UKC

NHS

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Here you go:

3
 JLS 07 Jan 2022
In reply to MG:

👏👏👏

 bouldery bits 07 Jan 2022
In reply to MG:

I think the NHS is good. 

I hope it doesn't end up like BHS. 

In reply to bouldery bits:

> I think the NHS is good. 

> I hope it doesn't end up like BHS. 

Or VHS !

 Stichtplate 08 Jan 2022
In reply to MG:

Not hard to see how the NHS is being dismantled 


19
 Stichtplate 08 Jan 2022
 Maggot 08 Jan 2022
In reply to Stichtplate:

Yeah, but no but yes but ... the Conservatives have given us 50,000 more nurses and 4,000 new hospitals. You and your silly coloured bar pictures.

12
 Stichtplate 08 Jan 2022
In reply to Maggot:

HaHa, you are funny

"The most recent NHS figures reveal there are about 39,000 vacancies for registered nurses in England, with one in 10 nursing posts unfilled on acute wards in London and one in five nursing posts empty on mental health wards in the south-east."

https://www.theguardian.com/society/2021/oct/09/nursing-crisis-sweeps-wards-as-nhs-battles-to-find-recruits

In reply to Stichtplate:

I think fluctuations around Covid might be hard to read into - of those september resignations how many were people who had returned or stayed longer to help out etc etc? 

Far more worrying is the long term picture, an ageing workforce in some sectors and an insufficient training pipeline:

https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#9-what-is-the-outlook-for-the-future
 

The training thing will be tough and expensive to crack:

https://www.rcplondon.ac.uk/projects/outputs/double-or-quits-blueprint-expanding-medical-school-places

 wintertree 08 Jan 2022
In reply to Stichtplate:

I saw that a few months ago and again today in Triggle’s article this morning.

It shows a different problem to me than the one you and Triggle see, although it’s also the same problem.

That chart gives the increase in NHS funding *above inflation*.  The eventual and unavoidable outcome of raising the NHS budget above inflation each year is that it eventually comes to consume the entire national budget.  At 4% above inflation as with early decades, the fraction of the nation budget it takes would double every 18 years or so.

It’s no surprise that the NHS has been taking an ever larger cut of the budget as people are living older (because of health improvements from across the board including working conditions and the NHS), and because people fall apart as they age, becoming ever more dependant on more medical care.

It’s no surprise that things have been worsening in the last decade when funding was pegged much closer to inflation.  Each year, that above inflation rise will become more prominent in the budget.

It’s an exponential funding model and it simply isn’t sustainable.  

So, what gives? A conversation that should have happened before pairing back the above-inflation part of the funding.

No easy or palatable answers.  

Post edited at 08:40
1
 mik82 08 Jan 2022
In reply to Stichtplate:

Healthcare inflation is usually several % above general inflation too, so the effect of lower real terms increases in funding is magnified.

I was just about to make exactly the same point as Wintertree above. The tax take has roughly risen in line with inflation over the past 10 years so if everything remained the same and the NHS budget increased by the long term average of about 4% above inflation then the NHS budget would double in 18 years and be roughly 50% of total tax take

From some quick back of an envelope calculations, the Health and Social care Levy would have to rise from 1.25% to 17.5% to cover this, assuming incomes rise in line with inflation. Would people be happy with paying an extra 17.5% tax for healthcare in addition to 20% income tax and 12% national insurance? This just to stand still too - you'd need much higher increases to get the improvements of the Blair era.

It's a very difficult conversation that no politician seems to want to start, otherwise they'll be accused of wanting to sell off "our NHS" and move to a US system. 

In reply to Longsufferingropeholder:

It's not just the amount spent on healthcare, it's how it's spent.

Between 2010 and 2020 the government has spent £113 billion on non-NHS Providers. It's the tried and tested method of running down public services so that people become desperate and pay to jump the queue. The media highlight the failings to build up a consensus to hand over public assets to be delivered for private profit to everyone's cost.

And Neo-Labour's answer to the crisis is further outsourcing.

https://www.bbc.co.uk/news/uk-politics-59910107 "Labour would use private providers to cut NHS waiting lists, says Streeting"

Another pledge broken by Starmer.

10
 Offwidth 08 Jan 2022
In reply to mik82:

A lot of that additional cost relates to the increasingly unaffordable way the NHS deals with medical liability claims (made worse by the NHS being underfunded, as an over-stretched service leads to more medical errors) There is another way.... Sweden is regularly given as an example where the cases are resolved largely without legal action. There was a recent documentary on this and other areas where clear improvements could be made... I'll try and re-find the link...done.

https://www.channel4.com/programmes/clapped-out-is-the-nhs-broken-dispatches

Everyone should be nervous of the US system as it is so utterly shit in public health terms (the worst average outcomes for a developed nation at the highest public funding cost per capita...ie before a dollar of health insurance spend... in public health terms the only thing it's good for is providing an overpriced excellent service for rich people).

​​​​

Post edited at 10:31
 Stichtplate 08 Jan 2022
In reply to Dr.S at work:

> I think fluctuations around Covid might be hard to read into - of those september resignations how many were people who had returned or stayed longer to help out etc etc? 

I'm not so sure on that one. Hard to find figures but certainly in the areas I've. had eyes on, the impact has been non-existent.

> Far more worrying is the long term picture, an ageing workforce in some sectors and an insufficient training pipeline:

Also a worryingly high drop out in nursing courses (30-50%) 

> The training thing will be tough and expensive to crack:

Not as expensive as the current solution. Locums currently cost the NHS 7 billion a year

In reply to cumbria mammoth:

Disagree . If you look at Germany or other European states  model it is a mix of both public, charitable and heaven forbid private providers. It really makes no difference if it’s free at the point of delivery whether your hip is replaced in either of those institutions. 

4
In reply to neilh:

Maybe so (with important caveats that I won't go into now) but that's not what's happening.

Healthcare is being denied (because the NHS is being run down to the point where it doesn't have the capacity to deliver it) so that desperate people are paying at the point of delivery.

The direction of travel is to keep reducing the level of service available on the NHS so that people are increasing forced into a private healthcare system. Starmer's Neo-Labour are signalling that they intend to continue this process.

Post edited at 10:44
6
In reply to cumbria mammoth:

You have to look at other delivery models which include higher taxation m. It’s no good harping on about it being “ destroyed”. You need another model or you are going to get nowhere. 
 


 

3
 mik82 08 Jan 2022
In reply to Offwidth:

The last figures I can find suggest the cost of negligence claims per year is about 5% of the NHS budget. Yes, moving to some kind of no-fault compensation scheme (e.g. New Zealand) would reduce that but it's not much when medical cost inflation is running at 3-4% above general inflation anyway.

The US system is the worst possible outcome, I'd agree. My worry is that we will end up with this system by default, by failing to confront the issue of a fully centrally funded system consuming an ever-increasing share of government spending.

It's already defaulting to a private system for any kind of routine care - for example your option for a hip replacement locally is to wait 2+ years for an appointment then 3+ years for the operation, or pay £180 to be seen within 2 weeks and £12,000 to have it done within a month. 

 mondite 08 Jan 2022
In reply to neilh:

>  You need another model or you are going to get nowhere. 

Are these other models any more effective in terms of cost? Since thats the key problem. People are living longer and medical science is coming up with ways to cure things which couldnt be cured in the past but at a significant cost.

In reply to neilh:

Apologies for the edit while you were replying, I don't think it's made your reply look out of context though.

There was a model where healthcare was provided to everyone by the state for free. That model has been deliberately undermined for decades now and now the effects are becoming acute. Just go back to the model that worked so successfuly.

4
 bouldery bits 08 Jan 2022
In reply to neilh:

> You have to look at other delivery models which include higher taxation m. It’s no good harping on about it being “ destroyed”. You need another model or you are going to get nowhere. 

>  

>  

Does anyone remember 'quantitive easing?'

Couldn't we have used that to pump money into the economy via healthcare rather than directly through giving it to people / institutions that were already incredibly wealthy?

Perhaps we need to 'quantitively ease' the NHS?

3
 Offwidth 08 Jan 2022
In reply to mik82:

Quite a few experts think its a lot higher but it's all shrouded in secrecy. The cost of gagged departures is another similar (if much smaller) problem. The basic problem is these costs are increasing much faster than inflation so something system-wide has to be done soonish.

Post edited at 10:56
 Stichtplate 08 Jan 2022
In reply to wintertree:

> I saw that a few months ago and again today in Triggle’s article this morning.

> It shows a different problem to me than the one you and Triggle see, although it’s also the same problem.

> That chart gives the increase in NHS funding *above inflation*.  The eventual and unavoidable outcome of raising the NHS budget above inflation each year is that it eventually comes to consume the entire national budget.  At 4% above inflation as with early decades, the fraction of the nation budget it takes would double every 18 years or so.

This is absolutely true but unless you feel the NHS currently receives adequate funding, it isn't the immediate concern. The immediate concern is that people aren't receiving adequate health provision and by all measurable indicators (waiting lists, life expectancy, etc) things appear to be getting worse.

> It’s no surprise that the NHS has been taking an ever larger cut of the budget as people are living older (because of health improvements from across the board including working conditions and the NHS), and because people fall apart as they age, becoming ever more dependant on more medical care.

It's not just an ageing population and the fact that more of us are living longer with multiple co-morbidities. As medicine advances more procedures and more drugs become available and more conditions become treatable. 

> It’s no surprise that things have been worsening in the last decade when funding was pegged much closer to inflation.  Each year, that above inflation rise will become more prominent in the budget.

Nope, but talking to the old hands, what is surprising is the rise in mental health issues which are presenting a huge drain on the service. Frequent flyers, people that can't get anyone else to listen to them, people that present so convincingly that they have multiple exploratory surgical procedures that all confirm there's no physical ailment, people on all sorts of medications and treatments for conditions that exist purely in their own heads. The list is endless and I've met a ton of them.

My pet theory is that as communal structures have disappeared, people have become sadder, lonelier and more fragile mentally: the local pub, working men's clubs, jobs for life in factories and pits that had been the centres of whole communities, local shops, a whole string of local based leisure activities and then pile on the fact that less and less of us are born and dying in the same towns and villages, surrounded by familiar faces. People weren't designed to be surrounded by strangers.

> It’s an exponential funding model and it simply isn’t sustainable.  

Agreed, but as I said above, exponential funding is only the major issue once an adequate. level. of funding has been reached. I don't think we're there yet. 

> So, what gives? A conversation that should have happened before pairing back the above-inflation part of the funding.

Well, either more people die younger and spend much of their later years in increasing pain and anguish or we pay more into the NHS. Alternately, if you're rich enough, you go private.

This is what is currently happening. Right now.

> No easy or palatable answers.  

Nope. Two choices, pain in your wallet or pain in your community 

Post edited at 10:57
2
 Offwidth 08 Jan 2022
In reply to Stichtplate:

Some very good points. For too long mental heath support in the NHS has been the Cinderella service. Proper (fair equivalent) investment will certainly have knock on savings elsewhere.

1
 RobAJones 08 Jan 2022
In reply to Stichtplate:

> I'm not so sure on that one. Hard to find figures 

I might be reading too much into personal experience, but isn't the return to some form of normality going to results in a lot of people retiring, and not just from the NHS. OK it is the age I'm at, but most of my friends intended to retire over the last couple of years but have put it off, (until this March in most cases) Also as a result of a lack of spending during the pandemic a few have brought their retirement forward as well. 

 Stichtplate 08 Jan 2022
In reply to neilh:

> Disagree . If you look at Germany or other European states  model it is a mix of both public, charitable and heaven forbid private providers. It really makes no difference if it’s free at the point of delivery whether your hip is replaced in either of those institutions. 

It really makes no difference unless you believe in the fundamental principle that we should look after each other when we're sick and not seek to profit from the misfortunes and maladies of others.

I'd be devastated if we abandoned such principles. Other opinions apply

2
 wintertree 08 Jan 2022
In reply to Stichtplate:

I generally agree with you - and in particular the failure to spend up front (which goes far beyond the NHS) leading to more costs down the line over mental health.  Not just mental health but physical health, eg obesity becoming a growing healthcare expense.

I also agree about more conditions being treatable as well as age issues; that’s at the fore in the US with what aducanumab is looking likely to do to the Medicaid budget (although we could digress in to the thorny subject of its approval in the first place).  I’d expect a lot more conditions associated with advanced ageing to become treatable - at some expense - over the next couple of decades.  Rare diseases and other serious life curtailing conditions to; and some of these cures will require expensive, ongoing treatment for the greatly prolonged life they extend.

> Well, either more people die younger and spend much of their later years in increasing pain and anguish or we pay more into the NHS. Alternately, if you're rich enough, you go private.

> This is what is currently happening. Right now.

I agree.

>> No easy or palatable answers.  

> Nope. Two choices, pain in your wallet or pain in your community 

It’s not a sustainable choice though.  

Averaging out the over-trend and -under-trend periods in recent government funding on the plot you shared,  the budget has consistently been growing exponentially above inflation.  As with a pandemic, those numbers start as a small proportion of the total and seem insignificant, until suddenly they’re not and it runs out of people/budget to consume.

Healthcare is about 10% of GDP now. Continue the long term trend from that plot of above-inflation rise and it’ll be about 20% in 18 years time.  We could cut 100% of education and defence to cover it?

This is not a problem we’ve just learnt about, it’s been fermenting away for 60 years, but it’s only in recent times that it’s really exploded as a practical issue - as with pandemic growth it’s all small numbers (vs the whole), right until it isn’t.

I’m all for pumping money in now, for example in (rather late) anticipation of staffing shortfalls, but at some point, raising the budget above inflation becomes fundamentally impossible.  LSRH’s plot shows healthcare spending as a fraction of GDP has tripled in the last 30 years.  Even the current government is raising funding above inflation, so that fraction of GDP will still be rising give or take bumps in the data.

At some point that has to stop.  Healthcare is consuming more and more of GDP.  It has been for 70 years, and now it’s breaking through to an unsustainable level. Either we significantly raise GDP, we make healthcare more affordable or we ration healthcare more.  Ideally a mix of the first two.  Moving to a mixed private model just shifts the difficult decisions from central authority to a narrative of blaming people for being poor, which is a much easier sell but totally corrosive socially.  it doesn’t solve the problem of the costs of healthcare growing with time, it just achieves rationing by wealth - which furthers the accumulation of more wealth by a very small pool of gigarich, no good will come of that.

