding or providing it than that envisaged in 1948 implies that it is no longer the "NHS".

In reply to Offwidth:

I am not sure social care is being forgotten, most I know are very aware of it as more of us have elderly parents in the system.

I just get annoyed by the lack of joined up thinking in this area. But as well as this being at govt level I also strongly view it as organisations protecting their own patch and I can imagine alot of people fighting a much needed change.You only have to look at the merger in Manchester and how the Labour party were very pro for it locally, but in London at HQ they were against it, to know there are political isses as well.Fortunatley I think that with money being so tight people came to their senses.

On the private insurance side, most of this is paid for by employers anyway, who provide schemes as part of their employment contracts. I know very few people who pay for it as a matter of choice.

In reply to marsbar:


How does he seem a bit dim? He seemed a pretty switched on young man on the documentary a year ago.
It wouldn't be the Liverpudlian accent would it, like? I can't believe that anyone on UKC would draw conclusions based on stereotypes......

In reply to neilh:

Forgotten in alll the NHS cost calcualtions....not dealing with the issue will end up as a lot more expensive in the long run.

In reply to Postmanpat:

I just love your fonz like inability to just say I was wr..wr... I was wr.. wr.. wr... I was wrrrong

We are geeks but the public are not and they love the NHS ideal so this won't end well. We are in a period where risks are spiralling way beyond past problems because of political failure, especially this big lie of the funding gap and its associated strain on local 'inefficient' units, patient safety and likely recruitment. Sure Labour are guilty as well but not so much in my view and they are not in charge (although JC must be starting to suspect that this might be the thing, that when it all blows up in 2017, might get him elected against all the odds).

In reply to neilh:

Insurance cover through work is just less efficiently deferring what we should get as pay but understandable from the organisation funding it (they want key workers treated and back ASAP). If you look at the data there is very significant non-work insurance funding and work subsidised funded (like my Uni organises) and then all the direct payments when people get a condition and realise how long they will have to wait for treatment... how many climbers out there still wait for NHS physio referrals (fast diagnosis and treatment of soft tissue injury makes a massive difference to speed of recovery)?

In reply to Offwidth:

>
Actually, I was wrong. I think I attributed Scotch Eggs comments to you. Sorry about that.
Obviously I'm never wrong on the important stuff

>
They love it because they are incessantly told that it is the "envy of the world"

In reply to Princess Bobina:

I think the doctors' industrial action is May's miners' strike. I fear that if she wins, and she means to, it will be the end of our NHS and the beginning of decades of unopposed Tory rule. She's decided to go right. The business about putting people back "in control" of their lives is a clear dog whistle to the libertarian/punitive wing of her party. Of course it really means every man for himself/roll back the state.
I think we've really had it this time...

In reply to Pete Pozman:

So do I

In reply to Postmanpat:
In terms of cost efficiency of what it is for the whole population in a modern western state with mass public support it is the envy of the world. Lets hope that doesn't soon become was. In terms of what richer folk can get from it its not so good and when the social care problem is factored in it looks worrying. Not uniquely so though I was in the Netherlands earlier this year and they are going through the same strains with austerity and its impact on families (having to meet massive unplanned and unpredicted cost increases for social care) .

In reply to Pete Pozman:

Bit of an overkill.....Drs and Miners in the same category.. it is a professional v govt industrial dispute..and quite alot voted for the BMA recommendtion to accept the terms..so lets get real

In reply to Offwidth:

I am not sure it is the envy of the world when I speak to Germans , Yanks, the French etc. Far from it>

In reply to Offwidth:


But not in terms of outcomes which are surely more important than uninformed popularity polls?

In reply to neilh:


You are obviously speaking to different Yanks to me.

In reply to Princess Bobina:
Back to the topic. As I understand it, after many months of dispute and negotiations both sides: the BMA and the government, accepted a compromise agreement. This agreement was put to the junior doctors by the BMA.

68% of (junior doctors) voted of which 58% rejected the deal. So about 40% rejected the deal and 60% didn't. The government decided to impose the deal.

The (new) BMA leadership then decided by a narrow majority (16-12) not to reopen negotiations (which the vote obviously mandated them to do), nor just to repeat their previous industrial action, but to hugely up the stakes by calling a longer strike, at shorter notice, followed by a series of longer strikes.

Senior doctors organisations have expressed their concern at this raising of the stakes and it seems highly questionable that the 60% of junior doctors who didn't reject the deal will support such aggressive action.

I suspect Mr.Pozman is right that Hunt regards the BMA as an organisation that need to be broken and I suspect that the BMA is playing into his hands by taking the Scargill route to self-destruction.

In reply to The New NickB:

Well there are a few of them so I guess there will be a divergence of opion.

In reply to Postmanpat:

Thought it was 16-14

In reply to Postmanpat:


*insert brexit comparison here*

In reply to Postmanpat:

What percentage of the population actually voted for this elected govenment? We have to accept all democratic votes with all their imperfections or none. The JDs have a clear mandate to strike and the real cost is to the NHS finance and the public affected by knock on delays in scheduled operations as emergemcy cover will be provided for essential services.

Scargill bypassed democracy at a crucial point in the miners dispute... if he hadn't things may have turned out different.

https://en.m.wikipedia.org/wiki/UK_miners%27_strike_(1984–85)

In reply to Offwidth:

My point is not that the vote doesn't mandate the BMA to continue to fight, and it has the right to do that as it sees fit. My point is that the votes (of doctors and the BMA leadership) don't appear to imply strong support for upping the ante and all the fall out that it implies. The BMA is acting legitimately but it may be acting very unwisely.

Scargill may the massive mistake of not calling a ballot, which you refer to, but he also benefitted from the massive peer pressure within the mining communities to hold maintain solidarity. Does this exist amongst junior doctors?

In reply to Postmanpat:
I'm sure they know that, but enough normal, moral intelligent JD's clearly feel like they are forced to act when they see the NHS rivets popping out. It's arguable when the BMA recommended accept they got too close to the game and missed the message (pay was less an issue than safety, retention and equality).. enough middle of the road JDs were so seriously worried about the future of their profession in the NHS, they voted to strike. Sure there will be peer reinforcement involved in this but thats another common to people who share ideals in democratic votes. If we want ethical professions don't be surprised with what happens whe the ethics start to spark against policy.

