UKC

Jeremy the total ....!

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 handofgod 05 Feb 2018

So in TM's recent cabinet reshuffle, one has to ask themselves; why was Jeremy Hunt so determined to keep his job as Health Secretary.

We've all heard how hes shafted junior doctors over pay and working hours but, it seems his chef d'oeuvre is yet to come and when it does, it will be in the form of privitising large parts of our NHS.

In fact; there will be multi billion £ contracts award to private entities, where tenders will be put forward similar to how public funded construction projects are bidded for. Large chunks of our beloved NHS will be run be companies who are more interested in profit and turn over rather than our health and well being. A depressing thought.

Scenario; 

After a serious climbing fall, you are rushed to hospital and an Orthopaedic surgeon is working on your knee. He/ she decides to fix your knee, a new knee joint is required. He/she decides the best component to use would be knee joint type A but pressure is being put on the surgeon from management to be more cost effective / lean so he/she uses joint type B, a far more inferior product but one which cost X amount less than joint type A.All of a sudden, your knee has been repaired but not to the best of the surgeon ability knowing the tools and devices available to him/her.

You see; health car can never be run in a profit making model. Yes our NHS is on its knees, but this is due to it being hugely under funded for many years under the conservatives. 

Luckily, it’s not quite a done deal for Hunt as, he his plans need to clear the scrutiny of the health select committee which is chaired by a former GP and crowd-funded application for judicial review with the backing of the one and only Stephen Hawking.

How fitting; this character has a surname only 1 letter away from the most hated of swear words.

Pray for our NHS.

 

11
 The Lemming 05 Feb 2018
In reply to handofgod:

And this is a sudden revelation to you?

 

The Conservatives and the NHS are not the best combination.  The NHS is way it is because of Conservative ideology and not down to just one man alone, no matter how much he is liked among his employees.

Post edited at 12:54
8
OP handofgod 05 Feb 2018
In reply to The Lemming:

Suppose it a sudden revelation for the 1000s marching over the weekend.

3
Lusk 05 Feb 2018
In reply to The Lemming:

> And this is a sudden revelation to you?

It's good to remind everyone of this though:

How fitting; this character has a surname only 1 letter away from the most hated of swear words.

4
 Dr.S at work 05 Feb 2018
In reply to handofgod:

Do you think that the ‘best’ drug/implant/procedure should always be picked irrespective of cost?

 

1
 Duncan Bourne 05 Feb 2018
In reply to handofgod:

Picking up on your scenario in the full privete scheme this happens:

serious climbing fall, you are rushed to hospital where the first thing asked is how you are going to pay for your treatment? Good news you have health insurance! Bad news it is invalid because in the small print you climbing accident is deemed self-inflicted. So you are now expected to use savings, re-morgage house etc. Of course if you absolutely can not pay then, under emergancy schemes they will treat any immediate threat to life and give you painkillers for your shattered knee and tell you to rest.

2
 The Lemming 05 Feb 2018
In reply to Duncan Bourne:

Seems fair.

 

Maybe we could change the name NHS to Trump Care or Obama Care?

4
Lusk 05 Feb 2018
In reply to Dr.S at work:

> Do you think that the ‘best’ drug/implant/procedure should always be picked irrespective of cost?


The problem with going for the cheaper option is that it invariably leads to failure.  Then you've got the cost of remedial work.  It's just booting the problem and cost down the road.  And matters medical, repeated trauma for the paitent.

5
 ClimberEd 05 Feb 2018
In reply to handofgod:

> He/she decides the best component to use would be knee joint type A but pressure is being put on the surgeon from management to be more cost effective / lean so he/she uses joint type B, a far more inferior product but one which cost X amount less than joint type A.All of a sudden, your knee has been repaired but not to the best of the surgeon ability knowing the tools and devices available to him/her.

> You see; health car can never be run in a profit making model. Yes our NHS is on its knees, but this is due to it being hugely under funded for many years under the conservatives. 

>

 

Do you understand the NHS? And NICE? 

All treatments are decided on on a cost/benefit basis. Which is why you occasionally read in the paper 'NHS won't fund my treatment' sob stories. That has nothing to do with privatisation, or the Conservative government, but simply a matter of allocating finite supply.

It is very easy (and wrong) to blame the Conservative government for the problems in the NHS. However,  the reality is that since it's original inception (when it was financially feasible) not only have treatments become far more expensive but demand has massively increased in a way never predicted - through increased end of years lifespan and keeping terminally ill people alive longer - making it much harder to provide the service needed on the money available. (contrary to expectations, governments aren't bottomless money pits). 

Jeremy Hunt, as an individual, is indeed an awful person. 

 

 

 

5
 nniff 05 Feb 2018
In reply to handofgod:

That's all very well as rants go, but it does not offer anything approaching an answer to the problem of an aging and growing population, limited financial means and science's ability to deliver more treatments at a price.   