We’re coming up to the point on the exponential curve where above inflation funding simply won’t work for much longer.  I don’t think I’m making this from a libertarian fantasy land mindset but from strongly wanting a centrally funded, socialised healthcare model that works sustainably going forwards. As I say, I don’t think a private model fixes this, it just fails most people in a way that transfers blame from their government to them.

What happens next with healthcare and society is a defining issue of the next generation.  

Edit: a parable of relevance from Fargo?

youtube.com/watch?v=jwIYEf1rdKo&

Post edited at 11:58
 Jon Stewart 08 Jan 2022
In reply to cumbria mammoth:

> And Neo-Labour's answer to the crisis is further outsourcing.

> https://www.bbc.co.uk/news/uk-politics-59910107 "Labour would use private providers to cut NHS waiting lists, says Streeting"

This'll go down well with you, but unsurprisingly I agree wholeheartedly with Starmer. You see I'm a pragmatist, I want to solve problems starting with the most urgent and working down the list, I'm not an ideologue.

I refer a huge number of patients from their routine eye exam for cataract surgery. Waiting lists were getting silly, like a year. There's nothing wrong with these people, and yet their lives are put on hold because the service wasn't available - they couldn't drive (great if you live in the middle of nowhere), read the instructions on their meds, enjoy reading or watching TV. All easily fixed if someone could provide the facility.

Private providers stepped in and blasted through the enormous backlog, and now I say to my patients "whenever you want them cataracts sorted, just gimme a bell and get you seen in a week or two". The providers carried on through covid with excellent isolation/ICP in place and my patients weren't scared to go (except when they got offered Preston!). The company in question ploughed back loads into the business and expanded so now I've even got a local site my patients can walk to! I do their post-op follow ups and can attest to the quality being superb.

So yes, I agree that the fact some money is being skimmed off for profit, and to pay for sales reps and all that private sector crap, but this is one case of low-hanging fruit where the outsourcing model has done exactly as intended. The NHS pay the same fee that the work would cost in house, and the company solve a massive problem in a matter of months and make a huge difference to thousands of patients lives.

Would I prefer it if the NHS could have just sorted it themselves without the skimming off? Course I do. Do I believe they could? No. Too much on. 

I don't want to see the whole NHS operated on this model, but for massive backlogs of piss-easy work that makes a huge difference to people's lives, it works. Swallow your pride!

I want good outcomes achieved as much and as fast as possible. I don't care about ideology. We can see that the NHS model has vast advantages over failures like the US system. It's in crisis. We need to throw more money at it, but we also need to use whatever's available to stitch it back together right now, rather than cut off its nose to spite its face (the hallmark of the ideologue).

I haven't got the answers, but the principle of universal healthcare free at the point of use must be upheld and has firm democratic support (I hope I'm right about this and that it can't be successfully subverted by the scum). Beyond that, a massive dose of pragmatism is going to be required to save what's important us.

1
 Jon Stewart 08 Jan 2022
In reply to wintertree:

Good points of course. But we don't have to hold everything else equal while pumping cash into the NHS, that would be insane.

> What happens next with healthcare and society is a defining issue of the next generation. 

Yes, obviously exponential funding growth is unsustainable, but is needed now. The pressures forcing it back into equilibrium has to come from other areas of policy and technology, i.e. disease prevention and effective scoping of NHS services as Stichtplate's post.

> Edit: a parable of relevance from Fargo?

Great!

 Stichtplate 08 Jan 2022
In reply to wintertree:

Lots of savings to be made in the NHS. As an organisation, its mind bogglingly inefficient.

Half the staff are non clinical, petty empire building is rife, the bureaucracy is insane (anyone read my recent rant on payroll?) and as for procurement... it's criminal. Imagine if every regiment in the British army had it's own procurement department and bought different weapons, vehicles and uniforms. Imagine if different regiments found themselves bidding against each other for the same kit. Crazy? Yep. Welcome to NHS procurement and the end result is that you can go down to your local 24 hour garage and buy a pack of paracetamol for a tenth of what the NHS is paying.

1
 Jon Stewart 08 Jan 2022
In reply to Stichtplate:

As a former civil servant, I can well imagine. 

Funny how they like merging hospitals so your nearest A&E is 2 hours drive away. But not so keen on merging stationery procurement and distribution centres.

In reply to cumbria mammoth:

Well up to a point .But it was Alan Johnson who pointed out that in the past we stopped operations in September etc because the money had run out.They were just shunted to the next financial year and people suffered.

I am never sure if there was even a golden age of the nhs.

Post edited at 14:10
1
 Stichtplate 08 Jan 2022
In reply to neilh:

> I am never sure if there was even a golden age of the nhs.

Nobody has mentioned a golden age. Everyone seems to accept the fact that we have an imperfect system tasked with an ever expanding role. Whether a universal public health system, free at point of delivery, is the answer, is purely a matter of personal perspective and morality.

If you're skint and sick it's vital.

If you're healthy, wealthy and not much concerned with the fate of strangers, not so much. 

 Jon Stewart 08 Jan 2022
In reply to Stichtplate:

> Whether a universal public health system, free at point of delivery, is the answer, is purely a matter of personal perspective and morality.

It's among the most successful public policies ever for improving the wellbeing of the population, up there with a clean water supply. 

Anyone who wants to take it away needs to admit to themselves that it's like taking away access to clean water to those who can't afford it. May their souls burn in hell for eternity.

The point I'm making here is that there's a very good reason that the NHS is "like a religion" - it actually does save souls.

5
 jimtitt 08 Jan 2022
In reply to Stichtplate:

> Nobody has mentioned a golden age.

Actually this ideological claptrap did:-

"There was a model where healthcare was provided to everyone by the state for free. That model has been deliberately undermined for decades now and now the effects are becoming acute. Just go back to the model that worked so successfuly."

I.e some decades past were the glory days, the rose-tinted NHS specs working well apparently!

3
 rurp 08 Jan 2022
In reply to wintertree:

Can’t argue with your maths makes total sense, though perhaps I can with your conclusion.

If we cross reference the increased spend on health care with life expectancy is there a correlation? 
 

we spend healthcare cash predominately  on the frail elderly in their final years.  Thus as frail life expectancy increases , health spending increases.

the current government have for the first time overseen a drop in life expectancy. 
 

as a result the doomsday scenario of all the cash is eventually spent on healthcare may not be a fair conclusion…

It only applies if life expectancy ( and frail life expectancy rise). The current government policies of inadvertently massacre the nursing home residents by failure to act and reducing life expectancy may solve the funding crisis you predict 

Even if healthcare spending grew, people would still reach a peak age and hence the correlation cannot continue unless we are going to see 200 year olds who stay frail with high healthcare costs for 100 of those. 
 

appreciate some of the increased spend is technology driven too. 
 

We solve it as we always have, rationing through NICE etc,  waiting lists and triage. 


Public opinion waves and elected governments push the funding up and down requiring more or less of the processes above to manage demand. Soon we will elect a government who ‘ overspend’ I suspect 🤞. 

1
 jimtitt 08 Jan 2022
In reply to Stichtplate:

> Lots of savings to be made in the NHS. As an organisation, its mind bogglingly inefficient.

> Half the staff are non clinical, petty empire building is rife, the bureaucracy is insane (anyone read my recent rant on payroll?) and as for procurement... it's criminal. Imagine if every regiment in the British army had it's own procurement department and bought different weapons, vehicles and uniforms. Imagine if different regiments found themselves bidding against each other for the same kit. Crazy? Yep. Welcome to NHS procurement and the end result is that you can go down to your local 24 hour garage and buy a pack of paracetamol for a tenth of what the NHS is paying.

When Bismark established the worlds first national social health system in 1883-1889 one of the three guiding principles was policies were to be implemented with the smallest political and administrative influence. The German health system has several firewalls between it and the government and rightly so, having politicians directly involved with both expenditure and operation has always been the weak point in nationalised industries. Having lived under both the UK and German health systems I know which I prefer. Treating the NHS as a holy cow is a mistake.

In reply to jimtitt:

> When Bismark established the worlds first national social health system in 1883-1889 one of the three guiding principles was policies were to be implemented with the smallest political and administrative influence. The German health system has several firewalls between it and the government and rightly so, having politicians directly involved with both expenditure and operation has always been the weak point in nationalised industries. Having lived under both the UK and German health systems I know which I prefer. Treating the NHS as a holy cow is a mistake.

I too have experienced the German system and it is excellent.  It does cost a larger proportion of GDP than the NHS, though.

I think the thing that should be protected is it being free at the point of use, or any fee being nominal e.g. £10 per course of treatment from start to finish regardless of if it actually cost £5 or £500,000.  The prescription charge sort of does that (basically capped at about £120 per year due to the monthly subscription option) but I think it could be fairer.  I don't support percentage co-pay systems, as while it helps affordability it negates the point of socialised health pretty much entirely.

I also think a "contract of National Insurance" would be positive, as it would define precisely what people are entitled to, and remove the "postcode lottery".

Post edited at 16:23
 Rob Exile Ward 08 Jan 2022
In reply to MG:

Very hard for me to know where to begin with the NHS - I've been following it, working with it and on occasion studying it for nigh on 60 years. So here follows a bit of 'stream of consciousness':

1) I don't believe it is always rubbish. I've presented to my GP with a damaged elbow at 8:30 am; by 11:30 I'd been referred to the local hospital, X-rayed, seen by a consultant, advised and discharged. Where in the world could that be bettered, however much money I might have  been prepared to spend? And even in these trying times; I mentioned to a nurse that I still had pins and needles in my fingers; I had a telephone appt scheduled with a GP within 2 weeks, and a nerve assessment at the local specialist clinic within 4 weeks, notwithstanding Xmas and New Year. (Carpal tunnel syndrome, since you ask - too much typing!) Other members of my family have had similar positive experiences.

2) It is an institution that both defines us as a nation, and one with which can and do identify - 2012 Olympics opening ceremony, anyone? A more than worthy replacement for the dark satanic mills or Empire that previously defined us. France may be defined by perfume, food and Academie Francaise, the US may have Hollywood, SWAT teams and a bloated military; I know which I prefer.

3) For something as fundamental (we all want to live) yet variable (some require virtually no healthcare throughout their lives - like my Dad - while others require huge resources, and no one can know in advance where they will fall on the spectrum) an insurance  policy makes perfect sense. But if everyone needs it equally, why not organise it centrally, cut out shareholders' 10 - 15% , benefit from access to cheapest funding possible, and ensure equal access to all?

4) Nationalised healthcare makes sense on so many levels. We can save on huge administrative overheads (or will be able to once  the Lansley reforms - 'internal market' -  wtf was that about? have been flushed through the system.) We can be guided by extraordinary institutions like NICE, which DON'T just consider cost, whatever the Daily Fail and contemptible Express might say, but take a hard look at effectiveness. (If BUPA had it's way, all men would be being screened for any number of diseases; more men would die  prematurely, either directly (by unnecessary interventions) or indirectly (by diverting resources away from more effective interventions) than would otherwise be the case. We can create partnerships between academia and practitioners in a way that has to be compromised when privatised medicine is involved. And we should be able to benefit from enormous economies of scale, by being able to assist with the development of new treatments and interventions, and pay least possible prices for drugs and other supplies. The fact that we don't, always, is largely down to...

5) The creeping privatisation that politicians of nearly every hue seem to think represents a way forward. So NHS procurement officials don't procure - they liaise with private agents to place orders. (When said private agents evaporated when the PPE crisis blew up at the start of the pandemic, said procurement officials had no idea what to do, except place orders with any plausible rogue who would 'promise' miracles.) I don't believe the Tories want to fully privatise the NHS; it suits them too much as it is, a great way for the private sector to siphon off public finds without true accountability. The vision I have is of the NHS as an enormous sow, fed by our taxes, lying on her side; while any number of private sector piglets scrabble to get the juiciest teats and suck the life out of her.

I could go on, but I've probably written enough...

2
 Stichtplate 08 Jan 2022
In reply to Rob Exile Ward:

Great post.

 Ridge 08 Jan 2022
In reply to Stichtplate:

> Welcome to NHS procurement and the end result is that you can go down to your local 24 hour garage and buy a pack of paracetamol for a tenth of what the NHS is paying.

That's procurement everywhere. Despite our organisation moving to central purchasing and having massive buying power, I can still buy anything from toner cartridges, to projectors, to stationery far cheaper by going down to Staples and paying full RRP. (Or I could if they'd let me).

 Stichtplate 08 Jan 2022
In reply to Ridge:

> That's procurement everywhere. Despite our organisation moving to central purchasing and having massive buying power, I can still buy anything from toner cartridges, to projectors, to stationery far cheaper by going down to Staples and paying full RRP. (Or I could if they'd let me).

Maybe so, but I've worked in the private sector for most of my life and if I'm buying 5 million widgets I get a much better price than if I'm buying 500. There are also huge saving to be had in employing 500 in one procurement team rather than 5000 in 50.

 Ridge 08 Jan 2022
In reply to Stichtplate:

A cynic might say a government run body like the NHS will be forced to use government approved suppliers who will mysteriously be: 

A. Far more expensive than the non-approved suppliers.

B. Owned by cronies.

But I couldn't possibly comment.

2
 Duncan Bourne 08 Jan 2022
In reply to wintertree:

I have the reason it is going down the pan

Posted by a sock puppet on our local facebook group (and when I say sock puppet I mean after the usual nonsense arguments I took a look at his suspiciously empty profile - I think there are a lot of these being created to place on local groups)

"Maybe stop forcing the staff to test then isolate in the event of a positive test..

If that doesn’t work stop sacking the staff who refuse to participate in the mRNA trials"

1
 Stichtplate 08 Jan 2022
In reply to jimtitt:

> When Bismark established the worlds first national social health system in 1883-1889 one of the three guiding principles was policies were to be implemented with the smallest political and administrative influence.

Correct me if I'm wrong but Bismarck didn't established the first national health system, he established the first national social insurance health system. Not quite the same is it?

>The German health system has several firewalls between it and the government and rightly so, having politicians directly involved with both expenditure and operation has always been the weak point in nationalised industries.

As does the NHS. There is no political involvement in how I treat my patients or, more pertinently, who I can treat.

