"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
So Truss spent six times the price of a pint of milk on crap jewellery?
That. Is. A. Disgrace.
£4.50 is more than a prawn sandwich from Pret...
So, members of the conservative party are slagging off other members because they are wealthy? Have I got this right? This is the Conservative party right?
We are no longer in Kansas, Toto.
I'm not usually a fan of Guardian opinion pieces, but I think this one has it right about the two candidates' "absurd class cosplay".
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
I agree.
I note that old Truss piece about cutting Government spending proposed cutting funding to public health programmes that encourage healthier eating, so unfortunately it looks like our next PM doesn’t agree with us.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
I'm afraid it is that bad.
The NHS took barely a quarter of government spending a decade ago. It now takes well over a third.
That isn't sustainable.
The NHS was always going to cost more as the population aged. How could you avoid that from happening?
At some point the population stops aging, or there are no young people left at all - which would be a slightly more serious problem.
At that point the NHS funding situation should stabilise.
So there's a one-off increase in the cost of the NHS due to the change in the population structure, and we should be looking at things like the pension age to help pay for it, as well as recognising that it's a price worth paying.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Healthcare in other European countries hasn't come out of the pandemic in anything like as bad a shape as the UK
There are things that can be done. Unavoidably some of these are long term, but that's no reason not to do them now, and if this Conservative government had done earlier them we wouldn't be in this state.
Neither Sunak nor Truss have any interest in addressing healthcare problems
The Johnson government of which Sunak and Truss are key members was elected on a promise of sorting out the NHS
Giving up on the NHS means privatisation. If that's the policy let's talk about it as such.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
I think it's a mistake to see spending on healthcare as strangling the economy. In a very real way - it supports the economy because it keeps people healthy enough to work.
Although I don't fully buy John Burn-Murdoch's analysis on this - it's striking how the UK is the only developed country where the share of working age people outside the labour force has kept rising after the initial pandemic shock.
When you look at the number of long-term sick going up... at least part of the reason has got to be the pressure the NHS is under, and the fact that there aren't the staff to cope.
Healthcare in other European countries hasn't come out of the pandemic in anything like as bad a shape as the UK
There are things that can be done. Unavoidably some of these are long term, but that's no reason not to do them now, and if this Conservative government had done earlier them we wouldn't be in this state.
Neither Sunak nor Truss have any interest in addressing healthcare problems
The Johnson government of which Sunak and Truss are key members was elected on a promise of sorting out the NHS
Giving up on the NHS means privatisation. If that's the policy let's talk about it as such.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
"Neither Sunak nor Truss have any interest in addressing healthcare problems"
This is a direct legacy of the likes of Johnson and Trump. Problems are to be ignored especially if they are complex. Scapegoats and dead cats are much easier to deliver than solutions.
How about we stop making it more expensive for working people to live and help them out. Student debt, housing, CoL, we are being shafted by this bunch of twats
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
I'm afraid it is that bad.
The NHS took barely a quarter of government spending a decade ago. It now takes well over a third.
That isn't sustainable.
The NHS was always going to cost more as the population aged. How could you avoid that from happening?
At some point the population stops aging, or there are no young people left at all - which would be a slightly more serious problem.
At that point the NHS funding situation should stabilise.
So there's a one-off increase in the cost of the NHS due to the change in the population structure, and we should be looking at things like the pension age to help pay for it, as well as recognising that it's a price worth paying.
I don't think it's a one-off, sadly.
I agree with increasing the pension age. I also think personal healthcare accounts need to be looked at by government on top, and I like @Foxy proposals on this.
Healthcare in other European countries hasn't come out of the pandemic in anything like as bad a shape as the UK
There are things that can be done. Unavoidably some of these are long term, but that's no reason not to do them now, and if this Conservative government had done earlier them we wouldn't be in this state.
Neither Sunak nor Truss have any interest in addressing healthcare problems
The Johnson government of which Sunak and Truss are key members was elected on a promise of sorting out the NHS
Giving up on the NHS means privatisation. If that's the policy let's talk about it as such.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
"Neither Sunak nor Truss have any interest in addressing healthcare problems"
This is a direct legacy of the likes of Johnson and Trump. Problems are to be ignored especially if they are complex. Scapegoats and dead cats are much easier to deliver than solutions.