In reply to Offwidth:


But the JDs didn't vote to strike. They voted not to accept the compromise deal. I am unclear actually what they now want out of a deal but, regardless, are the 60% who didn't vote against the deal going to agree that it is morally right to cause the trouble to patients and colleagues that this series of strikes will surely cause if they didn't feel strongly enough even to vote to reject the deal? Did all the 40% who rejected the deal believe that they had given carte blance to much more aggressive and potentially disruptive action?

In reply to Postmanpat:

You're making an assumption here. It's perfectly possible that Junior doctors that did not vote may support strike action for a number of reasons

* They support their fellow doctors
* They do not feel that contracts shouls be imposed on them
* They thought the vote was a forgone conclusion
* They were not able to vote or it was inconvenient to do so at a certain time

Etc etc.

You're purposely choosing a group of people that we don't have information for and asserting their preferences. As offwidth has pointed out, it's not unusual in democracy that a minority dictates the result of a decision but that does not automatically mean that the majority disagree.

How I feel about this overall I'm not sure - but lets not use blatantly faulty logic.

In reply to FreshSlate:





Rubbish. Where did I assert their preferences? I inferred perfectly reasonably that if they didn't vote they may not have had a strong view. (Obviously some couldn't vote for whatever reasons, but 32%??).

I asserted nothing. The clue is in the question marks.

In reply to Postmanpat:


Oh you inferred rather than asserted did you? Jolly good.

You've got no basis for saying that most junior doctors are morally against the strike apart from a vote where a majority voted against the contract which is now being imposed on them.

Which is clearly quite stupid.

In reply to FreshSlate:

I would guess that the BMA make it reasonably easy to vote and would be encouraging as many to do so. It is after all not a poor Union.

In reply to Princess Bobina:

The NHS is a rum old business.

Last strike A&E worked beautifully (even had empty beds here), because a) the public significantly stayed away (so the 30% that turn up that are neither accident nor emergency didn't show) and b) there was an entirely consultant-led service.

Sadly b) isn't sustainable from a roster point of view, nor affordable.

I wonder if the public in general realises that "junior" covers everyone not a consultant - so includes senior registrars that may have 10 years of post graduation experience (in general if you go for an outpatient appointment you will see a Registrar not the named consultant). Nevertheless, individual doctors in general do not have a good grip of how to run the NHS. The ones that step forward to lead transformation work and systems work across secondary and primary care (and social care) do - but, in general, they don't support the system staying as it is.

What's interesting is that some of the genuinely hard-to-swallow parts of the contract don't make the media. For example, if a junior wants to change specialty and has acquired salary increments in one specialty, they lose them and go back down the ladder to start the new specialty at the bottom. This is because career increments are now not automatic... which sounds ok on the surface, but produces the problem above. So saying "increments should be based on experience", whilst it sounds ok, is feared as a future choke on salary progression when it was intended just to enable the system not to progress poor performers...

The weekend thing is a bit of a side show - most doctors now agree that some sort of 7 day contract is inevitable and beneficial for care. The juniors that will lose out (initially - my point on progression hasn't gone away) are those working stacks and stacks of overtime, who shouldn't be doing it anyway - the argument about unsafe hours is actually more of an issue in the old contract. The issue is not about current pay, it's about future pay. Doctors spend 5-6 years at medical school (loans for years 1-4 so £60k debt); 2 foundation years paid low £20s; then another 5-8 years as juniors before perhaps getting a consultant post. Consultants basic pay is good, but not amazing considering the skills, training and quality of entry. So no suprise there's such a murky issue about private work and the involvement of NHS time, premises and resources in it.

Overall? I don't support the strike. But I think negotiations should focus on the anomalies that the contract has created and define better how increments/progression will be applied.

In reply to FreshSlate:


You need to read more carefully. I didn't either infer or assert that that most junior doctors are "morally against the strike". Nor did I, as you claim, assert their their failure to vote indicated disagreement.I inferred that if somebody doesn't vote for or against something (the contract) they quite probably don't have a strong or committed view in either direction (obviously excepting those that couldn't vote for whatever reason). That is obviously a reasonable inference.

I questioned what this might imply for their views on the relatively extreme position taken on industrial action by the BMA post the vote. You may suspect that loyalty to their peers or resentment at the imposition of the contract will drive them to supporting the more aggressive strike action. That is a possibility. I suspect that for many it won't.
Time will tell, but it's perfectly possibly to surmise different things without one of them being "stupid"

My suggestion would be that you refrain from posting post the pub.

In reply to Princess Bobina:



Fools. This type of strike is going to lose them public support and that's exactly what the tories wants them to do.

In reply to Postmanpat:





With all the implications, inferences, surmisations, indications, questions and suspicions; I wonder if you intend to stand behind anything you say at all.

In reply to FreshSlate:

That's actually the point. You confused a surmise with an assertion, which it very explicitly
wasn't, and then went off on one. Your whole premise was and remains mistaken.

There are obviously different ways of interpreting the likely progress of the industrial dispute. I assume you'd accept it's reasonable to discuss the various possible developments without being able to know what they might be.

Have a nice day.

In reply to JJL:
>
Interesting post. To an outsider, even one who takes an interest, it has always been hard to discover what the issues are. This may be partly because Hunt has done a good job in muddying the waters, but may also be because the doctors themselves don't agree or adopt a consistent line. It's been immediate pay and conditions, future pay and conditions, working patterns, payment for Saturday working, safety, funding and "saving our NHS". Or maybe all of the above.

In terms of negotiations, is the BMA willing to negotiate at this stage?

It looks like the disagreement over the details of terms and conditions have now been replaced by a battle of political wills between Hunt, who wants to break the BMA, and the left wing of the BMA which is highly politicised and wants to break the government.

In reply to Pete Pozman:

Do you think that if Theresa May ends the NHS then we will have decades of unopposed Tory rule? Is it likely that a party that ends the NHS will be unassailable over multiple general elections?