>Having lived under both the UK and German health systems I know which I prefer. Treating the NHS as a holy cow is a mistake. 

You've said this several times every thread the NHS has popped up. For the sake of clarity, how long since you lived in the UK and how often did you call on the services of the NHS?

Forgive me if I'm a little sceptical, but as I understand it German health care is provided by many different public and private providers. You seem to be saying they're all better than the NHS, regardless of provider, patient presentation or the patient's ability to pay?

I've never accessed German health care so pardon my ignorance, but I have Spanish and American. In Spain method of payment came up shortly after clinical assessment, in America it came up first. In the UK it just doesn't come up at all. This is what so many British people are proud of. Rightly so.

Post edited at 18:13
1
In reply to Stichtplate:

I reckon you would be surprised how many  of the wealthy use it .there are probably only a few thousand in the U.K. who are truly wealthy and do not need to.

Anyway you need to start off by defining it . Does it include social care or not is an obvious question. 

 Stichtplate 08 Jan 2022
In reply to neilh:

> I reckon you would be surprised how many  of the wealthy use it .there are probably only a few thousand in the U.K. who are truly wealthy and do not need to.

No Neilh, I work for the NHS, I go out to the patient's homes, I'm well aware of the socio-economic status of those I treat.

> Anyway you need to start off by defining it . Does it include social care or not is an obvious question. 

Why?

2
In reply to Stichtplate:

And therein lies the quandary. The German system seems to work! So do you bury your pride and say hang on a minute there are better options.if you are not prepared to acknowledge that then it will just carry ion as is. 
 

And we should not be proud of a consultant dominated system that allows public and private work and in some cases a bullying culture leading to incidents where  patients are mistreated. 

1
In reply to Stichtplate:

It either is or it is not . Define it and the costs if it as it has  a bearing on the direction. 
 

I have no axe to grind. But people are confused about the role of social care and NHS. People expect the NHS to provide social care. 
 

But as you know social care has a big impact on your role. 
 

In a car accident you attend do you know the wealth of the individuals …..

Post edited at 18:33
1
 Stichtplate 08 Jan 2022
In reply to neilh:

> And therein lies the quandary. The German system seems to work! So do you bury your pride and say hang on a minute there are better options.if you are not prepared to acknowledge that then it will just carry ion as is. 

>  

> And we should not be proud of a consultant dominated system that allows public and private work and in some cases a bullying culture leading to incidents where  patients are mistreated. 

I've made several posts on this thread outlining the many failings of the NHS. Not sure if you've read them, also not sure where I've implied we should carry on regardless.

3
 Stichtplate 08 Jan 2022
In reply to neilh:

> It either is or it is not . Define it and the costs if it as it has  a bearing on the direction. 

>  

> I have no axe to grind. But people are confused about the role of social care and NHS. People expect the NHS to provide social care. 

>  

> But as you know social care has a big impact on your role. 

You're going to have to be clearer as I've no idea what you're on about. It helps to quote what it is you're replying to, avoids all that confusing 'implying people have written things they haven't' stuff.

Post edited at 18:33
3
In reply to Stichtplate:

It’s a huge area all round and that is the problem with these type of threads. 
 

Think  I will stick with following the covid data

 jimtitt 08 Jan 2022
In reply to Stichtplate:

> Correct me if I'm wrong but Bismarck didn't established the first national health system, he established the first national social insurance health system. Not quite the same is it?

> >The German health system has several firewalls between it and the government and rightly so, having politicians directly involved with both expenditure and operation has always been the weak point in nationalised industries.

> As does the NHS. There is no political involvement in how I treat my patients or, more pertinently, who I can treat.

> >Having lived under both the UK and German health systems I know which I prefer. Treating the NHS as a holy cow is a mistake. 

> You've said this several times every thread the NHS has popped up. For the sake of clarity, how long since you lived in the UK and how often did you call on the services of the NHS?

> Forgive me if I'm a little sceptical, but as I understand it German health care is provided by many different public and private providers. You seem to be saying they're all better than the NHS, regardless of provider, patient presentation or the patient's ability to pay?

> I've never accessed German health care so pardon my ignorance, but I have Spanish and American. In Spain method of payment came up shortly after clinical assessment, in America it came up first. In the UK it just doesn't come up at all. This is what so many British people are proud of. Rightly so.

Implicit in "social" (as I wrote) was social solidarity, one of Bismarks founding tenets. Everyone paid in according to their means but treatment was equal.

The UK health budget is set by the government

34years under the NHS and 30 odd in Germany. Plenty of visits to the NHS, including intensive care, racing motorbikes is kinda hazardous. I've no complaint at my treatment in either country but it's better in Germany for sure.

Health care is provided by the local authority to the standard required by the state government. Who delivers the care is irrelevant since the standard is set elsewhere (immediately by the state government and German-wide by the national government).   My local hospital is owned by the district council and administered by a private operator who can be removed if the trustees are dissatisfied.

Since ALL Germans must be insured it isn't a question of who IS paying, simply who to send the bill to.

 Rob Exile Ward 08 Jan 2022
In reply to jimtitt: 

'Since ALL Germans must be insured it isn't a question of who IS paying, simply who to send the bill to.'

Firstly; how much bureaucracy does that require (to calculate the costs; submit the bill; resolve the inevitable disputes etc)? And, as a matter of anecdotal fact, my daughter needed healthcare when she was working in Germany, I can assure you they weren't too clever about it (and didn't get the several thousand euro they were demanding, either.)

Secondly, if ALL Germans must be insured (including vagrants? people of no fixed abode? people of limited mental capacity?) wtf is the point of forcing ALL Germans to pay insurance companies their 10 - 15% profit margin on top of their premiums? It makes no sense.

Post edited at 19:05
 jimtitt 08 Jan 2022
In reply to Rob Exile Ward:

Err, about 90% of Germans are in the STATE insurance fund, most of the rest like me are in MUTUAL insurance funds.

Nobody is making any profit. This is similar to most European "insurance" based systems.

Uninsured (vagrants etc) are treated under the government solidarity scheme as are illegal immigrants, they count as being in one of the state schemes.

Post edited at 19:34
 bruxist 08 Jan 2022
In reply to neilh and thread:

Three and a half weeks ago, a chap in his 80s fell on the pavement in front of a cafe in the town centre where I was working: cracked open his head and was bleeding quite badly. It was lunchtime on market day, so a fair few people around. 999 advised us to grab the public defib just in case, which we did; the staff at a nearby furniture shop came out with duvets to wrap him in (it was hovering around 0 degrees). An ambulance would be on the way, 999 said. The defib wasn't needed, so we took it back. Three hours later it started to get dark, and he was still there; the people looking after him had changed, though, as it's difficult for members of the public to give up their day because of a stranger's accident: they're likely to have jobs to go back to after lunch, for a start.

5.30pm and it's now pitch black, dropped below freezing, and I'm leaving work. He's still there, with yet another set of decent-minded members of the public trying to look after him.

The number of hospitals declaring critical incidents and ambulance services unable to operate normally now is much greater than it was then. I don't think this thread was intended to be a forum for people's opinions about NHS funding or the general kind of healthcare system we want in the UK at all. It came from a conversation in the plotting threads about the really critical damage being done to public health services right now by covid, and a desire to work out what impact that damage will have and is having - plus a sense that the majority of readers did not know just how overloaded the NHS is.

Focusing on Covid case figures & mortality data is a useful index to the general direction of the pandemic, but it's telling us less and less about what life is like today under the UK's 'living with covid' strategy. For most people, the greatest hazard of covid now is not going to come from contracting it. It's from the absence of a basic standard of emergency healthcare that we all assume is always there for us, but isn't at present - and we're only going to find this out when we need such healthcare.

These issues are going to vary by region, and I'd like to see more plotting like this, from Colin Angus - https://twitter.com/VictimOfMaths/status/1479484966232862726 - trying to map NHS capacity vs. staff sickness, showing real-world effects of the covid strategy UK Gov is following. (For what it's worth I don't think Colin's plots are a completely accurate depiction of the state of affairs at the moment, but he can only work with the dataset he's got access to.)

 redjerry 08 Jan 2022
In reply to mondite:

"Since thats the key problem."
Is cost really the key problem? Given that the UK spends less on healthcare per person that just about any other of the major western countries.
UK £2,989, France (£3,737), Germany (£4,432) and the United States (£7,736).

1
 wintertree 08 Jan 2022
In reply to bruxist:

I think we've been rather spoilt by the quantity and regularity of healthcare data made poublicy with regards Covid - there are many other healthcare measures that are more sporadically published (if at all) and are scattered over various locations rather than on one central dashboard.

As you suggest, I think a lot of other measures around healthcare service delivery (and things impacting that) are as important (or more important) right now as the Covid stats themselves when it comes to an individual's risks ec.

> but it's telling us less and less about what life is like today under the UK's 'living with covid' strategy.

I hope/think the pressure from Covid is going to start fading quite soon, but it isn't just Covid that's brought healthcare service levels to where they are, and other issues aren't going away.  

I see this as less about "living with covid" and more about "living with healthcare that doesn't have the needed surge capacity" at this point.  Right now, not-quite-endemic Covid is hammering that home.  If we'd had a bad flu season instead the situation could be similar, except that we wouldn't be testing and isolating asymptomatic flu carriers so we wouldn't have the same level of staffing absences. 

Nick Triggle has an article out today on the BBC where he points out that emergency department closures, routine operation cancellations, single-disease deaths of several hundred/day and the making of plans for emergency treatment facilities in tents are not new to Covid, and nor are worsening A&E wait times.

https://www.bbc.co.uk/news/health-59909860

In part I think a lot of people were "better" at turning a blind eye to healthcare's inability to function near normal during a bad flu season.   

I get the impression the ambulance service is stretched to record levels and waiting times but I haven't seen hard data on this winter vs past bad flu years.  I thought it a bit lacking of the article not to at least try and tackle the issues over ambulance waiting times as there's been a lot of anecdotes on this.

 Jon Stewart 08 Jan 2022
In reply to Rob Exile Ward:

Great post. But pardon me for saying, it just seems like basic common sense to me [shrug].

 wintertree 08 Jan 2022
In reply to rurp:

>as a result the doomsday scenario of all the cash is eventually spent on healthcare may not be a fair conclusion…

It's not a scenario that could never be allowed to happen, so it's not really a conclusion so much as a reductio ad absurdum to illustrate that something fundamental has to change.    

> It only applies if life expectancy ( and frail life expectancy rise).

Or if the health of the public continues to decline, requiring more and more medical care to maintain stable life expectancy - or as apparently is happening requiring more and more medical care to mitigate the rate at which it's falling.  What a dismal achievement we have made for ourselves

> The current government policies of inadvertently massacre the nursing home residents by failure to act and reducing life expectancy may solve the funding crisis you predict

Well, it might push it back for a few years.  

The phrase I really liked in your post was "frail life expectancy" - that really is the problem, isn't it?  A pro-active life-long focus on health building towards a healthily old age so far as possible is one part of the radical change we need to keep increasing life expectancy and QOL without an all-consuming budget.  Unfortunately we're moving in the other direction - let health damage accumulate for decades and then look to surgery and pharmacology to stave off the effects.

Post edited at 20:07
 AJM 08 Jan 2022
In reply to wintertree:

Lifespan Vs healthspan, right? We've done a lot to improve one, less to improve the other...

 wintertree 08 Jan 2022
In reply to AJM:

> Lifespan Vs healthspan, right? We've done a lot to improve one, less to improve the other...

In a nutshell, yes.

The biggest drivers for changing healthspan lie in our control - education, public health, diet, access to exercise and green space, air cleanliness, lifestyle.   Mostly upstream of the NHS.  If we had a universal seismic shift towards healthspan-optimised living tomorrow, it would still take a generation or more to flush the change through healthcare.

Post edited at 20:25
 mik82 08 Jan 2022
In reply to bruxist:

This has been normality for many parts of the UK prior to covid, it's just that the minimal reserve elsewhere has been used up also.  Pre-pandemic it was pretty normal locally to wait several hours for the situation you described and advice has been to get someone to take you to hospital in case of heart attack/stroke etc. 

A few months ago we had 5 hours for a response to a "category 2" - heart attack/stroke , and we've had two incidents of there being no ambulance response whatsoever. That's exactly what it sounds like - needing to go to hospital but being left at home. 

Post edited at 20:35
 Rob Exile Ward 08 Jan 2022
In reply to jimtitt:

'Err, about 90% of Germans are in the STATE insurance fund, most of the rest like me are in MUTUAL insurance funds.'

Err that still makes no sense. If it's a STATE insurance fund, then it's just another tax - but with its' own bureaucracy. Why not just cream off an agreed % from the total tax take? Like we do (though not enough, obv.) And it doesn't remove the overhead of quantifying costs of individual treatments - raising invoices - submitting them - then resolving conflicts etc.

We tried that in the UK under Lansley - it cost us billions. Probably more than Blair's IT NHS initiatives, but less than Test and Trace. And it was cr*p; bureaucracy for bureaucracy's sake.

 Rob Exile Ward 08 Jan 2022
In reply to Jon Stewart:

'it just seems like basic common sense to me [shrug].'

Apparently not.

And incidentally, I think your profession is quite an interesting case study of both the benefits and corrosive effects of private sector involvement in healthcare. I can get quite heated on both sides of the argument!

 Jon Stewart 08 Jan 2022
In reply to Rob Exile Ward:

> Apparently not.

Exactly.

> And incidentally, I think your profession is quite an interesting case study of both the benefits and corrosive effects of private sector involvement in healthcare

It's great at showing the downsides. I mean it's got upsides for me, I do an easy fun job and get paid well - but for patients? Nope. They should be getting impartial clinical advice. You wouldn't go to a GP whose salary depends on shifting drugs, so why should it be OK for your eyes? The only justification is that we can't do much harm by over-prescribing glasses and contact lenses...but there are loads of unnecessary surgeries being done, it's a disgrace.

Still a great job though, from a purely selfish perspective.

Dentistry is a racket too, obviously.

 LaGuardian 08 Jan 2022
In reply to Jon Stewart:

> Dentistry is a racket too, obviously.

It works, though. You can actually get a service for what you pay for. You can actually get treatment within a reasonable timeframe. You can also get check ups etc etc fairly regularly.