All things being equal, money is a substantial problem to which we need an answer and there is a limited number of options, along the lines of:

  • Do less
  • Use cheaper 'components'
  • Do the same more efficiently
  • Put more money in
  • Use better 'components' but make sure there's no re-work
  • An inspired combination of the above

Profit is not a bad thing, not least of all because it drives the economy that generates the cash for the NHS in the first place.  Furthermore, staff in the NHS are paid for their work, so you can't remove payment for work done from the equation entirely, whether that be by the individual or a company.  

Personally, the main grumble that I have is the obsession with keeping people going until all options have been exhausted, which currently seems to be draining the resources of pension funds, the NHS and social services.   

I'm pretty sure that if [someone] were to get an infection this winter that might otherwise see him off, he'll be treated regardless of his dementia, his inability to stop looking for his wife who died two years ago, the 24 hour care he needs (funded privately) and the absence of any meaningful component in his life now, bar the periodic acknowledgement that the view out of the window is nice.  And yes, I am very painfully aware of how desperately sad that all is, and I dread the next time he ends up on an A&E trolley again, for the distress it causes him and the resources it uses up in the NHS.  The most bizarre twist is that a big slice of the cash currently being poured into 24 hour care would otherwise go to the Treasury and the NHS via inheritance tax.

 

3
 The New NickB 05 Feb 2018
In reply to ClimberEd:

Your analysis somewhat falls apart when you realise thatof the G7 countries, we are the second lowest spenders on healthcare as a percentage of GDP.

2
OP handofgod 05 Feb 2018
In reply to Dr.S at work:

Let turn that question on its head. 

You're on the table and the surgeon is about to swap your hip for a nice new shiny one.

Cheap and cheerful which might require revision c.5 years down the line

or

Robust fit for purpose item which is going to last and see you through the rest of your days but cost more.

Which option would you like the doctor to select?

 

 

Post edited at 13:53
1
 MG 05 Feb 2018
In reply to handofgod:

Is anyone suggesting false-economy?  We have NICE, an organisation devoted to the opposite.

2
 Stichtplate 05 Feb 2018
In reply to The Lemming:

> The Conservatives and the NHS are not the best combination.  The NHS is way it is because of Conservative ideology and not down to just one man alone, no matter how much he is liked among his employees.

While I agree with you on this point, it isn't the full story. An ageing population combined with ever expanding treatment options and an increasing ability to extend natural life means health costs are only going to go in one direction.

But this isn't the full story either. What about the responsibility of service users? From your own standpoint how many jobs are you going to that don't warrant an ambulance compared to 10 years ago? Genuinely interested as all the crews I've worked with have quite a firm view on this.

OP handofgod 05 Feb 2018
In reply to MG:

Of course I understand NICE and the guidelines they set out but you're missing my point.

As soon as you privatise something you essentially turn it in a business and what are businesses in business for.... to make a profit.

As soon as you attach a cost to something, anything, you run the risk of inadequate care and provisions.

 

6
 jkarran 05 Feb 2018
In reply to handofgod:

> Pray for our NHS.

Fight for it. Nobody hears your prayers.

2
 MG 05 Feb 2018
In reply to handofgod:

> As soon as you attach a cost to something, anything, you run the risk of inadequate care and provisions.

A risk, yes, but not a certainty.  Switzerland, for example, has extensive and highly effective private healthcare (and also extensive and effective public healthcare). 

 

OP handofgod 05 Feb 2018
In reply to MG:

But the USA doesn't so what is your point here?

4
 neilh 05 Feb 2018

In reply to

You need a cost or you cannot fund it in the first place.

 MG 05 Feb 2018
In reply to handofgod:

That it is false to claim private healthcare will necessarily result in worse healthcare. 

GP's BTW are mostly private.

1
OP handofgod 05 Feb 2018
In reply to MG:

Yes yes, and what a total mess they are currently.

Have you tried to get an appointment ?

Also, strictly speaking; practice private. GPS still adhere to NHS guidelines etc.

 

 

1
pasbury 05 Feb 2018
In reply to handofgod:

Maybe Carillion can bid for them... err wait a minute.

2
 ClimberEd 05 Feb 2018
In reply to The New NickB:

> Your analysis somewhat falls apart when you realise thatof the G7 countries, we are the second lowest spenders on healthcare as a percentage of GDP.

However we are still higher the the OECD average.And what is being defined in 'healthcare' 

Pick your number. Lies damn lies and statistics. 

Sure a few hundred million, or a billion might make a bit of difference but this is a deep long term resource issue that isn't going to be solved by an extra 1% of GDP being spent on healthcare. 

1
 MG 05 Feb 2018
In reply to handofgod:

> Also, strictly speaking; practice private. GPS still adhere to NHS guidelines etc.