I'm genuinely perplexed by the seemingly widespread belief on these forums that the Tory government is determined to destroy the NHS as a matter of political ideology or that they want to privatise it in order to somehow line their own pockets. How would this work?

Like most mainstream political parties the Conservatives are in the business of attempting to win and hold on to power - they would have to be monumentally stupid to destroy the NHS even if it were a core belief!

I'm not talking about Tory cuts to the NHS or perceived mismanagement or any other criticisms, but the belief that the Tories are determined to destroy the NHS as a matter of ideology.

Genuinely interested in this question.

In reply to neilh:

My point is that the dispute is pivotal/historic. Overwhelmingly, the professional classes voted Remain and were brought low. My point is that May, who seems exceedingly shrewd, has seen long term political advantage in siding with the right wing of her party and by confirming Hunt as Health Secretary (no more than a PR man, unqualified for the job) she has drawn a line. The doctors cannot be allowed to win. The purpose being to finish off the centre left for good. This will clear the ground for the exciting future which an unopposed Tory government, red in tooth and claw, have in store for us.
I can only see the brightest and best leaving the UK, or what's left of it, and the country sinking into a sort of nationalistic alzheimers.
But you never know...

In reply to Postmanpat



Well, the BMA position is awkward as they recommended the current contract. It was the doctors that then rejected it.

I think these strikes will be tough to hold. It's almost a quarter of income being foregone, and the primary impact will be that consultants are needed for emergency care so planned elective work is postponed. Longer waiting times and cancelled operations will sap public support.

One silver lining may be to help reshape the public's use of emergency services (I hope). Grumpy consultants telling the minors to piss off and have an aspirin would be good.

In reply to Postmanpat:
"I wonder if you intend to stand behind anything you say at all."


That clears that up then. Carry on.

In reply to FreshSlate:



Good try. 4-10

In reply to Pete Pozman:
I think you are going into political overdrive about all the implications . It is when all said and done a contract dispute which has been dragging on for 3-4 years which to some extent has been hijacked by the"NHS is collapsing on its feet and will be gone in a couple years group".

I prefer reading postings by the like of JIL and Offwidths which are far better and informative.

In reply to neilh:

I don't think Pete is. I was prepared to cut May some slack; I could even understand her rationale for appointing Johnson as Foreign Minister (it has certainly clipped his wings, and at least he is a Europhile who can speak a few languages.) And I was impressed at her courage in postponing Hinkley Point. But she had a heaven sent opportunity to resolve a truly toxic dispute by not re-appointing that ignorant, incompetent, charlatan Hunt, and fluffed it.

So we remain committed to a an unwanted, unnecessary and unworkable plan for 7 day working that may, far from delivering 'world class service', (which it can't) , may well bring the NHS crashing to its knees, as junior doctors vote with their feet, support staff work to rule and patients become increasingly frustrated at the gap between the government rhetoric and the experience on the ground.

Which in turn will drive more people into private healthcare, - healthcare insurance will increasingly become part of standard employment contracts, and who knows, maybe Hunt is already eyeing up the Government imposition of private pensions on employers, with a view to doing the same for healthcare insurance - with the consequence that in a few years the NHS will be left with an underfunded rump, dealing with poor people, a bit like Medicare in the US. And our country will be catastrophically the poorer for it, whatever Postman Pat thinks.

In reply to mudmonkey5:






OK. I'm taking it as a given that the Labour Party is finished as an effective opposition. Isn't everybody? A new alignment in the centre of disaffected Labour MPs and Lib Dems will take a decade to become effectual. This is why I see the Doctor's dispute as pivotal.
I'm basing my view on my experiences in the 80s when the power of the Left was smashed by Thatcher who destroyed the miners then completely emasculated the Teachers, a profession, like the doctors, which once had significant political clout but is now at the mercy of right wing government ideologues. Look at the way education has been ransacked by the Tories. State education is now a rump, subject to the creeping control of private franchises.
The right of the Tory party is bent on dismantling the State. If the doctors win, that project will suffer. If they lose who then will stand against the Right?
(Corbyn's Labour will be a giant pressure group focused on internal dispute as new members realise the company they are keeping.)
The doctors are in the last redoubt. They fight for us all.

In reply to Pete Pozman:

Corbyn's base of support seem in pretty rude health and likely to carry him to victory in the leadership election - presumably they don't take this as a given! I actually agree with you though.


Not sure I see any link between the miner's strike, an unviable and outdated coal industry and the NHS/doctors. The teachers seem a pretty vocal bunch to me and I'm not sure how much politcal clout I really want them to have anyway!


The left? The electorate? Half of the Tories that are not far right?


Probably true!


Bloody hell, it's not Rorke's Drift you know.....

In reply to Pete Pozman:

>
Possibly they fight for people who share your view of how the world should work. The election results of the past four decades would suggest that this group does not constitute a majority, let alone "all".

In reply to Postmanpat:


Clearly, on the evidence of the Referendum, this is a right wing country; and that's official. Although I don't believe the majority understand the consequences of going this far to the right. On the basis that the NHS and public services are for everybody, then they do fight for us "all". I have no doubt that in the future there will be profound regret over where recent voting is taking us. If Clinton wins, the USA will pass us going in the opposite direction. AS Rob Ward says, the NHS will become a version of "Medicare".

In reply to Pete Pozman:

>
As far as I can tell the people of Germany, the Netherlands, Switzerland, France, Denmark, Japan, Sweden, Singapore and Canada, all of which have have mixed funding and/or mixed provision don't seem to up in arms demanding an exclusively tax funded and State provided health system. Perhaps they recognise the consequences of it....

In reply to Postmanpat

...and the rest?

In reply to Postmanpat: Perhaps the people of Germany, the Netherlands, Switzerland, France, Denmark, Japan, Sweden, Singapore and Canada, like in fact the people of the US, don't understand what we have:

'What - you mean you can just turn up at a GP; be referred to a consultant; get admitted to hospital; have all the necessary tests and treatment; and you don't have to pay ANYTHING?'