6
 Jon Stewart 08 Jan 2022
In reply to LaGuardian:

> It works, though. You can actually get a service for what you pay for. You can actually get treatment within a reasonable timeframe. You can also get check ups etc etc fairly regularly.

You can also get someone to smash your teeth up with the express purpose of them lining their pockets. Or be totally unable to access emergency care. It's shite!

I'm not very engaged in the system, so I don't want to argue about it really. But from what I know, I am not happy with how it works, and a dentist friend of mine took a very similar view as I do to optometry - he wasn't even jaded he was newly qualified.

1
 wintertree 08 Jan 2022
In reply to LaGuardian:

'ello ello.

2
 Jon Stewart 08 Jan 2022
In reply to wintertree:

Am I going to find myself asking "why is the Mail so left wing?" again? Too soon to know...

 Rob Exile Ward 08 Jan 2022
In reply to LaGuardian:

Um ... that ain't necessarily so. Since moving to Kendal my wife, daughter and me have all tried getting a dentist who will give impartial advice and treatment for a fair fee. So far we've been offered implants ('only 2 grand and we're really good at them!') or fillings that so far have cost £250 a pop (X-rays extra.) 

Net result, I'm still travelling to Cardiff to get my teeth fixed; I'm rather hoping my dentist outlasts me. (He loves his job; I once went in to the consulting room, Hotel California was on his stereo and the sunshine was streaming through. 'Ah Rob' he said, 'the Eagles and dentistry... it doesn't get much better!' And last week I went to see him, he was just starting after the break... 'It's great to have a drill in my hands again!')

 Andy Hardy 08 Jan 2022
In reply to cumbria mammoth:

If you want to maintain any vestige of a national health service, you really should support Labour, instead of coming on here, continuously knocking them.

Starmer is not your enemy. (Unless you are a CCHQ mole / troll)

5
 LaGuardian 08 Jan 2022
In reply to Jon Stewart:

> You can also get someone to smash your teeth up with the express purpose of them lining their pockets. Or be totally unable to access emergency care. It's shite!

Indeed. But at least if you’re not happy you can leave and go somewhere else.

2
 Dave B 08 Jan 2022
In reply to LaGuardian:

> Indeed. But at least if you’re not happy you can leave and go somewhere else.

A bit like the shoe event horizon?

 Jon Stewart 08 Jan 2022
In reply to LaGuardian:

I don't expect to find your arguments compelling.

In reply to Rob Exile Ward:

But things like Lansley were trying to force an internal market on a monopoly - probably not a fair comparator for the systems used in many EU states which seem to cost a bit more than ours but also give typically better outcomes.

It would be interesting to see the NHS run with clearly set out and higher (say Germany level) long term funding in place and 10 years of no Government meddling - I suspect most systems can be made to work well, but constant change is a killer.

 wintertree 08 Jan 2022
In reply to Dr.S at work:

> I suspect most systems can be made to work well, but constant change is a killer.

For a moment there I thought I’d walked in to a thread on education.

1
 LaGuardian 08 Jan 2022
In reply to Jon Stewart:

> I don't expect to find your arguments compelling.

Why ?

2
 Fredt 08 Jan 2022
In reply to MG:

The problems that the NHS have is summed up by one experience I had. 

My wife had terminal cancer. (The cancer care and treatment was first-class, no issues there)

I cared for a her at home, and had to change a dressing every day, a clear adhesive dressing, about 20cm x 15cm. The GP supplied us with some when they could, as did the brilliant community nursing team, but there were shortages, and when I asked why, I was told, well, they cost £50 each, and supplies were limited. 

I googled the dressing make and type, and found some on Amazon, absolutely identical, same type, same maker. 

£19.50 for a pack of 10.

In reply to wintertree:

> > I suspect most systems can be made to work well, but constant change is a killer.

> For a moment there I thought I’d walked in to a thread on education.

Indeed.

Take a sufficiency of people who care for their job. Give them reasonable resources. Give them reasonable training. Give them clear objectives. Leave them to it.

 wintertree 08 Jan 2022
In reply to LaGuardian:

> Why ?

Because you’re some shitbag troll back to pedal faux-naive support for private healthcare for the eleventyfifth time?

3
 jimtitt 08 Jan 2022
In reply to Rob Exile Ward:

Germany is a federal republic, health is a state responsibility; income tax the federal governments.

In reply to jimtitt:

Jim, you mentioned you are in a mutual insurance scheme - how does that differ from the state schemes?

 LaGuardian 08 Jan 2022
In reply to wintertree:

> Because you’re some shitbag troll back to pedal faux-naive support for private healthcare for the eleventyfifth time?

What is so wrong with mixed private/public healthcare ? Works fine for France, Germany and others.

7
 Jon Stewart 08 Jan 2022
In reply to LaGuardian:

Cause every time you say anything, the answer is "that's not true"; and for the reasons given above. All told, it doesn't feel like a stimulating tete a tete.

4
 LaGuardian 08 Jan 2022
In reply to Jon Stewart:

> Cause every time you say anything, the answer is "that's not true"; and for the reasons given above. All told, it doesn't feel like a stimulating tete a tete.

What have I said that is not true ?

4
 Jon Stewart 08 Jan 2022
In reply to LaGuardian:

Read it.

2
 LaGuardian 08 Jan 2022
In reply to Jon Stewart:

> Read it.

Read what ?

4
In reply to Fredt:

I'm not sure that's just the NHS, procurement seems extraordinary shit whatever the organisation.

I work for a huge and highly profitable IT company. I work from home and can expense various bits and bobs, including printer cartridges. Through the company procurement system it costs £80 per cartridge and a printer takes 4, yes, £320 for a full set. Amazon, £20 for the full set. I really don't understand it.

As for the NHS, my daughter was in hospital for 5 weeks after her birth, in intensive care and the high dependency unit, then a year of changing expensive dressing at home followed by more surgery. I can't fault the care we received and had we been in some countries we'd likely have been bankrupted by the cost.

She's now proving the surgeon wrong after he predicted she'd be okay but she'd never be a gymnast (granted only an amateur one!).

I'd happily pay more tax to adequately fund health care and I understand that huge organisations are by their nature pretty inefficient, I don't think there is some silver bullet of privatisation that would fix that.

 wintertree 08 Jan 2022
In reply to MeMeMe:

> I'd happily pay more tax to adequately fund health care and I understand that huge organisations are by their nature pretty inefficient, I don't think there is some silver bullet of privatisation that would fix that.

This is a key point IMO.  I’ve had similar procurement experiences within a higher education setting, and know many comparable examples from other institutions.

I totally agree that switching between public and private models is not the silver bullet here.  The grass is just different types of inefficient.

Figuring out how to build and run institutions with staffing levels in the range of 50k to 1m people that are robust, reliably, innovative, lean and efficient regardless of their funding and profit status , now there’s a Manhattan project to move humanity forwards.

 LaGuardian 08 Jan 2022
In reply to MeMeMe:

> I'd happily pay more tax to adequately fund health care and I understand that huge organisations are by their nature pretty inefficient, I don't think there is some silver bullet of privatisation that would fix that.

Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt.

In the case of a nationalised organisation, especially one for which there is political support for, what happens instead is that you end up throwing more and more money at it.


 

6
In reply to LaGuardian:

> Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt.

Yeah but having my healthcare provider go bankrupt would be pretty disruptive to providing continuity of health services. Not to mention that in order to avoid going bankrupt they'll probably be keen to limit spending money on patient care and/or increase fees rather than resolving the tricky and ultimately unresolvable issue of waste and incompetence.

 LaGuardian 08 Jan 2022
In reply to MeMeMe:

> Yeah but having my healthcare provider go bankrupt would be pretty disruptive to providing continuity of health services.

Indeed.  That's the problem with any monopolistic or centralised system. If it fails everybody suffers.

9
In reply to LaGuardian:

> Indeed.  That's the problem with any monopolistic or centralised system. If it fails everybody suffers.

A grim prospect as we've all suffered enough given all the wank spouted on half the threads on UKC lately!

1
 wintertree 09 Jan 2022
In reply to LaGuardian:

> Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt.

Bankruptcy must come fast if they’re paying your VPN bill, Rom.

1
 redjerry 09 Jan 2022
In reply to LaGuardian:

"Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt."

Having lived with the same american healthcare corporations for most of my adult life, I can say with some confidence that that is complete bollocks.
The.... government=inefficient.... private = efficient... line is utter garbage as well...did you learn nothing from 2008?

 LaGuardian 09 Jan 2022
In reply to redjerry:

> "Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt."

> Having lived with the same american healthcare corporations for most of my adult life, I can say with some confidence that that is complete bollocks.

> The.... government=inefficient.... private = efficient... line is utter garbage as well...did you learn nothing from 2008?

Nobody said that private is necessarily more efficient, if by that you mean providing value for money for the patient. Clearly the US system is terrible at doing that. 
 

I am not in favour of a US system though, I am more in favour of moving a little bit towards a French or German system. State provided insurance that you can top up with private insurance, and a range of providers, public and private that you can choose from.
It favours a patient centric approach as well as limiting the caveats of too big to fail / overcentralisation.

It’s pretty clear to me that the NHS is basically doomed unless something is done, at which point the default position will be a US style system. 

To an extent it’s already failing: many people who need care are just not getting it. We have almost 400,000 people waiting more than a year for routine surgery.

It will eventually reach the point of no return where the millions of people who are stuck waiting everywhere in the system are getting worse because of lack of treatment, therefore need even more treatment, creating even more waiting time, staff get burn out and demotivated and leave, and it spirals out of control.

Post edited at 00:54
8
 Stichtplate 09 Jan 2022
In reply to wintertree:

> Bankruptcy must come fast if they’re paying your VPN bill, Rom.

It's amazing really. All that time, effort and money spent trying to hide his identity and yet it's obvious he's back after just a couple of sentences.

Hilarious!

1
 jimtitt 09 Jan 2022
In reply to Dr.S at work:

> Jim, you mentioned you are in a mutual insurance scheme - how does that differ from the state schemes?

Basically that you can get more luxury like single-bed rooms in hospital, add-on dental treatment and so on. Costs more though, I'd be in the normal scheme if I could but there's an income cap.

In reply to jimtitt:

so does that work out as -

the destitute - state pays via general taxation

most people - must select either state insurance or another provider

the better off - must select another provider

And is state insurance a flat rate?

Post edited at 07:01
 jimtitt 09 Jan 2022
In reply to Dr.S at work:

14.6% of income, half by the employee and half by the employer. In general the federal government pays for the destitute, unemployed, children, non-working dependents etc (there are many occupational schemes which overlap somewhat).

 Duncan Bourne 09 Jan 2022
In reply to LaGuardian:

> Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt.

or they get bailed out by the government. Have you seen the rail service?

The other problem with private medical services is they work for profit and this means a preference for short term easy fix problems (braces for their teeth and correction of minor problems) but not so much support for longer term illness unless of course you have the money.

 john arran 09 Jan 2022
In reply to Duncan Bourne:

> The other problem with private medical services is they work for profit and this means a preference for short term easy fix problems (braces for their teeth and correction of minor problems) but not so much support for longer term illness unless of course you have the money.

Put simply, if your money is made by people getting sick, it doesn't pay to prevent them from getting sick.

 mondite 09 Jan 2022
In reply to LaGuardian:

> Very true, however in a private organisation when the waste and the incompetence gets really bad they eventually go bankrupt.

Depends on whether all your competitors are equally incompetent and whether you are providing a service which cannot be allowed to collapse. Does the phrase "to big to fail" remind you of anything?

 mondite 09 Jan 2022
In reply to redjerry:

> Is cost really the key problem? Given that the UK spends less on healthcare per person that just about any other of the major western countries.

Precisely. So considering the major problem facing us is how to fund this ongoing why would shifting to a more expensive model help?

 LaGuardian 09 Jan 2022
In reply to mondite:

> Does the phrase "to big to fail" remind you of anything?

See my post at 00:27 Sun

5
 mondite 09 Jan 2022
In reply to LaGuardian:

> See my post at 00:27 Sun

Which fails to address the fantasy about the private sector.

Getting back to the NHS why would changing the model work? How will it magically create more cash to invest?

If you look at France for example you will see much the same complaints about the health system being in crisis as you do here.

I would also note perhaps the NHS would have been better off if the tories hadnt spent the last couple of years throwing cash at the private providers to do not a lot

https://www.bmj.com/content/375/bmj.n2471

Post edited at 09:27
3
 mik82 09 Jan 2022
In reply to john arran:

>Put simply, if your money is made by people getting sick, it doesn't pay to prevent them from getting sick.

This isn't necessarily true. Private healthcare providers make a lot of money from "health checks". (The value of a regular health check is a different matter. There isn't really any evidence that they have any benefit in terms of health outcomes)

One of the larger healthcare chains in the UK - Nuffield (a charity, one of the largest in the UK, so not profit driven) also owns a chain of gyms - so definitely in the preventative health business also. 

 LaGuardian 09 Jan 2022
In reply to mondite:

> Which fails to address the fantasy about the private sector.

What fantasy ? Nobody is saying it’s a magic bullet.
We just have to be pragmatic and use private where it makes sense. Most likely you end up with a mixed private / public like other countries have.

> Getting back to the NHS why would changing the model work? How will it magically create more cash to invest?

Wealthy people would suddenly pay a lot more for their healthcare. That’s extra money going into the system for those who can’t pay.

> If you look at France for example you will see much the same complaints about the health system being in crisis as you do here.

No, there simply isn’t. It faces pressure yes, but nothing like the NHS.

> I would also note perhaps the NHS would have been better off if the tories hadnt spent the last couple of years throwing cash at the private providers to do not a lot

That I completely agree. The mode of privatisation adopted in this country is completely dumb. We’re basically giving a licence to private providers to spend taxpayers money.

It’s the worst of both world. We don’t get the benefit of privatisation which is patient centric care and patient choice, and all the downsides: profiteering, short termism, etc etc.

6
 mondite 09 Jan 2022
In reply to LaGuardian:

> We just have to be pragmatic and use private where it makes sense.

Okay so how, where and when? Remember all these systems you are praising cost a lot more than the UK system even after the endless "reforms" and inclusion of private companies. So given that exactly how is it going to address the funding crisis?

> Most likely you end up with a mixed private / public like other countries have.

You do realise we already do have that?