So why couldn't other private providers?  I'm not advocating private provision as I don't think the way things are provided is the problem, and any change would cause more losses due to upheaval than benefit.  However, claiming private=bad is clearly nonsense.

1
 The New NickB 05 Feb 2018
In reply to ClimberEd:

> Sure a few hundred million, or a billion might make a bit of difference but this is a deep long term resource issue that isn't going to be solved by an extra 1% of GDP being spent on healthcare. 

1% of GDP isn’t a billion, it’s £20bn. Surprising close to the figure that has been given as the approximate funding shortfall.

2
 The Lemming 05 Feb 2018
In reply to Stichtplate:

> But this isn't the full story either. What about the responsibility of service users? From your own standpoint how many jobs are you going to that don't warrant an ambulance compared to 10 years ago? Genuinely interested as all the crews I've worked with have quite a firm view on this.

 

I hope you will understand, if I do not give my thoughts on an open forum.

However I feel that more consideration should be given to the effectiveness of the 111 phone service.

Post edited at 15:21
2
 Stichtplate 05 Feb 2018
In reply to The Lemming:

> I hope you will understand, if I do not give my thoughts on an open forum.

I completely understand and in time I'll probably also learn to keep my mouth firmly shut, but I can't help feeling that an entire side to the debate on service stretch in the NHS is going completely unmentioned in government and in the media.

> However I feel that more consideration should be given to the effectiveness of the 111 phone service.

If by that you mean its complete ineffectiveness and a continued existence owing purely to the loss of face involved in winding it up.

Deadeye 05 Feb 2018
In reply to handofgod:

 

> In fact; there will be multi billion £ contracts award to private entities, where tenders will be put forward similar to how public funded construction projects are bidded for. Large chunks of our beloved NHS will be run be companies who are more interested in profit and turn over rather than our health and well being. A depressing thought.

Any evidence for this?

> Scenario; 

> After a serious climbing fall, you are rushed to hospital and an Orthopaedic surgeon is working on your knee. He/ she decides to fix your knee, a new knee joint is required. He/she decides the best component to use would be knee joint type A but pressure is being put on the surgeon from management to be more cost effective / lean so he/she uses joint type B, a far more inferior product but one which cost X amount less than joint type A.All of a sudden, your knee has been repaired but not to the best of the surgeon ability knowing the tools and devices available to him/her.

Happens now.  We're not willing to pay for an unlimited model - rationing in some form is inevitable.

> You see; health car can never be run in a profit making model. Yes our NHS is on its knees, but this is due to it being hugely under funded for many years under the conservatives. 

Aside from being nonsense, that's a complete non sequitur to your paragraph above - you haven't demonstrated anything of the sort.

> Pray for our NHS.

Dear God.  Some folk are idiots.

2
Deadeye 05 Feb 2018
In reply to handofgod:

> Yes yes, and what a total mess they are currently.

> Have you tried to get an appointment ?

> Also, strictly speaking; practice private. GPS still adhere to NHS guidelines etc.


More nonsense.  GPs are independent contractors that run cornershop businesses on a for-profit basis.  Nnothing wrong with that by the way; just that you're spouting rubbish.

1
 Sharp 05 Feb 2018
In reply to handofgod:

There was an interesting episode of reasons to be cheerful on the nhs which was quite informative and would answer a lot of your questions.

One interesting point raised was that the nhs is one of the most efficient health care systems in the world. Sounds good but what that means is that, for example, in America there is a huge incentive for doctors to order lots of tests and expensive procedures and to market the best available (and most expensive) options where as in the UK the incentive is the opposite, the incentive is to spend less, less tests, cheaper products and procedures etc.

 Free at the point of use is demonstrably the most cost effective way to run a health care system but I'm not sure it's true to argue that private funding means a worse end product (in terms of actual care/procedures/medicines). The whole point for providers in a privatised system is to charge as much as possible which is one of the reasons the nhs gets shafted by its private suppliers. There are many many reasons the nhs is something we should maintain but I wouldn't say privatisation means cheap products, quite the opposite is true.

1
 BnB 05 Feb 2018
In reply to The Lemming:

> I hope you will understand, if I do not give my thoughts on an open forum.

You're unceasingly keen to extract the wisdom of the UKC population on their various spheres of interest and expertise. The least you can do is return the favour. I for one would be genuinely interested.

 

3
 The New NickB 05 Feb 2018
In reply to ClimberEd:

> Pick your number. Lies damn lies and statistics. 

Bloody experts

 Stichtplate 05 Feb 2018
In reply to BnB:

> You're unceasingly keen to extract the wisdom of the UKC population on their various spheres of interest and expertise. The least you can do is return the favour. I for one would be genuinely interested.

Give the guy a break. Are you prepared to risk your livelihood for the sake of enlightening a handful of people alleviating their boredom on a random forum?