In reply to Pete Pozman:



Rest of what? Isn't that a reasonable sample?

In reply to Rob Exile Ward:



No, why would you think I meant that?

As it happens it varies from place to place.

In reply to Postmanpat:
Mixed provision or not most of the countries you list spend so much more on healthcare as to make the comparison meaningless. To catch up with those countries we would need to increase our health spending by more than our entire current annual defence budget. THAT is the core issue and one that we need to decide on as a nation - are we willing to pay?

In reply to Paul Atkinson:

As I pointed out above for several countries eg.Norway, NZ, Greece, Portugal and Canada private spending accounts for pretty much all the difference in overall health spending/GDP and for others such as France it accounts for a very significant proportion of the difference. The UK comes in at about 10th of the 34 (monitored by the Kings Fund) in terms of government spending on health/GDP ahead of eg. Australia,Spain, Finland, Italy,Canada and Switzerland.

If the UK is to increase its healthcare spending to peer group levels it behoves it to consider alternative funding mechanisms which are considered "normal" in many countries well to the left of the UK and also to be honest about the increases in tax required if it is to be entirely tax funded. It also behoves it to address the impact that free at the point of service has on demand for services, and the alternatives for controlling demand.
It must also obviously always be reviewing the most cost efficient forms of provision. It's thinking on both sides of the equation shouldn't be dictated by some inappropriate or outdated ideology, but by pragmatism: what works.

In reply to Postmanpat:

"The UK comes in at about 10th of the 34 (monitored by the Kings Fund) in terms of government spending on health/GDP ahead of eg. Australia,Spain, Finland, Italy,Canada and Switzerland.

If the UK is to increase its healthcare spending to peer group levels it behoves it to consider alternative funding mechanisms which are considered "normal" in many countries well to the left of the UK and also to be honest about the increases in tax required if it is to be entirely tax funded"

I don't disagree that there's a need for discussion about how we pay for healthcare and (being of the left) obviously taxation would be my answer and yours would be different.... but really the absolutely overriding question is HOW MUCH we pay altogether by whatever system; you again list countries whose annual health spend exceeds the UK's by more than our entire defence budget and that's where our problem lies. If we're going to spend at that level by whatever means then a massive national change in our priorities and approach is going to be required, perhaps to a level unseen since the advent of NHS. I don't think the UK public has got any grasp of the disparity in spend and what it means, a percent or two either way doesn't sound like much, and their expectations are disproportionately high - they're expecting a Harrods shopping basket and paying Netto prices.

As far as the juniors go: on the background of a massively underfunded system the preposterous "7 day NHS" comes along as an election propaganda sound byte and a load of bogus evidence is cynically used to support it. The stated goals are unachievable with the existing resources as the government well knows and the first point of attack has been to attempt to screw the junior doctors to help paper over the obvious cracks in staffing - paper over very thinly as medical staffing is just one of many unfixable parts of this nonsense. Unsurprisingly the JDs are not prepared to be Hunt's kamikaze squadron and have stood up for themselves and the future viability of the NHS. The whole force of the government's propaganda machine and right wing press has then been used to traduce and vilify one of the hardest working most dedicated groups in the country and every dirty trick in the book pulled out to push through a very divisive and unfair "divide and conquer" contract which the juniors have thankfully had the solidarity and integrity to reject. They have every reason to be angry and to distrust the government. If the JDs lose and this project is pushed further the consequences for the whole NHS and its patients will be disastrous. Far from this being a case of the JDs "playing politics" they have been attacked in a way that unavoidably conflates their contract struggle with the fight to protect and fund the NHS. A "small c" conservative bunch has been transformed in to a unified politicised fighting force by Hunt's hamfistedness. I hope the public will continue to trust the doctors and see the lies they are being sold by the government.. we'll see

In reply to Paul Atkinson:
>
Yes, I agree but the public is (one assumes) unaware of this because to speak the truth makes either side unelectable (it is assumed). To reach peer group spending levels implies an increase of about 20%in health spending. Financed from tax and NI that imply maybe a 12% increase in tax. Financed out of overall taxation maybe 5%. But given the demands from the left that spending be increased on everything else it would, in reality mean overall taxation rising by maybe 10% and income tax/Ni by more.(all back of the envelope stuff) .
This is not a vote winner.

The obvious alternative is some sort of insurance based element or some sort of co-payment system as used elsewhere. The left has made this unacceptable by its incessant cries of "privatisation", "save our NHS" etc.

So the short term option is to try and squeeze a quart out of a pint pot (even this is made difficult by the ideological idee fixe of both sides) .It's dishonest and won't work but the alternatives are out of bounds. The BMA, rather than fighting against anything except a straighforward rise in taxed funded spending, should all along have been cooperating to explore alternatives. It is not a little ironical that the great cry was that doctors would leave for Australia-ie.to just the type of health system they are fighting to block in the UK.!!

I don't have any sympathy for Hunt and I don't understand why May left him in place. But by confusing their narrative and , now, overplaying their hand, the BMA are at risk of scoring an own goal.

But until there is a genuine and open debate about the options for healthcare, and all options are on the table, then there is no real solution.

Although we might disagree on what the final outcome should be, it doesn't seem we disagree that the current conflict is avoiding the point.

In reply to Postmanpat:

None of these other systems has solved the problem of how to fund and deliver acceptable health care across a populationwhose demographics are cchanging in the way developed economies are, though. Far from encouraging rampant demand, the NHS is one of the best at containing costs due to a lack of perverse incentives. It also lowers barriers against good long term management of complex, and expensive, chronic conditions. I don't think it's proven that any of these other systems are better than the NHS on a pound for pound basis, or that the NHS would not equal them in outcomes, with better access and equity (very important aspects other systems fall down to varying degrees on).

I wouldn't rule out other options though, as I said above. We desperately need a proper debate on the future of health care, and an acceptance that money will have to be found from somewhere. But the models of provision in the places you cited- often mutual or social enterprises- evolved over decades, and in the context of the overall culture in their respective locations; I don't think it would be easy to create that sort of system from scratch here, and it's much more likely that commercial providers would seek to exploit the market created. That's not a future I look forward to seeing, and attempting to fund from taxation, unpalatable as it would be to the electorate, would still be preferable to me.

