Be Excellent To Each Other

The problem with private sector involvement in healthcare is that they're companies that are inherently driven by profit margins and shareholder value. Healthcare is somewhat the opposite. There are conditions that are extremely expensive to treat and the motivation is always going to be there for companies to find ways to not offer expensive treatments, or to find ways to avoid paying out at all. A national healthcare service has to be altruistic at it's heart, and that's a tough sell in the boardroom.

Surprisingly perhaps, but I agree. I wish people/Parties would have the political courage to just come out and baldly state the NHS, as a model, doesn't work (or is demonstrably much worse than the best of the rest), so instead of endlessly tinkering at the edges, bin the entire thing and start again with a Spanish, Austrian or Finnish mode (or whatever) from the ground up, in one giant hit. All we need to do is just copy what they do.

I don't think that's something you can state though. Yes, it's straining under pressure, but in terms of quality of care and survival rates it's consistently up near the top of the scoreboard.

I think the problem with people's perception of the NHS is that it is an attempt to get 60 gallons into a 55 gallon drum.

Seriously, how is it then that these private sector companies with shareholders and boardrooms ARE able to so successfully deliver in Austria, Spain, Finland or wherever? The answer lies in the frameworks upon which those systems require them to operate, and all we need to do is copy them.

It's not so much a case of whether the current structures and funding levels achieve the good outcomes now, but whether they will provide a similar or better standard in thirty years' time, especially against an ageing population, greater dependency ratios, and rising costs.

I probably need to spend a wet weekend reading papers from the Kings' Fund because I'm really not sure where to begin to attempt to answer these points.

Spain has the same model as us - fully funded state healthcare or private via insurance. It's pretty close to identical.

Wait, and so is the finnish model. I'm confused.

You did read that OECD table I linked to in my OP, right? It's one table, on one A4 piece of paper.

But seriously, I really should know better. You can never be told, end of.
As I've remarked before, it's the same syndrome as and his bust-up with GCSE Physics, and I've really no time for that kind of thing if I'm honest.

What "Private Sector based systems"? The countries you've mentioned, Austria, Italy, Finland, Spain, Canada all have universal public healthcare. You can't have universal healthcare without state intervention and involvement. (Note that even America has state-funded Medicare and Medicaid.)

The British NHS is historically one of the most influential healthcare systems. The Italian health system's name translates as national health service for a reason. The premier of Saskatchewan, Canada who introduced North America's first public healthcare system was deliberately influenced by the NHS. Just two examples. Yes the NHS is imperfect, but it is bollocks to claim that the NHS never influenced other countries.

If you want a reason why Austria has three times as many beds per capita, incidentally, it's because the system is funded by social insurance, therefore suppliers of healthcare (hospitals and clinics and so on) will have spare capacity. The supply and insurance/assurance elements of healthcare provision are de-coupled under that system, unlike the integrated NHS model.

London Underground was influential too, and that's lagging behind most other underground train networks.

Not that anyone mentioned influence, but still.

Privatising it will still only stand a chance of working if you either increase the money coming in (through people paying, or paying more) or decrease demand (and you want to do that by decreasing the number of people using it for things that will get better on their own, rather than sick people just being scared to go, but the latter will happen too).

The thing that's often missed by 'make it private, because private sector is skill' advocates is that demand is increasing by 4% per year, and money isn't. Doubtless there's some slack in any system, but healthcare is special, in that people will put more effort in more or less any time they can see that doing so saves lives/helps. In a pizza place? Less so.

Compare to that pizza place. Demand increases 4% each year. But no (or little) more money is received. First year, fine - you've got to make more pizzas, people have to work a bit harder. They get less downtime to chat, a little less happy perhaps, but you find a saving on tomatoes, and everything works. Next year, 4% more pizzas again. Still no more money, so no more staff. Maybe you find another way to save money, but keep the quality the same. Next year, 4% more demand again. By now, you're out of great ideas to save money. You're shipping out even more pizzas, your staff have no spare time, some of them quit, and are replaced by others - are they as good?

No business, long term, can cope with that - 4% increase in demand every year, with no extra revenue.

This graph (being the first one I found) suggests that spending is increasing by way more than 4% a year, though.

It is old! ignore it and I'll find a better one.

Ugh. They're nearly all as a % of GDP, which means nothing.

That was my replay to Cavey falsely claiming "Almost no-one uses the NHS model…". As Cras has noted in his posts above, Finland and Spain based their health systems on the NHS. It's a common claim by people in favour of privatising the NHS that no other country adopted or was influenced by the NHS model, which is very much untrue. Technically speaking, the NHS has been the most influential health system worldwide, along with the (West) German system, the latter inspiring nations as wide as Japan and Israel.