A good point. This is not about old skool Tory vs. Labour, but about a new type of hyper partisan politician who governs exclusively for headlines, makes promises they can’t possibly keep and creates chaos to obscure their record. It’s a social media fantasy land and a virus for our politics leading to the fast track to disaster.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Yes, it would. The US will do all it can to ensure it doesn’t happen - including diverting resources from Europe to the Asia-Pacific. So where does that leave us?
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
It would be better if Tories took some ownership of their poor record, rather than blaming others. The unedifying leadership contest is not pointing he way forward for them. We’re staring down the barrel of two years of chaos just when we need some leadership.
Meanwhile the NHS is in trouble, which impact peoples lives. It’s not a religion, it’s more important than that. The NHS represents life and death (or a pain free existence) for many thousands of people. A serious conversation about short and long term remedies is required. We need to get operations done now.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Our key weakness is that we have traded strategic resilience to save pennies. Globalisation has made the western economic system very fragile indeed, as we are now seeing. And in many cases, we have outsourced key components of our economic system to a country which defines itself as our adversary, whether we wish to acknowledge that or not.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
I'm afraid it is that bad.
The NHS took barely a quarter of government spending a decade ago. It now takes well over a third.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
Cars are the real culprit. I'm always shocked when I leave London how fat everyone is elsewhere. The main difference is people in London walk places.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
As someone who is quite anxious to consume some NHS resources (see above) I would be very interested in the comparative arrangements in, for example, France! I am, though pleased to be able to report that I've managed to get a GP appointment this morning; and I phoned just after 8 o'clock!
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Yes, it would. The US will do all it can to ensure it doesn’t happen - including diverting resources from Europe to the Asia-Pacific. So where does that leave us?
The point being that that is a considerably greater strategic threat to us than the Russian government behaving like a bunch of drunken lunatics with small cocks and delusions of grandeur. The invasion of Ukraine seems to have been the last roll of the imperial dice for them, and it's failed. Even though they probably will end up controlling parts of Ukraine at least for now, they have been humiliated and their army broken.
So China remains the greater threat to Europe. That's not to say Russia isn't a threat - we need to be upping our capacity to both counter and conduct cyber warfare, for instance - but even that wouldn't be possible without Taiwan.
It would be better if Tories took some ownership of their poor record, rather than blaming others. The unedifying leadership contest is not pointing he way forward for them. We’re staring down the barrel of two years of chaos just when we need some leadership.
Meanwhile the NHS is in trouble, which impact peoples lives. It’s not a religion, it’s more important than that. The NHS represents life and death (or a pain free existence) for many thousands of people. A serious conversation about short and long term remedies is required. We need to get operations done now.
I am trying to have that serious conversation.
You want to talk about The Tories.
Trust me, if we never had to talk about Tories ever again I would be delighted. The brutal truth is that we are stuck with them for at least two years,
The NHS needs help now, not just yet another reorg or ideological driven campaign. I would like solutions that deal with real problems, such as stopping people I care about having to wait 18 months in pain.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
The NHS’s priorities are democratically chosen: I don’t know why you say we have “no choice”.
People in France, Germany and Switzerland are, on average, paying more for their healthcare than we are. If you’re suggesting we should increase UK healthcare spending to match German levels, then I agree with you.
So Truss spent six times the price of a pint of milk on crap jewellery?
That. Is. A. Disgrace.
£4.50 is more than a prawn sandwich from Pret...
So, members of the conservative party are slagging off other members because they are wealthy? Have I got this right? This is the Conservative party right?
We are no longer in Kansas, Toto.
I'm not usually a fan of Guardian opinion pieces, but I think this one has it right about the two candidates' "absurd class cosplay".
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
I'm afraid it is that bad.
The NHS took barely a quarter of government spending a decade ago. It now takes well over a third.