In reply to Postmanpat:

The public dont want an insurance system, so no party is proposing one, so insurance is simply off the agenda for now. I don't think insurance schemes are always bad (they work OK in some places and terribly in the US) but it might well be cheaper to do it through tax and its irrelevant currently. What Europeans think about their service is also irrelevant: its as you said about perceived outcomes and the public doesn't compare international data. We need to raise our per capita expenditure if the public demand better (not a likely demand any time soon in my view). However, what is facing us next year is a very public drop in outcomes (when this funding gap mess pans out). The goverment must know this but I can't read why they dont act., Hunt is a disaster and maybe May kept him to sack him (as a distraction after an assumption that the JD's lose ....but the safety and recruiment issues they are striking about and other things they are worried about, like closures, remain) but then what?

In reply to Postmanpat:

In NZ most GPs charge the equivalent of GBP20-30 for an appointment. Patients discharged form hospital will routinely never attend follow up appointments with their GPs, due to the cost. These patients then re-attend ED with avoidable recurrence of illness and the cycle continues. Levels of access e.g. to chemotherapy drugs are way behind those seen in the UK and patients are often dependent either on the munificence of the pharmaceutical companies(!) or drug trials. The NHS manages to avoid this - for good or bad.

Social care locally is capped at about 3 hours of home help a week. Any more than that and best be off to a residential home. Partial funding doesn't solve infrastructure issues and an inability to train enough doctors. There is also much disparity in access to care and where there are financial barriers the least well of inevitably suffer. I am unaware of a system in which this is not the case: the NHS being by a long way the best of a bad bunch.

b

In reply to ben b:


We do our best to follow these patients up... So long as we receive a timely discharge summary (!). In our area at least there are vouchers available through Wellsouth to cover the cost of a GP consultation ($40) plus pharmaceuticals ($5). If you have concerns a patient will not attend a f/up due to cost then you can issue them with a voucher or let them know such a scheme exists and to enquire with their GP practice. Also with chronic illnesses they get discounted appointments which are typically $25 rather than the full $40 (Careplus).

I believe I can follow up patients better here than I could in the NHS system simply as I have more capacity to do so - 15min appointments, routine appointments not booked up weeks in advance for trivial matters etc. And less social problems to deal with - dealing with more medical matters and actual pathology.

The further patients are from hospital the more likely they are to attend a GP for f/up as it is cost efficient to so so - $40 versus fuel costs and parking etc.

Finally, it is interesting to note at the last NZ general election Labour tried to buy themselves into power at a late stage by offering free GP appointments to <18 and >65 but it spectacularly failed.

In reply to Pete Pozman:


Hunt is eminently qualified, overseeing the NHS is in his blood, Virginia Bottomley (former Health Secretary, then director of BUPA, now director of Smith & Nephew) is his cousin, his father was Chairman of South West Surrey District Health Authority until he became Chairman of Nuffield Hospitals. If you wanted someone with extensive contacts to deliberately run down the NHS to the point of collapse and bit by bit outsource its functions to the private sector until it has been privatised in all but name, then Hunt is the perfect candidate.

In reply to EddInaBox:


It's OK as the political opposition here will never allow this to happen as they are astute, well connected to the greater populous and totally focused on what's going on outside their own party right now.

In reply to Thickhead:

Interesting perspective- how different is the system to the NHS- are there contributions by patients to the cost of hospital care or outpatient appointments? Are the vast majority of secondary care specialists employed by the state as they are here? Is there a large insurance market, and do people access this directly or through employment? What is wellsouth?

Best wishes

Gregor

In reply to Offwidth:


Having been told for sixty+ years that the NHS (as funded by tax) is the "envy of the world" it is unsurprising that the public don't ask for anything else. It's never been suggested to them. It's up to politicians to encourage proper debate of the alternatives, not try and close debate down.

In reply to Princess Bobina:

I'm a Paramedic with 14 years in the NHS, and my Dad is seriously ill and been in hospital for the best part of a month, so I have seen both sides of it.

I still completely support the Doctors in their need to fight the imposition of this new contract, for them and for everyone else who will soon see a watering down of our unsocial hours agreements/ pay progression if they don't.

However the part I don't quite get is the need to all out strike, as with the current state of the NHS and it's utter reliance on the good will of staff, sacrificing their breaks and working large amounts of overtime, a "work to rule" could crippled the NHS overnight, and could also be maintained by staff for a much longer period. I'd like to see how Hunt and the Media would deal with that!!!

In reply to EddInaBox:

<then Hunt is the perfect candidate.

We used to have a Physics teacher called Dr Gott, and if we were under pressure from him we used to mutter " t squared equals d"
In the same way I would imagine that there are a good number of people who mutter "H equals C"

In reply to no_more_scotch_eggs:

>
No, it's an insoluble problem, but given the difficulties involved it is seems completely responsible not to look at the alternatives to see what they can offer and which aspects are transferable.Personally I think the rise in taxes required to to meet the long term costs of healthcare and all the other things that the State is required to provide is unsustainable. And I think it perfectly sensible to utilise private provision if it works. You, at least on the first count, disagree.

That disagreement is fine but frankly I've probably seen much more discussion of the real issues on UKC than I have by any politicians or by the mainstream media.

In reply to Postmanpat:

PP, why do you see raising taxes as unsustainable?

If we need to spend n billion extra per annum why is contribution from insurance etc any different from contribution by taxation? Especially if, like with pensions, some degree of compulsion is contemplated.

In reply to Postmanpat:
Id echo Dr S' s point. The money comes from our pockets one way or another. I'd have to be persuaded that alternatives to general taxation were at least as efficient and equitable. Im not currently (though would be prepared to change that position if compelling evidence was presented).

I entirely agree with your second point though- meaningful engagement with this by politicians or the media is utterly lacking. This creates the same vaccuum of information that was exploited in the brexit debate to run distortions and out and out lies. I worry that when the debate comes, projects fear and lie will again be the only shows in town.