> Wealthy people would suddenly pay a lot more for their healthcare. That’s extra money going into the system for those who can’t pay.

Sorry how are these people

> No, there simply isn’t. It faces pressure yes, but nothing like the NHS.

Wait until it gets its funding cut back to the same level.

> That I completely agree. The mode of privatisation adopted in this country is completely dumb. We’re basically giving a licence to private providers to spend taxpayers money.

So your solution is what exactly? Lets see a clear cut case including how exactly you would be dealing with the funding issues. Again remember all these systems costs a lot more than the UK one. So where are you going to get this cash from?

> It’s the worst of both world. We don’t get the benefit of privatisation which is patient centric care and patient choice

Claimed benefit. Aside from anything else choice is a problematic statement. For choice you need information and the time to digest and use that information effectively.

As for patient centric care I think you are confusing the fact its just more resources available due to increased funding plus, of course, if things do go badly wrong they get handed to the NHS for the ultra expensive support. So we come back to the spending more on the system. Where is this magic money tree?

 Phil1919 09 Jan 2022
In reply to MG:

Perhaps we should all agree to look after ourselves better and reduce demand. Encourage a wellbeing lifestyle.

 jimtitt 09 Jan 2022
In reply to mik82:

> >Put simply, if your money is made by people getting sick, it doesn't pay to prevent them from getting sick.

> This isn't necessarily true. Private healthcare providers make a lot of money from "health checks". (The value of a regular health check is a different matter. There isn't really any evidence that they have any benefit in terms of health outcomes)

> One of the larger healthcare chains in the UK - Nuffield (a charity, one of the largest in the UK, so not profit driven) also owns a chain of gyms - so definitely in the preventative health business also. 

Indeed, a large part of their business. Incidentally Nuffield is a trust set up by BUPA who also have no shareholders and re-invest all profits in the company. So much for profit-gouging investors!

 LaGuardian 09 Jan 2022
In reply to mondite:

> Okay so how, where and when? Remember all these systems you are praising cost a lot more than the UK system even after the endless "reforms" and inclusion of private companies. So given that exactly how is it going to address the funding crisis?

Actually they don’t.
Yes Germany or France spend a little bit more as % of GDP on healthcare, but that’s mostly because they don’t suppress voluntary spending. 

The reality is that the NHS remains an international laggard in terms of health outcomes. Survival rates for the most common types of cancer are several points behind those achieved by the best performers. The same is true for strokes, as well as for the more holistic measure of amenable mortality. Waiting times are also longer.

It’s also not set up to handle the changing demographic. Others on here have made back of the envelope calculations showing that the model basically fails.

Post edited at 10:05
3
In reply to Jon Stewart:

> This'll go down well with you, but unsurprisingly I agree wholeheartedly with Starmer. You see I'm a pragmatist, I want to solve problems starting with the most urgent and working down the list, I'm not an ideologue.

> I refer a huge number of patients from their routine eye exam for cataract surgery. Waiting lists were getting silly, like a year. There's nothing wrong with these people, and yet their lives are put on hold because the service wasn't available - they couldn't drive (great if you live in the middle of nowhere), read the instructions on their meds, enjoy reading or watching TV. All easily fixed if someone could provide the facility.

> Private providers stepped in and blasted through the enormous backlog, and now I say to my patients "whenever you want them cataracts sorted, just gimme a bell and get you seen in a week or two". The providers carried on through covid with excellent isolation/ICP in place and my patients weren't scared to go (except when they got offered Preston!). The company in question ploughed back loads into the business and expanded so now I've even got a local site my patients can walk to! I do their post-op follow ups and can attest to the quality being superb.

> So yes, I agree that the fact some money is being skimmed off for profit, and to pay for sales reps and all that private sector crap, but this is one case of low-hanging fruit where the outsourcing model has done exactly as intended. The NHS pay the same fee that the work would cost in house, and the company solve a massive problem in a matter of months and make a huge difference to thousands of patients lives.

> Would I prefer it if the NHS could have just sorted it themselves without the skimming off? Course I do. Do I believe they could? No. Too much on. 

> I don't want to see the whole NHS operated on this model, but for massive backlogs of piss-easy work that makes a huge difference to people's lives, it works. Swallow your pride!

> I want good outcomes achieved as much and as fast as possible. I don't care about ideology. We can see that the NHS model has vast advantages over failures like the US system. It's in crisis. We need to throw more money at it, but we also need to use whatever's available to stitch it back together right now, rather than cut off its nose to spite its face (the hallmark of the ideologue).

> I haven't got the answers, but the principle of universal healthcare free at the point of use must be upheld and has firm democratic support (I hope I'm right about this and that it can't be successfully subverted by the scum). Beyond that, a massive dose of pragmatism is going to be required to save what's important us.

If these private healthcare providers are having to invest to create the capacity to be able to step in to tackle the waiting lists then there is no pragmatic reason why the UK government can't just invest in the NHS directly to do the same.

If these private healthcare providers already have the resources but they are holding the country to ransom in order to make super profits at a time of national emergency with the result being the suffering of millions then these nationally important existing resources should be nationalised.

That's pragmatic but it may go against the prevailing unquestionable ideology where private profit is prioritised over public health.

2
 Jon Stewart 09 Jan 2022
In reply to cumbria mammoth:

> If these private healthcare providers are having to invest to create the capacity to be able to step in to tackle the waiting lists then there is no pragmatic reason why the UK government can't just invest in the NHS directly to do the same.

I agree in principle - but in practice, I don't think the NHS is set up to do it.

> If these private healthcare providers already have the resources 

The don't, they bid for big contracts, I guess.

> That's pragmatic but it may go against the prevailing unquestionable ideology where private profit is prioritised over public health

The point is that in the specific circs of e.g. cataract surgery, the market forces which would demolish the NHS if prevalent can be kept in check easily. Basically, I'm the gatekeeper of who gets cataract surgery and who doesn't. I refer according to a set of agreed principles (it's good too, it's not penny-pinching arbitrary criteria of how many letters you can see on the chart), so the provider can't talk people into have ops they don't need.

You're just following the same old pattern of letting the perfect be the enemy of the good. It's unfair to deny people the ability to see just because you want their eyes fixed on a more socialist funding model. That's screwing people over, big time!

I'm not ignoring the skimming off of public resources. If history was different, then the NHS would be this incredible, agile organisation that could grow capacity where it was needed in the blink of an eye, but it isn't! We've got what we've got, and we need to generate the best outcomes we can from the resources, now.

Deal with reality as it is, not how you'd like it to be.

In reply to Andy Hardy:

Universal healthcare for all free at the point of use from the NHS is already dead but there is still a chance for it to be resuscitated. 

People expect that the excesses of Tory ideological mismanagement will be reversed by an incoming Labour government.

Instead Starmer and Streeting want to increase private healthcare involvement in the NHS. When this happens a 2 tier health system, where the poor die early due to a lower standard of care, will be the unquestioned orthodoxy.

I will never vote for this.

Better for the Tories to implement a 2 tier system than for Labour to do the same, then people will still expect a future incoming Labour government to restore the NHS.

Post edited at 10:54
3
 Jon Stewart 09 Jan 2022
In reply to cumbria mammoth:

Well thanks for making the country worse.

2
 LaGuardian 09 Jan 2022
In reply to cumbria mammoth:

> Instead Starmer and Streeting want to increase private healthcare involvement in the NHS. When this happens a 2 tier health system, where the poor die early due to a lower standard of care, will be the unquestioned orthodoxy.

 

There is a balance to be struck between providing equal standards of care to everybody and providing better health outcomes overall.

Equity of care is not very useful if the service is increasingly poor.

If some people want to pay more from their own pocket for a better / faster service, they should be allowed to do so, and the NHS can use the extra income to improve the healthcare of those who can’t. It also means they can invest in more newer / better more innovative treatments and equipment  that would otherwise never be offered because, although they may be better for the patient, would not represent value for money if they were exclusively paid by the taxpayer.

Post edited at 11:52
5
 mondite 09 Jan 2022
In reply to LaGuardian:

> Actually they don’t.

Yes they do.

> Yes Germany or France spend a little bit more as % of GDP on healthcare, but that’s mostly because they don’t suppress voluntary spending. 

Ermm so they spend more. Also what is this about "supress voluntary spending". You can spend as much as you like on healthcare in the UK as well.  Although they do save money by handing you back to the NHS if it goes really badly.

> The reality is that the NHS remains an international laggard in terms of health outcomes.

Thank you for the quote from the IEA shills. Now who is funding them again?

We can look at other studies showing that the NHS relatively speaking pound for pound does well.

> It’s also not set up to handle the changing demographic. Others on here have made back of the envelope calculations showing that the model basically fails.

No system is setup to handle the changing demographic.  So given the alternatives are more expensive what are we getting by switching to them?

3
 mondite 09 Jan 2022
In reply to LaGuardian:

> If some people want to pay more from their own pocket for a better / faster service, they should be allowed to do so,

Like they are doing now? I am struggling to see what you are trying to argue here.

Incidently whilst we are discussing choice. You do know there is actually a trend in surgery to restrict choice by centralising complex operations. The reason being if someone does an operation once a year or so they are generally going to be less likely to get it right than someone who does it weekly.

 LaGuardian 09 Jan 2022
In reply to mondite:

> Yes they do.

> Ermm so they spend more. Also what is this about "supress voluntary spending". You can spend as much as you like on healthcare in the UK as well.  Although they do save money by handing you back to the NHS if it goes really badly.

You can't go to the NHS and tell them I'll give you 10,000 pounds to let me jump the queue, or get a a better / more expensive treatment. You basically have to go with what they offer in most cases.

> We can look at other studies showing that the NHS relatively speaking pound for pound does well.

It is true that the NHS is cheap compared to other system. This does not mean it is more efficient though. It just means it is cheap.

> No system is setup to handle the changing demographic.  So given the alternatives are more expensive what are we getting by switching to them?

What about getting older people - who generally are wealthier - to pay a bit more towards their care if they want to extend their life ?

6
 Stichtplate 09 Jan 2022
In reply to LaGuardian:

> You can't go to the NHS and tell them I'll give you 10,000 pounds to let me jump the queue, or get a a better / more expensive treatment. You basically have to go with what they offer in most cases.

Say you want you're hip doing now rather than in three years. You go private, pay 17K, get an NHS surgeon doing the op in his own time and if things go tits up, an NHS ambulance will come and pick you up at your private hospital and take you to an NHS one to make it all better (or not), free of charge.

That's how it works.

> It is true that the NHS is cheap compared to other system. This does not mean it is more efficient though. It just means it is cheap.

and how much better would it be if it received funding in line with most other rich nations?

> What about getting older people - who generally are wealthier - to pay a bit more towards their care if they want to extend their life ?

Principles? The fact that far more elderly are skint than are wealthy?

3
 LaGuardian 09 Jan 2022
In reply to Stichtplate:

> Say you want you're hip doing now rather than in three years. You go private, pay 17K, get an NHS surgeon doing the op in his own time and if things go tits up, an NHS ambulance will come and pick you up at your private hospital and take you to an NHS one to make it all better (or not), free of charge.

Might be for your hip. But for many things private treatment is either poorer quality than the NHS or simply not available. 

We now have the absurd situation where private health insurance will give you a cash benefit for using the NHS if their provider can't offer your the treatment or you chose to use the NHS. 

Post edited at 12:39
2
 LaGuardian 09 Jan 2022
In reply to Stichtplate:

> Principles? The fact that far more elderly are skint than are wealthy?

Some are. But many have significant assets, for example most are homeowners.

2
 LaGuardian 09 Jan 2022
In reply to Stichtplate:

> and how much better would it be if it received funding in line with most other rich nations?

Probably not that much better unless other changes are made. The system will stay focused towards processing as many people as possible, as cheaply as possible, instead of focusing on the individual and preventing rather than fixing.

More importantly, where do you get the money ?

Post edited at 13:12
4
 redjerry 09 Jan 2022
In reply to LaGuardian:

There is a gaping chasm between the way english conservatives and european center right parties think.
Would English conservatives drag the UK towards something that looks like a tightly regulated European-style system or a US style free for all?
I know what my guess would be given the state of UK politics. If I still lived in the UK I'd be shitting myself if it seemed that the conservatives felt they could get away with major changes to the NHS.
PS. in a truly private system 17k for a hip replacement?....you're dreaming...try $100+k. The total billing for my hip in the US was something like $120k.

Post edited at 17:01
 Stichtplate 09 Jan 2022
In reply to redjerry

> PS. in a truly private system 17k for a hip replacement?....you're dreaming...try $100+k. The total billing for my hip in the US was something like $120k.

I can well believe it but then, as I pointed out, in the U.K. the NHS provides the private sector with a catch all safety net if anything goes wrong, as well as having trained most of the private sectors staff. All free of charge.

 redjerry 09 Jan 2022
In reply to Stichtplate:

No doubt.
I think a real flaw in the way people think about these things is that you can't extrapolate out what private care looks like on a small scale within the overall envelope an NHS style system.
ie. Private care in the UK doesn't give an accurate picture of what a private system would look like.

 Rob Exile Ward 09 Jan 2022
In reply to LaGuardian:

'focusing on the individual and preventing rather than fixing.'

I'm intrigued about what business model you could propose that would make a profit from NOT generating demand for the goods and services you are set up to provide?

Post edited at 17:53
In reply to LaGuardian:

Toast. Excellent...

 Phil1919 09 Jan 2022
In reply to Rob Exile Ward:

As an individual you may have rules that you try and stick to to keep you healthy. Eg no take away food. Don't use car for certain journeys, walk or cycle. Don't eat sweets mindlessly. Bring rules like these into the mainstream though sensible governance. Eg don't give out too many take away licences, ban car advertising, limits sweets as we do cigarettes.

 jimtitt 09 Jan 2022
In reply to redjerry:

Hmm, average cost of hip replacement in the EU including rehab etc €5043 (2019) and the cost is dropping.

 bruxist 09 Jan 2022
In reply to mik82:

Hi Mik82. I'm that you've completely missed my point. Apologies if that sounds a bit harsh! But allow me to explain -

The point of my anecdote was that it happened three and half weeks ago. At that time, prevalence in the area it happened was around 200 per 100k. Now, just short of a month later, it's pushing 3000 per 100k, and that's with a testing system that just isn't keeping up anymore. Our local ambulance service has 1 in 10 staff off. Our local trust is even worse hit.