 

2
 The Lemming 05 Feb 2018
In reply to Stichtplate:

 

> Give the guy a break. Are you prepared to risk your livelihood for the sake of enlightening a handful of people alleviating their boredom on a random forum?

 

Wot he said.

 

Sorry

 

1
 timjones 05 Feb 2018
In reply to handofgod:

 

Is it any better to leave it in the hands of the public sector who  can't even manage to buy a few paracetamo for a realistic price?

 

Maybe we should focus on results rather than political ideologies?

 

1
 ian caton 05 Feb 2018
In reply to handofgod:

Sure, give it more cash. 

Where from?

What would be the max % of GDP spent on the NHS that the economy could sustain ?

 The Lemming 05 Feb 2018
In reply to ian caton:

Bring back work houses.

 Tyler 05 Feb 2018
In reply to timjones:

> Is it any better to leave it in the hands of the public sector who  can't even manage to buy a few paracetamo for a realistic price?

> Maybe we should focus on results rather than political ideologies?

Perhaps the paracetamol issue could be fixed without privatisation of the NHS? You seem to be taking one small issue and using as a reason to make huge changes, so I almost as though you are ideologically driven. 

1
 Tyler 05 Feb 2018
In reply to Deadeye:

> Any evidence for this?

The fact its already happening? 

1
 pneame 05 Feb 2018
In reply to handofgod:

> After a serious climbing fall, you are rushed to hospital and an Orthopaedic surgeon is working on your knee. He/ she decides to fix your knee, a new knee joint is required. He/she decides the best component to use would be knee joint type A but pressure is being put on the surgeon from management to be more cost effective / lean so he/she uses joint type B, a far more inferior product but one which cost X amount less than joint type A.All of a sudden, your knee has been repaired but not to the best of the surgeon ability knowing the tools and devices available to him/her.

Oh no, that's all wrong - he picks knee joint C because he gets kickbacks from the company that makes it. It's 2x as expensive as type A (because it's the latest and greatest) and completely untested in the real world. It must be better because it's more expensive.

1
In reply to handofgod:

> After a serious climbing fall, you are rushed to hospital and an Orthopaedic surgeon is working on your knee. He/ she decides to fix your knee, a new knee joint is required. He/she decides the best component to use would be knee joint type A but pressure is being put on the surgeon from management to be more cost effective / lean so he/she uses joint type B, a far more inferior product but one which cost X amount less than joint type A.All of a sudden, your knee has been repaired but not to the best of the surgeon ability knowing the tools and devices available to him/her.

Bad example. Firstly, its unlikely you would have a replacement knee after a climbing accident. The most likely trauma would be a breakage of the long bones, not an instant removal of artculate cartilage which is what a hip/knee replacement would be for. 

 

The second mistake here is to assume that one knee replacement is better than another. The NHS has a contract in place with several manufacturers e.g. Stryker, DePuy J&J, Zimmer, Smith and Nephew etc. Each joint manufacturer's products are about the same cost, about 3k apiece for a TKR and each are equally effective, in the right hands. The differences come from the different instruments used to fit the knee, which can vary enormously, and so the surgeon will ofyen decide based on his personal experience with the tools.

The final point often overlooked is that the most expensive implant is not necesdarily the best. The cemented Exeter Hip is probably the cheapest THR on the market and its probably the most widely used, researched, and understood implant on tbe market.

 

 

 ian caton 05 Feb 2018
In reply to The Lemming:

? Was only asking.

 stevieb 05 Feb 2018
In reply to ian caton:

https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&start=2014...

I don’t know how much we could afford, but looking at this, most countries who we might want to emulate spend 1-2.5% of gdp more than we do. 

If we think Donald is right and we want to emulate the US, then we get a whole 8% more. 

1
In reply to pneame:

> Oh no, that's all wrong - he picks knee joint C because he gets kickbacks from the company that makes it. It's 2x as expensive as type A (because it's the latest and greatest) and completely untested in the real world. It must be better because it's more expensive.

The joint market is hugely competitive so the only implants which are much more costly than the standard ones are one designed for the very young patient or revision joints which can be vastly more expensive but equally complex to build in the body.  

Incentives do exist to try and get a trust to use more or a certain product but they come in the form of reduced cost as the trust breaches certain thresholds. This industry is highly regulated such that the surgeons are no longer allowed to take gifts from reps or enjoy golf days etc.

 French Erick 05 Feb 2018
In reply to MG:

> That it is false to claim private healthcare will necessarily result in worse healthcare. 

> GP's BTW are mostly private.

I disagree with your assessment: It'll only become worse for the poor. The rich has always been seeing to themselves privately, after using whatever they could get free from the NHS.

3
 ClimberEd 05 Feb 2018
In reply to The New NickB:

The exact numbers are irrelevant. If you think the NHS is getting £20bn you are in cuckoo land.

 timjones 06 Feb 2018
In reply to Tyler:

I'm pointing out that both options have a similar inherent flaw.