(No, of course that isn't me saying the NHS in 2016 is perfect or in a good state, or that other countries duplicated the NHS down to the last detail.)

I guess the comment I'd make here, JBR, is that if there is a '4% increase in demand' each year, presumably this will be down to factors like an ageing population (as well as an increasing one through net migration) - but these factors are surely little different to the other better 'competitor' systems of Europe or Canada costing similar amounts, for more bangs-per-buck? How come they can cope better, achieve more beds per capita (for similar outlay) than our creaking NHS, with its burgeoning deficits and so on?

The other point to note, of course, is that as Grim... says, it's not even the case that the NHS budget is static and unchanging, it's anything but. Real terms spending has very much increased these last 10 years, despite lean, post 'financial crisis', austerity-driven times.

My understanding is that NHS net expenditure (resource plus capital, minus depreciation) has increased from £75.822 billion in 2005/06 to £117.229 billion in 2015/16 (+55%). Planned expenditure for 2016/17 is £120.611bn (+3% on last year), and deficits (i.e. overspending beyond budgets, a 'business overdraft' if you will) are increasing to boot. So really, the pizza place analogy doesn't work mate.

According to that, the yellow line (i.e. actual cash spend, at 2010/11 prices) went from £60Bn in 1997 (end of the Tories' rule) to c.£110Bn in 2007 - that's not far off doubling in a mere decade. Bloody hell, that's a massive increase, and we're *still* bobbins..?.

By way of comparison, this health spend rose from c.£39Bn in 1980 to perhaps £42Bn in 1990 (i.e. over 10 years of Tory govt). That's a real terms increase of around +10% for the entire decade (not +100%)

You keep asserting this, but I don't know where you're getting it from.

http://www.nhsconfed.org/resources/key- ... on-the-nhs



If your only metric for a healthcare system is value for money, then I can see a valid source for concern. But it absolutely should not be the only, or most important metric.

Also, see the last couple of pages for further examples, Austria, Australia etc.

I don't mean to sound nasty, Cras, you're a nice guy and one of life's true gentlemen. I like you a lot. Frankly though mate (IMO) you will never see this, because for whatever reason, you too far vested in the beliefs and arguments you've been making for the last few years (albeit I cast my mind waaay back to 'the early years' and, IIRC at least, you used to think as I do).

But then Craster linked to a independent study ranking the UK above those countries you mentioned. You can find plenty of categories where the NHS does better for less cash. The WHO ( admittedly back in 2000 ) put us pretty much in the middle of those countries.

Plus, it's worth mentioning, that many of the countries with far worse health services than us have large private sector involvements I agree there's plenty wrong with the NHS but I'm not convinced that more private sector involvement is the answer.

But it worked so well with Southern Rail!

I know people who end up driving for 30 mins each way just to get a train from a Southeastern station rather than a Southern one. By the sounds of it they couldn't have ended up with a worse service if they specifically set out to do so.

Well to be fair, I tried answering your query in 2 words.

Look, all I have said - all I have ever said - is we should simply COPY and emulate the best systems which are so demonstrably performing better than our own, for similar cost. If that involves partial, or even substantial public sector involvement then so be it, I could not give a toss/there is no ideological barrier. Fuck ideology, in fact (something else I've long said as well, for the record. I leave all that slavishly following stuff for its own sake to others).

To my mind it really is very simple. In business, if stuff isn't working in comparison to what others do and can achieve for similar outlay/investment or whatever, I change it. After all, it's not as if I've got the luxury of not doing so, because my competitors will do the same whether I like it or not. It's a tough old world out there.

Aaaand we're back to the USA Healthcare example syndrome (same man, different hat on).
No-one has said, of course, that ALL private sector = good, there are loads of lousy private sector firms, many go bust every week. So quite why an example of the US Healthcare system or Southern Rail are relevant, neither of whom are being advocated, is anyone's guess.

They're not! I just like hearing the horror stories of people whose commute I no longer have to share!

*applause*

The problem is the _way_ we privatise. It's not based on 'who can give the best service and the best value' it's based on 'that company is shit, but it's run by my cousin. Once I get sacked or votes out, he'll give me a cushy job with a megabucks salary... Best make sure they survive until then. More subsidies!'

Cynical, I know.

I think the main point of it is that if we tear things up and start again then there is a significant risk that for all the good intentions, we could end up with something worse than what we started with.