What we had previously normalized as a sadly degraded standard of emergency healthcare is starting to look decidedly attractive in comparison.

This was published today: https://centralbylines.co.uk/is-the-nhs-overwhelmed-jakes-last-friday-on-earth/ . Worth considering that what it describes happened at the same time I'm referring to, just over three and half weeks ago.

A lot of the talk around the NHS always being under pressure in winter, and wait times being stretched to the point where serious damage is done, seems to me to gloss over what is happening right now. It strikes me as quite bonkers that we're still talking about if healthcare becomes overwhelmed, when it clearly already is. That degree of pressure wasn't inevitable, and to me it appears a much more devastating restriction on our ability to live normal lives than any of the NPIs previously in place.

2
 Dave B 09 Jan 2022
 MaryPlat 09 Jan 2022
In reply to bruxist:

> What we had previously normalized as a sadly degraded standard of emergency healthcare is starting to look decidedly attractive in comparison.

> This was published today: https://centralbylines.co.uk/is-the-nhs-overwhelmed-jakes-last-friday-on-earth/ . Worth considering that what it describes happened at the same time I'm referring to, just over three and half weeks ago.

Sobering accounts. Incredible that we leave people with a heart attack wait 9 hours in A&E. If that is not the system being in a state of utter failure then I don’t know what is.

3
In reply to MaryPlat:

Keeping the mods busy today...

 bruxist 09 Jan 2022
In reply to Longsufferingropeholder:

Oh ffs, not another one? And not just missing the point, which is blameless, but deliberately miscontruing the point?

 Stichtplate 09 Jan 2022
In reply to MaryPlat:

The whole story smells like bullshit to me Rom...and then you go to Central Bylines Facebook page and read "June Roche's" account and there are four comments. No condolences from friends. No heart broken messages from family. Nothing.

 jimtitt 09 Jan 2022
In reply to Dave B:

Well you wrote "PS. in a truly private system 17k for a hip replacement?....you're dreaming...try $100+k. The total billing for my hip in the US was something like $120k." 

 As you've discovered it's £6710 privately in Lithuania and maybe €17,000 in Germany. Keep crying about your $120k.

6
 Stichtplate 09 Jan 2022
In reply to jimtitt:

>  As you've discovered it's £6710 privately in Lithuania and maybe €17,000 in Germany. Keep crying about your $120k.

It was you that quoted an average of 5K for the op in the EU and it wasn't Dave who paid $120k for his hip replacement?

 bruxist 09 Jan 2022
In reply to Stichtplate:

That makes no sense to me. Why on earth would family condolences be posted on a newpaper article published a month after the death? The guy would be long buried. If you've got other reasons for smelling a rat then fair enough, let's hear them - but those you've given above are really untoward.

In reply to LaGuardian:

It’s not true to say that more people paying privately necessarily frees up capacity in the NHS for everyone else. Aside from what’s already been said, we’re already short of clinical staff. Most private services are provided by NHS clinicians either working overtime or reducing their NHS hours. So to expand the use of private services usually means reducing NHS capacity for the same procedures. The overall capacity stays pretty much the same, and wealthier people do indeed get to skip the queue, but things get worse rather than better for everyone else. Add to this the fact that those providing private services tend to be the more experienced staff (no one wants to spend thousands and thousands of pounds to be seen by a junior doctor) and your proposed model further degrades the NHS by reducing the skill base available. It’s a total fallacy that everyone benefits from more people paying privately. 

1
 Stichtplate 09 Jan 2022
In reply to bruxist:

> That makes no sense to me. Why on earth would family condolences be posted on a newpaper article published a month after the death? The guy would be long buried. If you've got other reasons for smelling a rat then fair enough, let's hear them - but those you've given above are really untoward.

The details smell off from a clinical point of view. It isn't a newspaper its a "citizen journalist" page. If someone's 98 year old Granny pegs out and a relly flags it up on on FB you'll get multiple posts from friends and family offering comfort.

In this case the wife has posted an, on the surface, heart rending account of her 48 year old husband dying and leaving a young family behind, but not one person that actually knows her has responded. Sound legit to you?

In reply to jimtitt:

> As you've discovered it's £6710 privately in Lithuania and maybe €17,000 in Germany. Keep crying about your $120k.

The $120k was IN THE US. The whole point of that stream of discussion was that the UK does not want to go down a US healthcare model. There are other mixed economy models that the NHS could adopt, but, as has been pointed out, our Tory government is much more likely to go with the US model, encouraged by generous US donors and lobbyists.

 bruxist 09 Jan 2022
In reply to Stichtplate:

Yes, it does. Partly because it's not a 'citizen journalism' page: Byline have fact checkers, which is more than we can say for most UK media. Secondly, no, I wouldn't expect anything on such an article from friends & family: their condolences would have been voiced a month ago, on personal accounts, directly to the person concerned. As far as I can see, they were. Her twitter, which is public and can't be retrospectively faked, stacks up. I can't see a single indicator that warrants scepticism from a media literacy point of view, but from a clinical point of view you'll know better than I, and if there's a 'tell' there then it's worth hearing; otherwise I think your scepticism is misplaced.

 Stichtplate 09 Jan 2022
In reply to bruxist:

> Yes, it does. Partly because it's not a 'citizen journalism' page: Byline have fact checkers, which is more than we can say for most UK media. Secondly, no, I wouldn't expect anything on such an article from friends & family: their condolences would have been voiced a month ago, on personal accounts, directly to the person concerned. As far as I can see, they were. Her twitter, which is public and can't be retrospectively faked, stacks up. I can't see a single indicator that warrants scepticism from a media literacy point of view, but from a clinical point of view you'll know better than I, and if there's a 'tell' there then it's worth hearing; otherwise I think your scepticism is misplaced.

If that's the case then I'm wrong and I apologise. The clinical facts still don't stack up though, 48 year olds with those sorts of recent medical histories and those sorts of presentations aren't considered 'fit to sit'. I can't even begin to envisage the series of failures required to allow this to happen.

From their site "Central Bylines is a regional online newspaper that supports citizen journalism."

Go on companies house and you'll find the parent company, Bylines Network Limited, registered less than 6 months ago with an address that appears to be an accountants in Barnsley. Too recent for any company accounts to be published, but forgive me if I don't buy that they're a legit newspaper.

 jimtitt 09 Jan 2022
In reply to Stichtplate:

> It was you that quoted an average of 5K for the op in the EU and it wasn't Dave who paid $120k for his hip replacement?

Indeed, it was somebody else doubting you could get it for 17k privately.

The €5k was from a reasonably reputable Swiss website and seems reasonable as an EU wide average.

 wintertree 09 Jan 2022
In reply to Stichtplate & bruxist:

This outlet appears to be completely separate to the Byline Times - the Byline Times being a highly credible undertaking indeed.  I'd not come across Central Bylines until now.

Edit: Improving my reading skills, they are "supported by BYLINE TIMES."  Companies house shows their Ltd entity as having two directors shared with Byline Times.  No idea how much of the rigorous editorial approach from Byline Times makes it in to this entity - it looks more community driven rather than editorial driven. 

Diving down the twitter hole, I have formed some opinions but a public forum really isn't the place to get in to it.

Post edited at 21:50
2
 bruxist 09 Jan 2022
In reply to Stichtplate:

I think you might be looking at the wrong company: it's clearly associated as the persons with significant control overlap, but it's obviously not the parent. The parent is co. no. 10143080 according to their site. They ran a massive media festival back in 2018, so have been going as a major concern for at least that long.

Post edited at 21:46
 bruxist 09 Jan 2022
In reply to wintertree:

Hm. Do you think they're not a part of the Bylines network at all? There are lots of local versions - Yorkshire Bylines is great, and a very useful replacement for the collapse of our local Johnson Media-owned press. Their complaints address is the same as Yorkshire Bylines.

 Stichtplate 09 Jan 2022
In reply to bruxist:

Nope. the link posted is to central bylines

 https://centralbylines.co.uk/is-the-nhs-overwhelmed-jakes-last-friday-on-earth/

from their about page: "Website designed and built by Yes we work based on an editorial platform developed for and in collaboration with Byline Times." which seems to be about the sum of their involvement with Bylines eg, F all.

Here's their page at company's house

https://find-and-update.company-information.service.gov.uk/company/13512419/officers

Take a look at the FB page of the team the man in question coached for and December last year sees everyone with a Birthday get a shout out and one poor lad with a fractured ankle gets a get well soon post...nothing for their coach that tragically died at just 48. 

Understandable if I'm a little sceptical?

Edit: doesn't look like a Jake Roche was registered as dying in Nottingham any time in 2021 either. I'll repeat, understandable if I'm sceptical? Especially so since it's yet another "new" poster who first brought this tragedy to our attention.

Post edited at 22:30
 wintertree 09 Jan 2022
In reply to bruxist:

I'm a bit confused TBH.  There's clearly links, but I think perhaps the regional sites are more community led with some degree of tieback?  If Byline Times are expanding in to regional news, I think that's a good step.

 Dave B 09 Jan 2022
In reply to jimtitt:

I think you'll need to cite the website for me to believe it as an average. 

 redjerry 09 Jan 2022
In reply to jimtitt:

Thats sort of my point. Throughout Europe, healthcare costs (including private healthcare costs) are held in check by the healthcare systems in place (both national and hybrid). What you get without those systems is the US system. (hence the "truly private" in my statement).
 

In reply to Jon Stewart:

> I agree in principle - but in practice, I don't think the NHS is set up to do it.

> The don't, they bid for big contracts, I guess.

> The point is that in the specific circs of e.g. cataract surgery, the market forces which would demolish the NHS if prevalent can be kept in check easily. Basically, I'm the gatekeeper of who gets cataract surgery and who doesn't. I refer according to a set of agreed principles (it's good too, it's not penny-pinching arbitrary criteria of how many letters you can see on the chart), so the provider can't talk people into have ops they don't need.

> You're just following the same old pattern of letting the perfect be the enemy of the good. It's unfair to deny people the ability to see just because you want their eyes fixed on a more socialist funding model. That's screwing people over, big time!

> I'm not ignoring the skimming off of public resources. If history was different, then the NHS would be this incredible, agile organisation that could grow capacity where it was needed in the blink of an eye, but it isn't! We've got what we've got, and we need to generate the best outcomes we can from the resources, now.

> Deal with reality as it is, not how you'd like it to be.

I'm glad to hear of an example of a symbiotic relationship that seems to be working well. 

What we can see though is that from at least 2006 (Blair's government), NHS spending on private providers has risen from 3% to 8%.

(graph available here https://fullfact.org/health/how-much-more-nhs-spending-private-providers/ and you can extend the graph forwards by looking at DHSC annual reports but I can't find anything for prior to 2006).

The period where private sector involvement in the NHS has more than doubled is the same period where the NHS has collapsed. Your area of expertise may have thrown up a good example but, on the whole, increased private sector involvement seems to have worsened outcomes.

Not only that but Wes Streeting is not talking about keeping market forces in check. He says he will be spending more money on the private sector than necessary but he will blame the Tories for it. Just like the Tories, Starmers Neo-Labour are ideologically committed to pouring public money into private profit.

> Well thanks for making the country worse.

When all the choices are committed to the same destructive ideology then there is no choice but it's worse if the Labour Party deliver the destruction as there will be no hope of restoration after that happens.

 jimtitt 10 Jan 2022
In reply to Dave B:

> I think you'll need to cite the website for me to believe it as an average. 

What you belive is of no interest to me.

8
 Dave B 10 Jan 2022
In reply to jimtitt:

That that overly aggressive reply made me laugh.  

Someone else could claim the average cost is £10,000, or £20,000 and rising and we would be no further forward. 

The only prices I have found are generally higher for private healthcare, but it isn't clear how private price relate to cost. I'm not sure that double of triple the cost is likely. 

There is a paper from 2008 that lists some cost around Europe 

https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.1328

However, these are very likely to be very out of date. 

 jimtitt 10 Jan 2022
In reply to redjerry:

> Thats sort of my point. Throughout Europe, healthcare costs (including private healthcare costs) are held in check by the healthcare systems in place (both national and hybrid). What you get without those systems is the US system. (hence the "truly private" in my statement).

>  

But the US system is far from "truly private", around 2/3rds of health spending is by the government and another 1/4 by insurance. Provider-wise 79% of hospitals are public/non-profit. Sure it's expensive (and for some crap) but to blame it all on "private" can't be the answer if as you say the hybrid system should automatically restrain the private sector.

In reply to jimtitt:

Its always struck me as being incredibly misinformed that the US system is " private". The amount the Federal govt spends on medicare etc is huge.$776 billion in 2020. Mouthwatering

1
 mondite 10 Jan 2022
In reply to neilh:

> Its always struck me as being incredibly misinformed that the US system is " private".

Equally misinformed to say that the NHS is an institution which cannot be changed (just see the endless changes inflicted on it eg Lansley reforms or just type into google NHS reforms and see all the dates which get popped up as auto complete) and that the private sector isnt already heavily involved (see GPs for starters).

For the USA though saying it is private is accurate enough for the day to day usage which would impact most of us who dont fall under the special categories. Medicare though utilises the primary private system its just it covers those uninsurable due to age.

 jimtitt 10 Jan 2022
In reply to neilh:

This debate isn't exactly being furthered by all the misconceptions sprayed around, "insurance" = ripped off by profit hungry shareholders when in reality they are mostly state-controlled/owned ansd non-profit (even in the ultimate bogey-man the USA they are strictly controlled regarding the proportion of income which must go to direct health costs). Exactly which countries has a purely-private health system is hard to identify but for sure it isn't the USA, neither funding nor provision.

At the other end of the ideological spectrum I'm suprised that Cumbrian Mammoth doesn't hold up Brazil as the shining example, they after all lead the world in universal, free at point of use health care provision with all and any medical treatment and medication equally available to all within the Brazilian borders. That the WHO rates them 125 for performance is a bit of a downer to ideologists I guess.

4
In reply to mondite:

It covers a bit more than that including those  past retirement age for preexisting medical conditions. Most self employed people in the USA heave a seigh of relief when they hit that age for prexisting medical conditions. Knew a guy who had cancer who was basically waiting for 6 months until he got to 65  so he could go on medicare. He earned alot of money and was self insured so to speak. he explained to me how it worked.I could not believe it.Its incredibly confusing about what is/is not covered.Almost impossible for us to understand.