In reply to Postmanpat:
Sure it is but they are mainly cowards and even if they were brave, educating the public isn't so easy... so it will remain an intellectual argument, whereas the consequencies of the funding gap are flying towards us like a runaway train. Maybe the answer to my question was they intend to crash the train to 'fix' it. Remember this governemnt created more than half of the funding gap by running an expensive bogus market in the Landsley reforms (following a manifesto promise by the conservatives not to mess with the NHS) and by pushing for the 7 day NHS in the face of the facts (on the basis they can't renage on manifesto promises!).

In reply to Thickhead:

Thanks Rob. Yes the SLAT worked hard on the vouchers though i hadn't realised that they were now available. And hopefully HCS will help with the discharge summaries : in fact should be one for you tomorrow

B

In reply to Dr.S at work:

>
Because an insurance premium is simply a "flat fee". It's a fixed cost like fuel or petrol. If a family's premium goes up then they cut back a little on other expenditures.

Increases in tax have a much broader impact on economic behaviour. They make working, saving and investing less lucrative, which means that, at the margin, people would reduce their engagement in these activities. Tax funding comes at a greater economic £deadweight loss£ than premium funding, because it changes people£s behaviour to a greater extent.

Social insurance systems can afford higher spending levels, because they are funded in economically less damaging ways.

But, as noted above, the UK stands out for its relatively low level of private sector spending on health. Ultimately,if an increase in health spending comes from government spending, however the money is raised, then other elements of spending eg. education, welfare etc will suffer. Whether one agrees with the austerity mantra or not, it is commonly accepted that there is a limit to fiscal spending so something has to give.

In reply to Postmanpat:

More intellectual irrelevance and that very real crash is still coming. A 20 billion funding gap doesn't close by magic efficiency gains....significant reorganisation and closures are the only possible alternative (to a funding or policy U turn) and the history of public acceptance of smaller reorganisations of services doesn't exactly bode well. Its crazy that the tories stick to this mad 7 day pledge when so many other manifesto promises are dust.

In reply to Offwidth:


It's not "intellectually irrelevant". There are two issue; how the NHS is funded and provided or rationed over the next 2-5 years and how it is done over the next thirty years. The discussion about SHI,v tax, v private etc funding is entirely relevant for the latter

In reply to no_more_scotch_eggs:





You pay for GP consultations if you're >13. It's subsidised a bit more until you're 18 then it's generally full cost, however as above there are vouchers for hard up patients and various other incentives for chronic diseases etc.

Secondary care is 'free' and the vast majority are employed by the state but do at least some private work, some do only private work.

You do pay for prescriptions, very little for funded ones but those which aren't funded can be hefty hence why access to some of the newer and possibly better chemotherapy drugs can be restrictive.

A lot of people have insurance, though I wouldn't know the stats. Particularly in Auckland it seemed a lot had it through work. In Dunedin probably about 15-20% of my referrals are private, but that would vary between specialities.

Wellsouth is a PHO network which provides extra funding for primary care, a bit like a CCG I guess.

In the UK an average patient sees a GP >6 times a year, here it is 2-3. There are a number of reasons for that but cost being the main one. It's a much more civilised system to get through as both a supplier and as a consumer, and as a parent with a young family I have some experience of that.

Copayments are well established here and are are recognised part of being in NZ - people in the main are well used to it and sometimes are surprisingly willing to pay - I think I have made only one physio referral that wasn't private for example in 3yrs.

Emergency Departments are busy, but not on a UK scale. Dunedin covers a geographical region bigger than Belgium and sees approx 120 patients in 24 hrs, which is how many we were seeing in Bangor 10years ago.

There is no perfect system and the co payments do seem quite large at times, but I do genuinely believe this system is better as a Dr and as a patient.

In reply to Postmanpat:

Does that not depend on the type of tax? a flat fee or flatish fee similar to rates would appear ro behave a lot like an insurance premium and could be budgetted for as an additional expense.

Whilst I accept that there is a limit to taxation, we appear to be about 10% behind the germans in taxation levels, so perhaps there is some space for expansion?

In reply to Dr.S at work:

When I was lad my dad paid 33% Income Tax: nationalised transport, funded NHS, no tuition fees and student grants for almost all. The Lottery is a voluntary tax and we seem to get something for something there.

In reply to Dr.S at work:

>
In other words a hypothecated tax poll tax? It should certainly be part of the conversation. The obvious difficulty is that if it is a flat fee then it will be seen as unfair-like the poll tax, and if it is linked to income it will have the same distorting effect on behaviours as regular income tax. Amongst the other difficulties is that because it will fall exclusively on individuals as opposed to being spread across general tax revenues so it will have a bigger impact in individual tax.


Germany's tax revneue/GDP is less than 5% (2.6 % points) higher than the UK's. The Netherlands, for example, is about 2% higher so there is not much space for expansion.

In reply to Postmanpat:

Correct me if i'm wrong, but is moving up to german taxation levels about 50 billion quid extra (using the Uk govt income and GDP figures from wikipedia and increasing the UK ratio by 2% point upwards from current levels)? No doubt there would be some loss in GDP with increased taxation, but I'd think we would still have a net benefit?

I think a hypothecated tax is the way to go - loys of people already think NI is that - so why not make it true? flat rate vs % of income is of course tricky, as you say. Harder to see folk rioting against paying more for health care than for the poll tax though.

In reply to Dr.S at work:


I estimated the numbers above. It think it involve either adding about 12% to income tax/NI or 5% to overall tax to bring UK healthcare spending up to peer group levels.. That is, of course, if healthcare is the only area that the government decides to increase spending on. It's not necessarily impossible but I read some report saying that less than half of people would accept a tax increase even if were for the purposes of healthcare spending, so it's a tough one.

In reply to Princess Bobina:

Junior Doctors….pah! They misjudge their worth.

In reply to Postmanpat:

Yep, no easy answers to pulling an extra 20-40 billion into the NHS budget which seems to be the order of change required. I guess the benefit of doing it via taxation is that it could be staged - increase taxation by 1% per year for 5 years, allowing time for the economy/people finance to adapt, and also not flooding the healthcare system with money overnight so it has time to adapt and use the extra resource.