The NHS is far from perfect, but it is demonstrably better than most, and consistently gets rated as one of the best systems in the world. To rip things up and start again, providing a better level of care, with no interruption of service, with no extra cost to the taxpayer, without the government providing sweetheart deals to their favourite private healthcare providers (and if you can find me any without major Tory links I'll be impressed) is just a massive, massive gamble.

And it's a gamble that will kill thousands if we get even a little bit of it wrong, or play a little bit too much into vested interests.

The current government have shown themselves to be utterly unable to get even close to organising Brexit, and have failed to meet their economic goals on the deficit every single year. Why do we suddenly think that if they were to take on the single biggest restructure in the history of the world, they would do it with a level of perfection that is literally impossible?

If we could tear it all up and start again, and do it fairly, and without any cost to the level of care provided, then I'd be all for however it was done. I use private healthcare; I've nothing against it in principle.

I just don't think it is possible to do, and certainly not without a shitload more competence than we have in the government, and I consider them a shifty rabble who are still far better at this kind of thing than the opposition would be.

Last year my father in law who lives in Dublin had some issues with sodium levels caused by medication he has taken for years

He was on a bed in a corridor for the best part of 2 days before getting on a ward, then a week later was back again for more or less the same wait!

I'm lucky that I have BUPA for all of us through work, although it gets you in quickly there is a blur between private and NHS, a lot of the consultants work for the NHS then do mid afternoon to late evening private work a few days a week.

I remember to taking my son to the local hospital for a private appointment when he was a baby. The local hospital is brilliant but has shit parking due to its location and the fact it has a helicopter landing pad which stops them from building a high car park.

So we were late and then the consultant was 30 minutes late so I was pissed off as I was paying etc. When she arrived she apologised and told me she had been called in to an NHS patient who's child had died during birth As she was the senior consultant she had do deal with that and manage the upset that the junior doctors obviously had. I immediately got over myself when hearing this but it was the first time I realised that private is not 100% of the consultants time.

I do sometimes wonder what effect BUPA has on people without it, I guess you jump the queue maybe not directly over an NHS patient, but the NHS consultants are using some of their time for private work. I have it so will use it, but would be happier if I was drawing on a pool of people that were 100% dedicated to it.

I don't know if private companies will help the NHS, I guess they would want profit, but I think that there is money wasted by the NHS so maybe there could be a balance? What won't work is the faceless shit companies that were put in place to manage tax credits and disability allowances.

good, long, piece by A Campbell on Trump, Brexit and the successes of the campaigns.

Good read, that.

The stuff nightmares are made of.

Whilst I don't disagree with much he says there it still seems a bit rich for a fucking spin doctor, a hired bullshit artist, to be moaning about post-truth politics.

Quite.

I literally refuse to voluntarily read a single word of that man's output.

Man, this "I agree with Mark" malarkey has to stop.

I need to stop agreeing with Myp...oh, we've done that.

I know it sounds a bit bad, what with Labour in derisory 4th place in a by-election, during what should be a time of mass protest against an at-times shambolic government, but hey, it's not all bad.

Corbyn and his team *absolutely trounced* the Bus Pass Elvis Party.

"Sleaford and North Hykeham" sounds made up, the sort of constituency one of Berties pal's is being made to run for by his uncle in order to keep receiving his allowance. Also, 37% turnout is bloody awful, isn't it? I know By Elections rarely have high turnout, but that sounds really low.

It's awful. But, here we are.

So you've never heard of the Sleaford Mods?

YouGov:

CON 42 (+3)
LAB 25 (-2)
LD 11 (+2)
UKIP 12 (-2)
GRN 4 (=)
SNP 5 (=)

4th-5th Dec
N=1,667
Tabs/writeup https://t.co/8GjwWGWaVe

Lowest Labour in opposition since '83

The Lib Dems are on the rise!

Margin of error notwithstanding.

Corbyn's starting to make Michael Foot look good - all as predicted.
I reckon the Tories will hit 50%, seriously. Labour's decline should bottom out at around 16%.

I hope so.
I'd love to see Labour annihilated out of existence and the Lib Dems massively stronger. I thought the Con-Lib coalition was awesome, far better than this Con govt. for my tastes.

I actually voted LD during the GE before last.

If people see Brexit (or whatever actually happens) as going well, and Corbyn keeps Corbyning, I think you're right and Labour may well get stomped.

Also, don't knock the Bus Pass Elvis Party. They speak a lot of sense regarding corporate power on our High Streets, animal welfare, rural infrastructure and amenities, and the installation of Euthanasia Booths in Wetherspoons.

I voted LibDem in 1997, 2001, and 2005. But after the reduction in 2015 from a party to more of a cosy soiree I think it's far too soon to roll out the banners.

Don't you live in Tatton?

Not far off....