There again alot of people in the NHS have to wait a couple of years, so nothing surprises me.

2
In reply to jimtitt:

Nicely put.

3
 Rob Exile Ward 10 Jan 2022
In reply to neilh:

Nobody in the UK has to wait 'a couple of years' for cancer treatment. That's unhelpful tosh.

And I still can't see what all these insurance schemes bring to the party. How does paying a 3rd party premiums, whether or not they are a NFP organisation, and then paying out from said pot to an arms length  healthcare provider, make the system 'efficient'? Whether NFP or not both parties will be chiselling to either minimise expenditure or maximise revenue; the only advantage that I can see is that it might provide a more secure funding stream, though if it is as regulated and controlled as you and Jim say it is then the insurance providers are limited in their scope anyway.

The biggest thing we could do with the NHS in my view is to remove it from direct government control, as is the (much smaller) BBC; a director general (respected by at least 51% of the workforce!) and a board of governors who actually bring expertise to bear, would be mind-blowing. Personally, I think there's an opportunity there for an opposition party to capitalise on the affection with which the NHS is held by proposing that, and blind side the Tories; unfortunately they don't seem to see it that way. Devolution hasn't helped either.

In reply to Rob Exile Ward:

yes it is tosh on cancer ( although we do not figure well in terms of cancer treatments as I understand it in comparison with Western Europe) I am talking generally about for example cataracts or hip replacements and was using it as an example to say we also push things back.

Jeremy Hunt did suggest that really things like funding training for Drs and Nurses etc should be pushed to the OBR so it was independent of politcial control. He does come up with interesting ideas these days based on his experience.

 jimtitt 10 Jan 2022
In reply to Rob Exile Ward:

That IS the point of doing it through insurance funds, they are controlled by the users (patients) and negotiate on behalf of them with the providers with the general conditions/standard of provision set by an independent commision made up of the providers, funds and the state. That's how it works in Germany, the power of the politicians is extremely limited.

2
 Rob Exile Ward 10 Jan 2022
In reply to neilh:

When he was Secretary of State he made some pretty grim, ignorant ideological calls - a '7 day NHS' and junior doctors' contracts, to name but 2. It comes to something when someone with his track record is now seen as one of the few voices of reason left within the Tory party... 

 Rob Exile Ward 10 Jan 2022
In reply to jimtitt:

'the power of the politicians is extremely limited.' Well I think we can both agree that that is a good thing. The money that has been squandered within the NHS in response to political 'initiatives' - launched by both parties - beggars the imagination. 'Internal Market.' 'Choose and Book.' 'Connecting for Health.' '7-Day NHS'. 'Test and Trace'... 

 redjerry 10 Jan 2022
In reply to jimtitt:
Wouldn't argue with the basic private/public terminology, please replace "truly" with,  how about?, "a lot more".
But the basic point still stands. More privitisation (like the US)
will likely lead to more expensive (and less effective)  health care. 
The incentives within the (please use appropriate pronoun) private US system are all wrong.
 

Post edited at 16:39
 mondite 10 Jan 2022
In reply to Rob Exile Ward:

> 'the power of the politicians is extremely limited.' Well I think we can both agree that that is a good thing.

It depends who replaces them. A major problem for the UK is both parties when in power seemed to be firm believers that the private sector was superior and did their best to ensure that was the case.

The politicians in Germany still have a lot of power both at federal level in terms of regulation and then also regional levels where they are more directly involved.

In reply to Rob Exile Ward:

And the junior doctors contract maybe worked out ok ish in the end did it not ( knowing some junior Drs I read of or hear  no complaints or mutterings on the contract overall certainly they do not come up in the current mess----- after all it was probably not his idea in the first place.).

But yes you are right and maybe his track record/experience now  helps him along the way.Alan Johnson once said that no Labour or Tory politican gets out of it unscathed if they are the Secretary of State..Its a blood bath for any politican now taking on that role. Javid looks haunted these days( so he should mind you).

Hunts comments on negotiating with the Treasury on funding for Drs training are fascinating.

In reply to redjerry:

Its going to be expensive either way.....

 jimtitt 10 Jan 2022
In reply to mondite:

Well the federal government regulate (set the standards and objectives) and also involve themselves in equalisation so the poor länder don't get worse service, the ĺänder are responsible for delivery and the local authorities for direct implementation, my local authority decided our local hospital needed a pedeactrics unit as the next one is 35mins away (with an expanding young population) and as they own the hospital anyway are just building one out of their own pocket. Flexibility which under a monolithic juggernaught is unlikely.

 mondite 10 Jan 2022
In reply to jimtitt:

> Flexibility which under a monolithic juggernaught is unlikely.

Aside from the NHs is a monolithic juggernaut but is instead a bunch of separate trusts (or whatever they are called this week).

In addition the duplication of services isnt necessarily a good thing since you not only increase costs but also depending on what is being provided potentially increase risk if they each start treating fairly rare conditions independently.

 chris_r 10 Jan 2022
In reply to Rob Exile Ward:

> The biggest thing we could do with the NHS in my view is to remove it from direct government control, as is the (much smaller) BBC; a director general (respected by at least 51% of the workforce!) and a board of governors who actually bring expertise to bear, would be mind-blowing.

That was pretty much the set-up with NHS England, under Simon Stevens. Massive autonomy on how to spend £130bn a year, away from government and Department for Health control. It looks like that autonomy is now being removed, and the chief exec has gone.

 jimtitt 10 Jan 2022
In reply to mondite:

> Aside from the NHs is a monolithic juggernaut but is instead a bunch of separate trusts (or whatever they are called this week).

> In addition the duplication of services isnt necessarily a good thing since you not only increase costs but also depending on what is being provided potentially increase risk if they each start treating fairly rare conditions independently.

Naturally it's coordinated, the two other hospitals which normally would receive the patients have beds freed up for other demands. There are other reasons as well to build, my local hospital is an outstation teaching hospital for the Munich medical university so they can provide more places for training pediatricians. For specialist treatment it's a ten minute helicopter ride to the second largest childrens hospital in Germany anyway.

In reply to jimtitt:

How does that work with charitable or private hospitals that feature in Germany. 
 

what do the wealthy do ? Use the system or go private say in Switzerland?

 jimtitt 10 Jan 2022
In reply to neilh:

There's enough luxury private clinics for the well-heeled usually beside some alpine lake!

In reply to jimtitt:

> This debate isn't exactly being furthered by all the misconceptions sprayed around, "insurance" = ripped off by profit hungry shareholders when in reality they are mostly state-controlled/owned ansd non-profit (even in the ultimate bogey-man the USA they are strictly controlled regarding the proportion of income which must go to direct health costs). Exactly which countries has a purely-private health system is hard to identify but for sure it isn't the USA, neither funding nor provision.

> At the other end of the ideological spectrum I'm suprised that Cumbrian Mammoth doesn't hold up Brazil as the shining example, they after all lead the world in universal, free at point of use health care provision with all and any medical treatment and medication equally available to all within the Brazilian borders. That the WHO rates them 125 for performance is a bit of a downer to ideologists I guess.

Never knew that about the Brazilian healthcare system but not a surprise to learn that a right wing government is undermining a free and universal public healthcare system. A lesson for what's in store for us here.

I do know that the diversion of public funds into private healthcare providers has doubled over the last decade and in the same period the NHS has slipped from 1st to 4th in the Commonwealth Fund ranking of 11 high income countries and from 9th to 12th in the Legatum Prosperity Index ranking for Healthcare.

https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly#rank

https://www.prosperity.com/rankings

Post edited at 22:32
 jkarran 11 Jan 2022
In reply to Stichtplate:

> And staff have had enough

I'm not disputing staff have had enough, the last couple of years on top of the sustained  systematic neglect must have been, must be, awful. However... even without the burnout and trauma of the pandemic would you not expect to see a big spike in resignations over the coming year or two as a result of the better-than-trend staff retention during the 2020/21 period and the temporary return of retirees etc? Those temporary returnees and those who deferred resignation/retirement to see the NHS through the worst of covid (fingers crossed!) will naturally be shed at a rate well above trend as the pandemic phase comes to an end (seems premature to call that but even pessimists can hope sometimes).

jk

 Stichtplate 11 Jan 2022
In reply to jkarran:

I can only report what I'm seeing in my own sector. What I'm seeing is a surge of people jumping ship mid career and the reasons they're giving are burn out, rock bottom morale and despair at plummeting standards

 jkarran 11 Jan 2022
In reply to Jon Stewart:

> Private providers stepped in and blasted through the enormous backlog, and now I say to my patients "whenever you want them cataracts sorted, just gimme a bell and get you seen in a week or two". The providers carried on through covid with excellent isolation/ICP in place and my patients weren't scared to go (except when they got offered Preston!). The company in question ploughed back loads into the business and expanded so now I've even got a local site my patients can walk to! I do their post-op follow ups and can attest to the quality being superb.

The problem with this is that the investment presumably isn't going right into the bottom of the training pipeline, it's effectively drawing capacity out of the NHS further exacerbating the problem for those who can't afford the private option. A great choice for the private providers, they get more capacity and more demand but it's utterly broken in the longer run.

I have a lot of sympathy with people who want to offer good service and those who need it but private care provided in this way is being built using material pulled from the foundations of the NHS.

> I want good outcomes achieved as much and as fast as possible. I don't care about ideology. We can see that the NHS model has vast advantages over failures like the US system. It's in crisis. We need to throw more money at it, but we also need to use whatever's available to stitch it back together right now, rather than cut off its nose to spite its face (the hallmark of the ideologue).

I don't think my concern is purely ideological, I think the NHS was pulled together at a very particular moment in history and is of immense value, once it's crumbled it doesn't, can't get built back up again without another moment like 1948. If private services ac operate genuinely in parallel without denuding the NHS of labour and experience it's potentially as you see it, a temporary crutch but I'm not convinced that's the case. It's this that's the bigger worry than the profit cost to me, the cracks in the NHS are showing but once it collapses it will not be re-built. The vast majority of us will be much worse off, likely exposed to the costs and risks of the American system for all but emergency care.

> I haven't got the answers, but the principle of universal healthcare free at the point of use must be upheld and has firm democratic support (I hope I'm right about this and that it can't be successfully subverted by the scum). Beyond that, a massive dose of pragmatism is going to be required to save what's important us.

I get the argument for pragmatism and I'm not wholly opposed, the problem is as more and more bypass queues, pumping more money into private providers than the NHS the skilled workforce doesn't grow, we're drawing resources from the NHS to that money (and potentially a less difficult work environment). Eventually 'free at the point of use' becomes little more than an empty slogan, true in principle but without the staff care is rationed to the point of near unavailability, the remaining service used only by a minority of desperate 'scroungers' and 'the irresponsible', or whatever the Mail will brand them (cf populist treatment of immigrants), while 'honest hard working responsible folk' pay through the nose for insurance and timely care.

jk

Post edited at 09:37
 Offwidth 13 Jan 2022
In reply to jkarran:

More NHS records broken: latest on the number on hospital waiting lists in England (November) is 6 milliion (1 in 20 waiting more than a year) and are known to be worsening; for waits in A&E, of the million users in December, 73% missed the four hour target; for those who needed a bed on a ward, 120,000 admitted spent more than four hours waiting (about a third); 13,000 waited over 12 hours (another record); 12.5 thousand bed blocking in the week to Jan 9th (due to failure to arrange care) up 20% on the week (BBC news 24 @ 11.13).

Demand for ambulances were just down from the October records: 9 minutes to reach an 'immediately life-threatening' call-out (the target is 7); for strokes and heart attacks more than 53 minutes on average (target is 18).

 jimtitt 13 Jan 2022
In reply to jkarran:

Just a question of the system, there is a parallel private training system for nursing staff and doctors here, ambulance staff are anyway independently trained.

 Stichtplate 13 Jan 2022
In reply to Offwidth:

> Demand for ambulances were just down from the October records: 9 minutes to reach an 'immediately life-threatening' call-out (the target is 7); for strokes and heart attacks more than 53 minutes on average (target is 18).

Those figures kind of understate how bad it is. The last 2 years has seen a 27.5% increase in cat 1 calls, while at the same time Paramedic Emergency Service crew are being paired up with untrained staff under emergency measures and sent out as full fat ambulance crews.

Net result; slower response times and less clinical training on scene when crews do arrive. 

Knock on effect: huge increase on pressure on staff which is resulting in more experienced staff leaving or going on long term sick.

Vicious circle.

 Stichtplate 13 Jan 2022
In reply to jimtitt:

> Just a question of the system, there is a parallel private training system for nursing staff and doctors here, ambulance staff are anyway independently trained.

You really can't get it into your head that the vast majority of British people are happy with the system.

What they aren't happy with is that system being steadily dismantled through a combination of political interference, chronic underfunding and poor management, with all three of these factors being intrinsically linked.

 wintertree 13 Jan 2022
In reply to Stichtplate:

> Vicious circle.

Viscous spiral towards a vanishing point.  Far worse than a vicious circle.

 Offwidth 13 Jan 2022
In reply to Stichtplate:

I know exactly what it's like working long term in an understaffed and over pressured team.  The difference between us is your patients face consequences of death and much worse life outcomes because of it. I can't stress how much I sympathize with being in the middle of something like that. I don't know how you keep going and tip my hat that you do.

I've just had to turn off Javid on the news as it was making me really angry. He was boasting about how wonderful his government are at a time when the NHS is under the most pressure it has ever been under, and made even worse by his decisions over and above the damage the shadow minister pointed out (list below*). Keeping the NHS working was the primary control measure in the pandemic and our NHS, Public Health and Care System is in the worst state of any health system in Western Europe. His response to the opposition statistics was to pretend the opposition don't care about NHS workers. This man is scum to be calling on such dishonest rhetoric in such a crisis.