In reply to Postmanpat:
Hypothetical futures in the face of a 20 billion funding gap right now seems almost the definition of an irrelevant intellectual argument to me. Do you think the public will swallow the reorganisation and closures dressed up as efficiency savings or wil the government U turn and effectively dump the 7 day NHS and or funding holdback (or if a bit of both at what rough level)?

For the 4 decades I have been interested in health economics many right wing thinkers have said the NHS is unsustainable so we will have to move to insurance or rationing at some point. Yet we currently still have an NHS, the outcomes on a per capita spending basis (the system efficiency) look as good as any major economy and yet our per capita health spending bumbles along near the back of these and we can afford to burn money on daft reorganisations to inject a bogus market and run an expanded 7 day service most experts think we dont need (on the laughable basis that tories don't renage on manifesto commitments). We have got here partly by fixes and fiddles but the main current potential savings are the most recent political impositions and there is no logical reason to not suppose something will give when irresistible forces hit immovable objects: so more fixes and fiddles mean the funding basis can remain as mainly taxation. Neither of us can measure what the voters will say and the politicians will do in the mid range but right now no party has an alternative policy and the public are solidly behind the NHS as it is.

In reply to Postmanpat

This is the sort of practical thought I'd like to see more of from the right (as opposed ro ideological naval gazing), from Roy's blog today:

"News and Comment from Roy Lilley

How long should it take to reconfigure services? How long is a piece of string!

Of all public services, health is about as near to the public's heart as it gets. Try and move a clinic from one side of the street to the other and wait for the roof to come in.

Stakeholder buy-in, cross service agreement, unions, health-watchers, councils, Royal Colleges, CCGs, MPs, the public, Uncle Tom Cobley can all stick their oar in.... and derail the best laid plans.

We have to accept we are in the game with public money, so the public should have a say. We know changes in primary care are likely to impact GP's income and they have money invested in their practices. We understand shifting services up-ends consultants and their private practice income.

Staff may not be able to fit in a new place of work with childcare, spouse's use of the car, public transport and time tables.

The public may have real travel concerns, the cost of car-parking and where to go in an emergency.

Those who don't have skin in the game, have money.

Change is slow, deliberate and ponderous. That's why the NHS hasn't changed very much and why reconfiguration generally works... the result of consensus.

A straightforward consultation has to take 14 weeks and end2end, three months is the quickest I've seen and generally they can go on and on for years!

All of that's been fine for the last 68 years but it's not going to work for the next 168 weeks... that's about what's left of the 5 Year Forward View.

I spent a day with wonderful Worcester NHS Trust. Battered by an overheating health economy, recruitment problems, CQC lunacy and years of indecision. They know they have to get on; it's make yer mind up time.

The enthusiastic, loyal staff know what needs to be done. Closing this, moving that and sorting stuff out. The solutions are obvious, the benefits scream out.

So what's the problem?

Like a lot of Trusts they are trapped in an out of date modernisation framework that will take them years to work their way through. Each step of the way monitored by the naysayers waiting to trip them up with a judicial review because there is a spelling mistake on page 517 of their strategic plan.

Obstructionists exploiting delays and wrinkles to stave off the inevitable.

Worcester has to make changes... to circle the wagons. They have three (and a half) CCGs pulling in different directions. The CQC who have made it impossible to recruit and a paediatric service that has to be moved and refocused, to make it safer. We all know specialists in the sector are becoming rarer than hen's teeth.

They have to concentrate the talent, coalesce excellence and be frank about why.

It's time for all the players to start with the patient and work backwards. Selfless, courageous leadership that parks self-interest.

There is not the money, not enough staff and they are left, juggling a problem gifted to them by politicians; the chaos of the Lansley reforms and austerity funding.

Wonderful Worcester's predicament is replicated across England.

The solution must be a new, fast-track consultation process. Something like:

Seventy days max, starting with the presumption... change will happen.
No consultation documents longer than two sides of A4.
No one may object unless they have actually been to a public board meeting and listened to the arguments.
Social media the backbone communications route.
Paramedics have to give an opinion, in public.
All changes must be clinically led.
... and, NHS managers have to talk plain English and stripped-pine truth about money and why they are doing, what they're doing.
The changes the NHS needs are urgent. They should not defy the democratic process, they should dignify it with the speed and clarity it deserves.

Transparent so that everyone can have a say, lawyers will not be able to order a new BMW on the proceeds and the political protagonists can throw bricks at Downing Street, but not down the street where we need to make changes happen.

I know of no health service worker, clinical or otherwise, who comes to work, intent on poorer services. But, I know lots who are realists.

Worcester are realists, we should listen to them and the others like them, wrestling with a bureaucracy rooted in the past, and help them plant the seeds of a new NHS for the the future."

In reply to Thickhead:
Thanks Rob.

I'd disagree with that (outside of surgical specialties and dermatology): a few cardiologists, a gastro, and a rheumatologist. No respiratory private opinion south of Christchurch. Maybe Dunedin is an outlier, but Chch seemed about the same.


And we get 6 hours not 4 - but still manage to blow it


I think most of the time you are right, but the distribution of income may be different in NZ to the UK.
cheers
b

In reply to Offwidth:


Quite a contradictory reply. Short term fixes are the plague of British government. Yes, we face a big immediate problem which needs to be dealt with, but we also need a long term agreement about how health care should be financed and delivered. That requires what you dismiss as "intellectual argument". Without that agreement we will suffer a succession of quick fixes which is just what we don't want.

You then complain that the "right wing" has argued the NHS is unsustainable upon existing lines whilst highlighting that the NHS faces an immediate and critical crisis. It doesn't seem to occur to you that this crisis may be the culmination of the failure to adequately address the underlying issues. It was of course as sure as night following day that all the problems of the NHS would be attributed to the coalition reorganisation this avoiding other issues. It's long been recognised that the NHS had and has plenty of room to improve efficiency but, as you acknowledge "no party has an alternative policy"

In reply to Offwidth:



Absolutely, but to enable this to happen an appropriate system has to be put in place to enable it. That involves the much despised "intellectual argument".