 Philip 06 Feb 2018
In reply to Duncan Bourne:

> Picking up on your scenario in the full privete scheme this happens:

> serious climbing fall, you are rushed to hospital where the first thing asked is how you are going to pay for your treatment? Good news you have health insurance! Bad news it is invalid because in the small print you climbing accident is deemed self-inflicted. So you are now expected to use savings, re-morgage house etc. Of course if you absolutely can not pay then, under emergancy schemes they will treat any immediate threat to life and give you painkillers for your shattered knee and tell you to rest.

Why should the NHS entirely pay for repair of a climbing injury?

A&E yes, then the a suitable high quality treatment back to a non threatening condition, but given it is the result of deliberate dangerous activity shouldn't you have some insurance to cover enhanced treatment?

For example, a repair to get movement Vs a repair to allow a return to climbing. How much free physio? After all you were probably paying for climbing wall use, why not pay for the exercise classes to get movement back?

If you crack a tooth you get a filling under NHS and more options privately. Why not the same for other conditions where there are degrees of repair.

Obviously the same doesn't apply to medical treatment, where you have it or you don't. So how much it would save the NHS is probably get small.

3
Jim C 06 Feb 2018
In reply to ClimberEd:

I thought  lifestyle health issues like drink and drugs, obesity  might have got a mention from you , or has the demand for treatment for those issues 

 not gone up as much as it would appear from media reports? 

In reply to French Erick:

> I disagree with your assessment: It'll only become worse for the poor. The rich has always been seeing to themselves privately, after using whatever they could get free from the NHS.

I get private healthcare through work. Ive used this service recently due to an issue with my hip which includes two consultations, an MRI and CT scan, all picked up by the insurer.   I dont get a NHS disount for doing so and still have to pay my Tax and NI at the normal rate.  How does me not clogging up the NHS in this respect, not using NHS machinery, not using a consultants time make the NHS worse? I still have to pay.

 martinturner 06 Feb 2018
In reply to handofgod:

It seems as soon as anyone ever suggests the public (the people actually USING the NHS), putting more money into the NHS, everyone throws a hissy fit! 

Using VERY crude maths... 65million people in the UK. Say 12million children. 2million unemployed. Leaves us with very roughly 51million people, paying NI. 

Add £1 a month onto NI payments. £1. Even the poorest of the poor, in employment, can justify £1 a month. That’s £612million extra to put into the NHS. 

Could go further and put £2 a month for basic tax rate, £3 for higher tax rate payers. 

It’s such a small amount, it’s unnoticeable. Yet accumatively its a huge amount! 

Yet as soon as it’s suggested that WE give the NHS more money, and not the government. It’s the end of the world and no politician is willing to put their heads on the line for that idea.

 

 ClimberEd 06 Feb 2018
In reply to Jim C:

You're right, I did miss those out (not on purpose). Also cause massive increased strain. 

 

 DerwentDiluted 06 Feb 2018
In reply to martinturner:

> Add £1 a month onto NI payments. £1. Even the poorest of the poor, in employment, can justify £1 a month. That’s £612million extra to put into the NHS. 

> Could go further and put £2 a month for basic tax rate, £3 for higher tax rate payers. 

> It’s such a small amount, it’s unnoticeable. Yet accumatively its a huge amount! 

Chimes with my thoughts, as with social care. I don't understand the aversion to increased taxation to fund what people are already paying for directly.  We (as a society) seem to have a peverse reluctance to put our hands in our pockets to fund that which we value most. Personally I'd welcome an extra penny or two on tax if it adaquately funded the NHS and social care. 

 The New NickB 06 Feb 2018
In reply to ClimberEd:

> The exact numbers are irrelevant. If you think the NHS is getting £20bn you are in cuckoo land.

Not being out by a factor of 20 is quite relevant. The question isn’t what the NHS is getting, it is what it needs and would get if we lived in a sensible grown up country with the right priorities. This would still be less than the average for comparable economies.

1
 The New NickB 06 Feb 2018
In reply to TheDrunkenBakers:

Private medicine is highly subsidised by the NHS, for that reason you shouldn’t get any sort of discount or rebate, but yes you are taking pressure off some NHS services.

In reply to The New NickB:

> Private medicine is highly subsidised by the NHS, for that reason you shouldn’t get any sort of discount or rebate, but yes you are taking pressure off some NHS services.

In my case it isnt. The whole bill  was picked up by the insurer. Thats the point

 ClimberEd 06 Feb 2018
In reply to The New NickB:

> Not being out by a factor of 20 is quite relevant. The question isn’t what the NHS is getting, it is what it needs and would get if we lived in a sensible grown up country with the right priorities. This would still be less than the average for comparable economies.