*just some of what Javid did wrong after Hancock left: let covid run too hot leading the system under continuous strain through the autumn (back to your point on what that does to NHS staff, waiting lists and deaths); pick a fight with NHS CEOs and a return of the idiotic target culture that led to the Mid Staffs tragedy; picked unnecessary fights with evey staff side group;  enforced the departure of unvaccinated care staff, leaving the care system in even more of a crisis for no health protection gains; hasn't U turned yet on the NHS unvaccinated staff being at a minimum removed from front line duty (5% across the UK and 10% in London), where they are so desperately needed, with the deadline for first jabs in three weeks; messed up test plans for omicron; effectively giving up on vaccination by ignoring the rolling out of known good practice, despite boasting about it and blaming the unvaccinated#; finally defending the PM today who blatantly broke government rules in the height of the first lockdown.

# I think those failing to get vaccinated are being foolish, are hurting their country, the NHS and their staff, but I can't blame them when they get the news they trust through social media; because the companies that run the services, and our government that regulate them, have done so little to remove organised active efforts on vaccine misinformation.

3
 TomD89 13 Jan 2022
In reply to Offwidth:

> More NHS records broken: latest on the number on hospital waiting lists in England (November) is 6 milliion

That appears to be a full 2 million more on average than pre-pandemic.

NHS staff forgoing test requirements, not having to isolate, and not being forced out of their jobs due to incoming mandates (also an additional barrier for future recruitment) would go some way to speeding this up; or at least not making the problem much much worse. The small increase in potential covid spread, in a overwhelmingly vaccinated/prior immunity population, would possibly not be more harmful than having further treatment delays for more severe disease eg. strokes, heart attacks, cancer etc where delayed treatment is definitively more fatal or life changing. I presume that's the direction we are moving in anyway, so perhaps a realistic look at whether delaying that for a few more months might be warranted or not? 2 million+ worse health outcomes dwarfs far smaller covid prevalence increase?

I understand it's a complicated and inter-related matter, and we've recently reduced the isolation period slightly, but I can't help feel that those thousands of staff missing 5 days:

  • For mostly asymptomatic or mild, cold type illness
  • To protect people with very high likelihood of existing immunity....
  • ...that are already in hospital, a place with the highest capability to prevent person to person transmission and best place to be if you suddenly develop a bad case (eg. noticed, and preventative treatments deployed, early).

TLDR; stop seeing healthcare issues through a primarily covid focused lens, de-emphasis on it's emergency threat status and move faster to a more holistically considered strategy to deal with the backlog. 

4
 jimtitt 13 Jan 2022
In reply to Stichtplate:

> You really can't get it into your head that the vast majority of British people are happy with the system.

Well I'll admit I didn't realise UK ambulance crews were trained to see what is in my head!

5
 Offwidth 13 Jan 2022
In reply to wintertree:

Forgot to comment on the CDC rules on quarenteen and isolation. The opposition raised this as being too slow a change (I'm still unsure until I can see UK details and how they pan out, as I don't want infected or exhausted staff being forced back to work).

https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

 Offwidth 13 Jan 2022
In reply to jimtitt:

You could be a lot kinder on these threads since we are comparing a vintage MG with a vintage Merc. Our NHS  'drivers' care and do their best, too often at risk to themselves.

 jimtitt 13 Jan 2022
In reply to Offwidth:

Didn't realise this thread was merely for moaning about things and praising ambulance crews, others are using it to look at the advantages and disadvantages of other systems which could perhaps be partially incorperated into the UK health system.

4
 Offwidth 13 Jan 2022
In reply to jimtitt:

Yes and there is nothing more important in that than levelling up on GDP share of expenditure. NHS staff typically do the best they can with the limited resources they have. Going further down the expenditure ladder and looking at Cuba (ignoring their horrible political system) their health service gives phenomenal value for money.

I've linked that Dispatches documentary showing other big changes we could make without changing the nature of the NHS for the same expenditure (by reducing avoidable costs).

 abr1966 13 Jan 2022
In reply to TomD89:

> That appears to be a full 2 million more on average than pre-pandemic.

> NHS staff forgoing test requirements, not having to isolate, 

Are you seriously suggesting this? I'll give you an example...do you think my daughter, who works in a paediatric oncology ward with very poorly children... with hugely suppressed immune systems should go in to work untested or if covid positive?

> ...that are already in hospital, a place with the highest capability to prevent person to person transmission

This comment illustrates that you have little or no understanding of what is happening in hospitals or of viral spread...

1
 cb294 13 Jan 2022
In reply to Stichtplate:

German system vs. NHS?

Even 20 years ago, if you had ANYTHING serious or you required a dentist, the first thing was to grab your EU insurance form and  hop on a plane back home to the continent.

In my own experience the NHS has given me sepsis after I slashed my wrist when a piece of  iron bar snapped, covering the wound in dirt and soot. At A and E I was given a sterile water drip to clean out the wound myself but no rack or bucket, so I sat on the bench in the waiting area of a major uni hospital with a rubbish bin I found in the corner to collect the blood an water mix, and the bag of sterile water on my head. Got sown up, went to a confernce the next day, and surprise, surprise, woke up in the hotel the next day with my arm as thick as my leg and oozing pus from the wound.

I have, however, received excellent and quick treatment for an ankle injury at the same hospital, while a friend who was diagnosed with leukemia during pregnance at the same place was given an estimate of 8 weeks befor she would have been seen by a consultant. Again, she was on a flight home the next day and then straight to the hospital for diagnosis and treatment. No point in joining the lottery if you have an alternative!

While I find the idea of a nationalised health povider appealing in principle (health should not be a commodity!), the way it is organized does leave the funding level open to political pressure. IMO this predictably results in the chronic underfunding seen today as long as small state neoliberalism holds sway as the standard political and economic dogma. If you want a functioning, state run health system you may have to go all in: Health provision was actually quite good in the former GDR! *

Clearly, UK medics individually are not better or worse than those in Germany, but for the whole system you simply get what you pay for.

Seen from the outside, the emotional attachment to the NHS strikes most continental expats in the UK as rather bizarre. No idea what they are doing now after the reciprocal treatment has ended post Brexit.

CB

*Obviously that was a bit tongue in cheek, intermediate examples like the Scandnavian systems do exist!

In reply to cb294:

It’s good to hear expats experience of their local healthcare systems. They also demonstrate how hybrids involving mix of sectors to deliver could work easily in the U.K.  But I doubt from a legacy perspective whether we could ever switch the turmoil would be to great. It’s a real pity.  

 mik82 13 Jan 2022
In reply to cb294:

This is definitely something I've noticed with patients from many European countries. They're often  aghast at the labyrinthine processes and delays compared to what they're used to at home. Like why do they have to go on a waiting list for months whereas at home when they're told they need a specialist appointment they just phone up and book one the next week?

1
 elliot.baker 13 Jan 2022
In reply to jkarran:

> exacerbating the problem for those who can't afford the private option

you both make good points, but apologies if I’ve misunderstood - isn’t Jon S saying he refers patients to the private provider who do the work “for the NHS”, ie the patients don’t need to pay for anything. That’s the “private” healthcare model at play here - not “private patients” paying for their own care. 

if so there is no concern about affordability for patients, in this context? 

In reply to Offwidth:

> You could be a lot kinder on these threads since we are comparing a vintage MG with a vintage Merc. Our NHS  'drivers' care and do their best, too often at risk to themselves.

No one is doubting that any uk healthcare staff are hard working and care, but the "don't question the national treasure" means it's impossible for the nhs to improve for the 21st century. Maybe the 20th century structure and funding model just isn't optimum for 21st century treatments and service? 

In reply to cb294:

Indeed, broadly similar in sweden a blended system of public and private. But a key factor is booking direct, you don't waste local doctor or nurse slots for something that clear needs a referral. I've just checked now and I could get an appointment tomorrow afternoon with a physio, that's the kind of treatment speed that heals folk quicker and keeps the workforce working! 

 Rob Exile Ward 13 Jan 2022
In reply to summo:

You are talking extraordinary b*llocks, if I may say. The NHS is constantly evolving, constantly developing new pathways, protocols, ways of working ... it's extraordinary how such an organisation maintains enthusiasm for change, particularly when under a constant barrage of criticism by people who should know better.

As for funding ... if it makes you feel better, hand 20% of the cost of any treatment you receive to a friendly insurance company. It won't make any difference to the outcome, but at least you can kid yourself that you're receiving US style treatment.

5
In reply to Rob Exile Ward:

Glad to hear all is well in the nhs then. 

Why when you have some aspects of care privatised, does it have to involve insurance companies? A private provider is just paid directly for each patient. You just gave a perfect example of don't knock the national treasure, going off on some insurance tangent. 

2
 Rob Exile Ward 13 Jan 2022
In reply to summo:

Have you ever been a 'private provider'? On a small scale I have - 3 times.  It's a 'compromised' situation, to say the least.

Which isn't in fact to say that private providers can't or shouldn't be used within reason ... but always recognising that they are a step on a very steep slippery slope.

In reply to Rob Exile Ward:

> Have you ever been a 'private provider'? On a small scale I have - 3 times.  It's a 'compromised' situation, to say the least.

Obviously not. But maybe there are better private provider models elsewhere in Europe? Again it's back to the don't question the national treasure. 

 mondite 14 Jan 2022
In reply to summo:

> Obviously not. But maybe there are better private provider models elsewhere in Europe? Again it's back to the don't question the national treasure. 

No its asking for the benefits? The problem with all these models is they cost more so switching to them when the primary problem is funding is somewhat counterintuitive.

I love how people trot out the moronic "dont question" since its primarily done by politicans who are trying to hide that they are buggering it up.

In related news looks like the government is handing over even more cash to the private hospitals.

https://www.theguardian.com/society/2022/jan/13/sajid-javid-nhs-england-private-hospitals-omicron

 TomD89 14 Jan 2022
In reply to abr1966:

> ...that are already in hospital, a place with the highest capability to prevent person to person transmission and best place to be if you suddenly develop a bad case

> This comment illustrates that you have little or no understanding of what is happening in hospitals or of viral spread...

So you're now going to tell me a place that has a higher understanding of viral transmission, wears more high grade PPE (effectively fitted), and has more rigorous medical hygiene standards than a hospital. For bonus points you can tell me a place you'd rather be when you realise you're one of the unlucky ones with a bad case of covid. When you do that I will happily concede your point.

>do you think my daughter, who works in a paediatric oncology ward with very poorly children... with hugely suppressed immune systems should go in to work untested?

People with hugely suppressed immune systems are at risk from basically all transmissible diseases and special precautions are taken around them anyway, that won't change. Maintaining testing in these scenarios is obviously sensible, if NHS staff normally working in this setting are found to be positive they could be redeployed to other less immuno-sensitive wards.

My understanding is that someone exposed to the virus is not then immediately infectious to others that same day, it's usually day 3, once virus has been able to incubate that they are then infectious. You wouldn't necessarily need to stop testing in it's entirety, it's just a matter of being more strategic about how you handle positive cases and dropping the automatic 5 day isolation.

You can just dismiss every suggestion outright and continue to apply one size fits all across the board and send all staff home who test positive for 5 days. The waiting times will continue to increase, NHS staff will get more stressed, more will leave, less will join, and that will reach it's inevitable conclusion. That's the path we are on. What's your counter-suggestion?

Post edited at 08:48
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 jimtitt 14 Jan 2022
In reply to summo:

The guy waiting for an MRI scan at 8;15 this morning was state insured, referred at 12 yesterday. I'm privately insured and was referred at 12.30 and had a CT scan at the same time, the radiology clinic is completely private. It's a matter of the two systems working together.

My wife sees both public and privately insured patients as well, like Jon Stewart above she is an opthalmologist and for cateract patients the waiting time is until Thursday with no referral system as they are operated in-house. Because the practice also does private eye corrective surgury they can justify an operating theatre and an expensive laser system and staff to the benefit of the normal patients. It's called symbiosis.

Interestingly one sees that the US health insurers have recorded unprecedented profits last year due to the lower numbers of hospital visits and operations because of Covid. This excess profit does of course have to be repaid to the insured as the margin is capped, the actual profit was 3.8%.

In reply to jimtitt:

I though you said you were insured via a mutual?

Of course the paradox in the UK private system( BUPA, Spire and other hospitals) is that it is often staffed by NHS consultants, doctors and nurses doing 2 jobs.And the system allows that to happen.

I guess its the same in Germany with consultants etc. Or am I wrong?

Post edited at 09:17
 jimtitt 14 Jan 2022
In reply to neilh:

Private insurance is anything outside the state insurance, most if not all are mutual funds, they even have them in the USA (Blue Cross is probably the best known).

Apart from the exclusive luxury clinics for the very well heeled there's no seperation in the hospitals as the government is not a provider (i.e. there is no NHS). My local hospital is owned by the district council, operated under contract by a commercial operating group and takes all types of patients. Who works where I've no idea but there must be some crossover as my wife occasionally provides emergancy pediactric cover in the hospital although she works in a normal practice.

In reply to jimtitt:

Having some services privatised isn't the same as insurance funding them. Private facilities are paid a fee direct from state health services, there's no insurance scheme or profit for an insurance company.

In reply to mondite:

> No its asking for the benefits? The problem with all these models is they cost more so switching to them when the primary problem is funding is somewhat counterintuitive.

Maybe they cost more because prompt treatment, with modern facilities, medication etc.. isn't cheap? That's the discussion the nhs, the public and mps need to have. 

Of course it gets lost in sentiment... always starting with "I'd just like to thank the hard working nurses, doctors....." by the time the platitudes end no one wants to say the nhs needs 2 or 3% on income tax across the board. 

 jimtitt 14 Jan 2022
In reply to summo:

> Having some services privatised isn't the same as insurance funding them. Private facilities are paid a fee direct from state health services, there's no insurance scheme or profit for an insurance company.

You mean in the UK? I know.

In reply to jimtitt:

> You mean in the UK? I know.

I mean in sweden I can book direct with a private physio, or dermatologist for say removing a suspect mole, and other practioners. All private, I pay the same appointment fee as if I went to a state run equivalent, the providers claim additional costs against the state. Their computers are integrated with the state system and with an ID system there aren't any avenues for fraud either. There is no insurance, or insurance provider profit at all. 

Post edited at 11:02
In reply to jimtitt:

Its the terminology which confuses to those if us in the NHS system. Mutual funds are not what most people view as profit sucking vampires. BUPA is similar in its financial structure in that its profits are reinvested back in the business and not to its shareholders.

In a way the likes of BUPA are providing rent seeking facilities( the hospital etc) to the NHS when the NHS contracts services to them.So it is almost similar to your set up.


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