Essentially what these people are complaining about is the inability of Trusts to manage themselves according to local needs, because they are trapped within a centralised bureacratic framework. Guess what, free them from that and there will be success and failures and the politicos and media will be up in arms about the rise in health inequality.

In reply to Thickhead:

Similar to Sweden, roughly £10 for a doctors appointment, £25 for specialist/A&E. Annual cap of around £150, or free for those on benefits of some kind. Same with prescriptions.


Some private places do state work directly, like those dealing with suspicious moles, no referral needed you book direct. Get treated and the private place obtains the full cost for the services it provides at a later day from state behind the scenes. I had a mole removed, tested and an answer back within 2 weeks of first phone call so it seems to work pretty well. But it cost me two £30 visits. Beyond these micro establishments which work for the state anyway say; physios etc.. there are practically no private hospitals or health insurance schemes, it's not even a consideration.

People are happy to pay, it's seen as taking a little responsibility for your health. Do I really need to see a doctor, or should I just rest for day, as I know in my heart of hearts that's what I should do anyway? But, the cost of £10 isn't so high that someone is going to sit at home and die to save the money.

Staff at all levels are paid well, generally motivated, work less hours than the UK, although doctors don't earn as much, the lower level staff earn more than the UK. It has it's faults even with this system and higher taxes in general, it's still challenged financially.

In reply to Postmanpat:

Half the crisis is austerity (falling behind what new labour spent as a percentage of GDP) and the other half is the insistence on a 7 day NHS and an internal market. Given that, I see no evidence there is a funding crisis coming from the NHS, it is one being forced on it by the government, right now. In difficult times its fair enough we face cuts but its not fair enough we tell the public the service will be protected, when the reality is filling a self imposed 20 billion gap is going to be painful (and if we dumped the daft political ideas hardly any cuts or savings would be needed).

Commentators like Roy Lilley are not suggesting removing all of the 'beaurocracy' just small bits of it where there is no evidence that it improves outcomes and adapt the rest that is neccesary to run the service to focus on outcomes, spreading good pracitce that works, and empowering and motivating front line staff: rather than top down dogma like the force feeding of 7 day operation and internal markets. Your arguments for a need for insurance, like past commentators, have no proof its the best option in a situation where its not even clear that we need to look for new options if we U turned on bad political decisions and in the short term its not even possible as an option to be on the table. So the idea looking at insurance funding is important right now looks daft and in the meantime if the government don't back down, quick fixes that will impact patients way worse than this strike, are all we have... every trust has to find its share of that 20 billion.

In reply to Offwidth:

He's bl**dy good is Roy Lilley, why he isn't running the NHS is beyond me.

In reply to Offwidth:

>
Even the most negative estimates I've seen suggest that the costs of implementation of the reforms was £3b and the running costs £4.5bn so I would be interested to see your calculations. It's obviously true that the rise in NHS spending has abated but, as I noted above, the blip upwards in spending/GDP in 2008/9 was actually largely a function of falling GDP, so the fall in the ratio since that is a largely function of rising GDP. As of the last published figures (2014-15) spending /GDP was higher than in 2007 or 2008. The real slowdown in spending growth and therefore spending/GDP has not yet happened (and probably won't).

The big ongoing problem is that healthcare costs rise well above the rate of inflation and that there is a finite ability to fund that

>
What they are presumably suggesting is more bottom up control and less central control. Amen to that. Maybe they could call them "free hospitals" ?

Isn't that the opposite of the abandonment of the internal market and return to a planned system that so many demand?

In reply to Offwidth:

Incidentally, I know that the Grauniad/Observer swung rightwards recently but nevertheless this article on the misjudgement of the BMA leadership is interesting.

https://www.theguardian.com/commentisfree/2016/sep/04/observer-view-bma-jun...

In reply to Postmanpat:

Add the estimated costs of the Lansley reforms and you are close to half the 20 odd billlion before all the uncosted disruptions to NHS staff over these two dumb political decisions. Staff time often ends up being elastic in the NHS.

On markets there is a big difference between forced tendering and letting local organisations get on with stuff. What people demand seems ro me to pretty detatched from the detail until local closures come up or things like fast lenthening waiting lists get public exposure.

In reply to ben b:

I think Dunedin is a little different as it has a huge hospital for the size of place that it is. GPs I have spoken to who have worked in say Wanaka or Queenstown (admittedly people who live there are swimming in cash) have a much higher private referral rate. My private referral rate in Auckland was about 50% of all referrals.

There are a few more specialities than that though even in Dunedin:
Most ?all surgical specialities have private provision.
Dermatology may as well only refer privately.
Cardiology.
Endocrinology/Diabetes.
Gastroenterology.
Rheumatology (I nearly always refer to public though).
Pain clinic.
Radiology.
Paediatrics.
Neurology.
Gynaecology.
Ophthalmology.
Sleep clinic.
Allied health - physio, psychology etc.

Admittedly no respiratory - sometimes people ask should they go north for private treatment but I tell them why pay for an inferior service

R

In reply to Thickhead:


















FTFY

In reply to Dr.S at work:

I refer to Invercargill for that.

In reply to Thickhead:

I had a fella with sheep apnoea once many moons ago... hit by a frozen lamb at the works and phrenic nerve stopped working. The most kiwi health problem ever. And yes it was covered on ACC

b

In reply to Postmanpat:

That article is below the quality I'd expect from the Guardian leader but not unexpected to me as the leader writer has form on this particular subject. The BMA JD committee have clearly made some mistakes and have even got egg on their faces at times (those emails and most recently the U turn on the timing of the first strike), yet they had no choice but to escalate when the deal they supported was rejected... the idea being spread in some places that JD's voting to reject didnt realise strikes would happen is naive in the exteme (being kind). Trade Union law is very tight in the UK and any sniff of dubious ballot outcomes are pretty much always subject to legal challenge... the strike mandate in this case is pretty obviously clean.