I'll have to do some digging around that. We couldn't afford to put £20bn into the the NHS (and I don't think anyone sensible of any political persuasion would say that we could). So the question, if the numbers are correct (as I said I don't really believe many stats) are how other countries do it. - what else do they spend money on, what they count as healthcare, what is government spend vs private spend etc. 

 ClimberEd 06 Feb 2018
In reply to DerwentDiluted:

> Chimes with my thoughts, as with social care. I don't understand the aversion to increased taxation to fund what people are already paying for directly.  We (as a society) seem to have a peverse reluctance to put our hands in our pockets to fund that which we value most. Personally I'd welcome an extra penny or two on tax if it adaquately funded the NHS and social care. 

Because, currently, the government has a policy of not hypothecating taxes. So if you give them an extra £ there is no surety it is for the NHS. If that were to change (and I believe it is being discussed for exactly this purpose) then people's attitudes would change.

 Tyler 06 Feb 2018
In reply to martinturner:

> It seems as soon as anyone ever suggests the public (the people actually USING the NHS), putting more money into the NHS, everyone throws a hissy fit! 

> Using VERY crude maths... 65million people in the UK. Say 12million children. 2million unemployed. Leaves us with very roughly 51million people, paying NI. 

> Add £1 a month onto NI payments. £1. Even the poorest of the poor, in employment, can justify £1 a month. That’s £612million extra to put into the NHS. 

> Could go further and put £2 a month for basic tax rate, £3 for higher tax rate payers. 

> It’s such a small amount, it’s unnoticeable. Yet accumatively its a huge amount! 

> Yet as soon as it’s suggested that WE give the NHS more money, and not the government. It’s the end of the world and no politician is willing to put their heads on the line for that idea.

I think you'll find most of us arguing the 'govt' put more money into the NHS are arguing for increased taxes to do this.

 Tyler 06 Feb 2018
In reply to timjones:

> I'm pointing out that both options have a similar inherent flaw.

No, the inherent flaw of private business running the NHS is that the private entity exists solely to maximise profits and frequently revenue. That might be fine in some markets where content cutting, poor service, excessive profits and wreckless lending will be driven out by competitors but when large contracts are awarded for periods , of necessity, of multiple years there is a monopoly where such behaviour makes sense to the private enterprise, to the detriment of the consumer.

 The New NickB 06 Feb 2018
In reply to TheDrunkenBakers:

> In my case it isnt. The whole bill  was picked up by the insurer. Thats the point

They didn’t pay for the training the consultant had with the NHS, they didn’t pay for the emergency NHS back up that you thankfully didn’t need. That’s the point. Although we are getting away from the main subject.

 The New NickB 06 Feb 2018
In reply to ClimberEd:

Of course we could afford 1% of GDP, if that was a priority. Don’t forget, your sensible politicians are taking is to a possition where losing 2% of GDP is the best possible scenario, apparently it’s worth it.

 timjones 06 Feb 2018
In reply to Tyler:

Is it outsourcing to a private business that is the problem or piss poor procurement procedures by the very same people that can't even get a simple paracetamol order right?
 

The whole privatisation scare story appears to be driven by people that are using the NHS as a political football in order to further their own ambitions.

 

Party politics is a nasty divisive system.

 Duncan Bourne 06 Feb 2018
In reply to Philip:

interesting point Philip. Should the NHS foot the bill for self-inflicted injury? Which should by rights include not only climbing injuries but also smoking related and obesity related diseases, car accidents where negligence is proved, drinking related diseases, not to mention other sports related accidents.

Having insurance is also an interesting thing. It is in the interest of the insurance company to make money, which is why medical insurance in the US is great for cosmetic and short term treatments which incur a single cost and bad for long-term and chronic illness and injury, where they will pay out up to a point then stop.

My original point was that a fully private health service only benefits shareholders and those with the ability to pay. For the rest of us you are one bad fall off destitution

 Tyler 06 Feb 2018
In reply to timjones:

> Is it outsourcing to a private business that is the problem or piss poor procurement procedures by the very same people that can't even get a simple paracetamol order right?

Take away the requirement for procuring a private outsource contract and one of those problems goes away! Even if a private contract works as we would want the private company would be walking away with a 10-30% profit, that's 10-30% of Govt spending on health doing nothing useful for the country. Then you have to add in the administrative overhead of running such a contract, conservatively that'll be 5% . So where's the upside? The private company will not be bringing in much expertise, that already exists in the NHS, it will TUPI in most employees or use people that have already trained and worked in the NHS. So we are expected to assume a load of companies that have already made a hash of running govt contracts in different areas, or companies that have been cobbled together with the sole intention of winning these contracts (remember, that's their primary objective, they won't have been set up to altruistically provide health care to the masses) will then know how to run the NHS more cheaply and efficiently than it is already?

> The whole privatisation scare story appears to be driven by people that are using the NHS as a political football in order to further their own ambitions.

Are you denying that we are moving towards increased privatisation than the NHS?

 Tyler 06 Feb 2018
In reply to ClimberEd:

> It is very easy (and wrong) to blame the Conservative government for the problems in the NHS. However,  the reality is that since it's original inception (when it was financially feasible) not only have treatments become far more expensive but demand has massively increased in a way never predicted - through increased end of years lifespan and keeping terminally ill people alive longer - making it much harder to provide the service needed on the money available. (contrary to expectations, governments aren't bottomless money pits). 

The Tories are obviously not the source of all the problems facing the NHS but they can chose whether to spend more on the NHS or whether to raise taxes to do so, so for that they are entirely culpable. There is no bottomless pit but there are choices that can be made, there was a top down re-org of the NHS which has achieved little, it seems. This govt could, if it had wanted, added £350million per week to the health and welfare budget.

 

Post edited at 10:53
 Tyler 06 Feb 2018
In reply to Philip:

> Why should the NHS entirely pay for repair of a climbing injury?

Because we don't want to tie the NHS up in endless legal disputes about whether each trip, slip, heart attack, case of cancer or whatever it treats is self inflicted?

 Tyler 06 Feb 2018
In reply to The New NickB:

> Not being out by a factor of 20 is quite relevant. The question isn’t what the NHS is getting, it is what it needs and would get if we lived in a sensible grown up country with the right priorities. This would still be less than the average for comparable economies.

This is worth repeating!

 
 Philip 06 Feb 2018
In reply to Duncan Bourne:

> interesting point Philip. Should the NHS foot the bill for self-inflicted injury? Which should by rights include not only climbing injuries but also smoking related and obesity related diseases, car accidents where negligence is proved, drinking related diseases, not to mention other sports related accidents.

I'm not sure you can blanket self-inflicted. The idea of the NHS is equal access for all. What I was referring to is the more expensive treatment of sports (and related) injuries that result from the sport and where the care required to return the patient to their former level of mobility is greater. I think in this situation it's appropriate to have some insurance. Maybe car insurance should have a medical component too.

A quick Google suggest smokers pay more tax than their NHS burden. So in a way it's accounted for.

 Philip 06 Feb 2018
In reply to Tyler:

> > Why should the NHS entirely pay for repair of a climbing injury?

> Because we don't want to tie the NHS up in endless legal disputes about whether each trip, slip, heart attack, case of cancer or whatever it treats is self inflicted?

They wouldn't. Do you have this level of wrangling over prescriptions, sight tests or dental check-ups. Other areas where NHS cover some but not all.

 Tyler 06 Feb 2018
In reply to Philip:

> They wouldn't.

Oh OK then, I could foresee lots of cases which might result in dispute but if you say it won't happen......

 

 timjones 06 Feb 2018
In reply to Tyler:

I believe that there is a huge difference between privatisation and outsourcing.

 

 jonnie3430 06 Feb 2018
In reply to timjones:

> I believe that there is a huge difference between privatisation and outsourcing.

I agree, if it was private and you had insurance you'd get a good service. Outsourcing however is just crap for everyone other than managers in both organisations and shareholders.

1
 neilh 06 Feb 2018
In reply to Tyler:

There are as you know quite a number of European markets and models which seem to happily have both private entities and public entities providing medical care under a publicly funded umbrella.Nordic countries do this and in places like Germany etc  it is quite common to go to private hospitals for public treatments.

Denying this ( burying your hand in the sand approach) and trotting out these arguments that private entities are bad always falls flat in its face imho.

 The New NickB 06 Feb 2018
In reply to neilh:

However, if you consider how underfunded healthcare is in the U.K. compared to those models. The NHS appears to be a remarkable efficient way of delivering universal healthcare.

 Tyler 06 Feb 2018
In reply to neilh:

> There are as you know quite a number of European markets and models which seem to happily have both private entities and public entities providing medical care under a publicly funded umbrella. Nordic countries do this and in places like Germany etc  it is quite common to go to private hospitals for public treatments.

We do it to a certain extent here but at what point do we say enough is enough? If we ended up with a health system like the Nordic countries then fine but what's to say we don't end up with one like the US. We have a system that works well but could work better with more funding - say equivalent to that which Norway pays. What improves by changing the model? Who benefits and how?

> Denying this ( burying your hand in the sand approach) and trotting out these arguments that private entities are bad always falls flat in its face imho.

I'm not saying private entities are bad but there is no reason to think they will do better with a similar level of money and by using them you are, by definition, removing a certain amount of money from the overall pot for share holder dividend?

Post edited at 14:55
 Duncan Bourne 06 Feb 2018
In reply to Philip:

I am not entirely sure that sports injuries are necessarily more expensive. Plus I doubt that in most cases you could restore former mobility. Plus it still doesn't cover what happens when insurance doesn't work due to small print and backsliding by insurance companies. To be fair insurance probably would work better for injuries (assuming you can afford it) as it is a single point repair cost. It is always big long term costs that flatten you .

Yes smokers (and drinkers) pay more in tax but that doesn't mean it goes to the NHS

 neilh 06 Feb 2018
In reply to The New NickB:

Do not disagree.

But to imply that public is the best when you have things like North Staffs, Blackpool etc etc does blunt the argument slightly.

It is a very mixed picture.

To deny private could be one of the solutions ( along with others) is just political ideology gone mad.

 neilh 06 Feb 2018
In reply to Tyler:

You find a way using the best of both. You do not drive out private because of this weird idea that all private companies are bad because they make a profit.

 ClimberEd 06 Feb 2018
In reply to Tyler:

> This govt could, if it had wanted, added £350million per week to the health and welfare budget.

 

Lol, are you a disappointed 'Brexiteer' ?! 

 

 The New NickB 06 Feb 2018
In reply to neilh:

> Do not disagree.

> But to imply that public is the best when you have things like North Staffs, Blackpool etc etc does blunt the argument slightly.

You are still much safer in an NHS hospital than you are in a private one. 

> To deny private could be one of the solutions ( along with others) is just political ideology gone mad.

The current ideology gone mad appears to be to specifically exclude public provision, regardless of evidence.

Rigid Raider 06 Feb 2018
In reply to handofgod:

Complete nonsense from the OP; among other things I find it impossible to believe that the NHS provides a two-tier service where prosthetics are concerned. 

Having a sister who is an experienced senior nurse and who is married to a recently-retired CEO of a large NHS hospital, it disgusts me when people trot out these ill-informed whining stereotypes. When the chips are down and the keyboard warriors are repatriated from somewhere abroad for the NHS to repair their bodies they will see the devotion and professionalism of the staff and, I hope, feel shame at having badmouthed the people who are working to fix them. I've never met the Health Secretary so I've no idea of his character but I'm pretty sure none of the keyboard warriors would have the balls to stand up in front of him and insult him to his face.  

2
OP handofgod 06 Feb 2018
In reply to Rigid Raider:

> Having a sister who is an experienced senior nurse and who is married to a recently-retired CEO of a large NHS hospital

You lost me as soon as you mentioned CEO.... but I will leave that discussion for another day.

In the meantime; google NHS CEO salaries.

Also, think you've somewhat totally missed the point we are making here. No one is bad mouthing the amazing job doctors and nurses even your sister does. Quite the opposite.

And, I would jump at the chance of a sit down with Jeremy. He's been invited to numerous discussions / debates run by junior doctors but refused the invitations.

 

 

Post edited at 16:28
 neilh 06 Feb 2018
In reply to The New NickB:

Clearly there are mixed views on this from around the world.Both have a place.

 Tyler 06 Feb 2018
In reply to neilh:

> You find a way using the best of both. You do not drive out private because of this weird idea that all private companies are bad because they make a profit.

I shouldn't need to repeat it as I said clearly in the post you are responding to I don't have any ideas that "all companies are bad", I do think that health provision should be treated differently to other enterprises. At the moment more and more is becoming privatised and the govt have not said at what point they want to stop so there is obviously a concern that if we don't have this discussion now then in a few years time we may well end up with something more akin to the US than we are comfortable with. You also still haven't said what the problem is with the model we have now, what the benefits of a more privatised system is nor pointed out a country with a largely private system that does better with less funding that covers everyone. 

 Tyler 06 Feb 2018
In reply to ClimberEd:

> Lol, are you a disappointed 'Brexiteer' ?! 

No, I'm a f*cking livid remainer. That aside you have to agree that the amount of funding that goes into the NHS is largely within these control of the govt of the day. 

 Tyler 06 Feb 2018
In reply to neilh:

> But to imply that public is the best when you have things like North Staffs, Blackpool etc etc does blunt the argument slightly.

What is there about increased privatisation that would make that sort of thing less likely? Given the size of the organisation and the complexity of the work it does to have so few failing departments seems quite an achievement .

> To deny private could be one of the solutions ( along with others) is just political ideology gone mad.

But what, other than ideological dogma, is the benefit of increased privatisation? We already have choice through private health provision, we have universal health care free at the point of use, we have very efficient use of resources so why is here reason to think the private sector could do better and still be able to skim 20% off the top?

 Tyler 06 Feb 2018
In reply to Rigid Raider:

> I've never met the Health Secretary so I've no idea of his character but I'm pretty sure none of the keyboard warriors would have the balls to stand up in front of him and insult him to his face.  

I  think a lot of people would have a harder job standing up in front of him and not insulting him.

 The New NickB 06 Feb 2018
In reply to Rigid Raider:

Have you actually read this thread?

 

In reply to ClimberEd:

> Lol, are you a disappointed 'Brexiteer' ?! 

Is Brexit the new Godwin?

Any suggestions for a name?


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