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
Where’s your evidence that the French, German or Swiss systems are more efficient? The usual international comparisons put the UK as being more efficient.
Among all the problems currently there are some which are amusingly trivial:
Sandy Domingos-Shipley has three children, aged 15, 13 and eight, who are all Leeds United supporters.
Normally she would buy them the new kit as soon as it was released before the start of the season but this year she hasn't been able to, with the club saying it won't be on sale until late August.
Although Sandy said she would still be buying the kit when it was available, she added: "The season will be four weeks in and for the kids it kind of ruined the moment because it became our own tradition.
"It makes no sense because that's when you know that you're gonna get lots of people to buy."
Kate Ferguson @kateferguson4 · 1h Rachel Reeves says Labour has ditched its plans to renationalise industries
“They were plans in a manifesto that led us to our worst election defeat in nearly a century” #today
I suspect we will see that argument used to ditch anything vaguely awkward for the Labour Party - who are now utterly focussed on winning the next election..
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
Cars are the real culprit. I'm always shocked when I leave London how fat everyone is elsewhere. The main difference is people in London walk places.
You need to walk a long way to make up for all the cakes people eat.
Perhaps those Bake Off programs should come with a health warning.
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
Where’s your evidence that the French, German or Swiss systems are more efficient? The usual international comparisons put the UK as being more efficient.
The healthcare outcomes they deliver for their populations in cancer survival rates, diabetes, stroke and post-op mortality:
As someone whose health situation seems to be deteriorating by the day I am extremely concerned by the headlines about lack of NHS staff. If I stop posting soon it may be that my hands are sufficiently immobilised to prevent me opening the computer; typing is already beyond me, so I'm dictating. And sometimes the result is very odd indeed; I didn't think my accent was that strange! At time of "writing" I can dictate but have to edit a few words, which sometimes takes a while!
Kate Ferguson @kateferguson4 · 1h Rachel Reeves says Labour has ditched its plans to renationalise industries
“They were plans in a manifesto that led us to our worst election defeat in nearly a century” #today
I suspect we will see that argument used to ditch anything vaguely awkward for the Labour Party - who are now utterly focussed on winning the next election..
It's a shame they've abandoned the railways, the rest is fair enough, not priorities for this stage
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Interesting. Where does that come from?
OK, I see it's to do with the cost of insulin only. I thought the efficiency point was wider.
It would be better if Tories took some ownership of their poor record, rather than blaming others. The unedifying leadership contest is not pointing he way forward for them. We’re staring down the barrel of two years of chaos just when we need some leadership.
Meanwhile the NHS is in trouble, which impact peoples lives. It’s not a religion, it’s more important than that. The NHS represents life and death (or a pain free existence) for many thousands of people. A serious conversation about short and long term remedies is required. We need to get operations done now.
I am trying to have that serious conversation.
You want to talk about The Tories.
Trust me, if we never had to talk about Tories ever again I would be delighted. The brutal truth is that we are stuck with them for at least two years,
The NHS needs help now, not just yet another reorg or ideological driven campaign. I would like solutions that deal with real problems, such as stopping people I care about having to wait 18 months in pain.
Nice political rhetoric - "help now", "solutions to deal with real problems".
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
Because it's difficult to get usable data from Europe while the US is very open book and very easy to compare against.
The one system I have a vague clue about is Bulgaria because I replaced the IT systems of one of their biggest insurance firms.
But there private medical care isn't sold as private care it's sold as Better Care which makes comparing it with elsewhere really awkward.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Yes, it would. The US will do all it can to ensure it doesn’t happen - including diverting resources from Europe to the Asia-Pacific. So where does that leave us?
The point being that that is a considerably greater strategic threat to us than the Russian government behaving like a bunch of drunken lunatics with small cocks and delusions of grandeur. The invasion of Ukraine seems to have been the last roll of the imperial dice for them, and it's failed. Even though they probably will end up controlling parts of Ukraine at least for now, they have been humiliated and thei army broken. So China remains the greater threat to Europe. That's not to say Russia isn't a threat - we need to be upping our capacity to both counter and conduct cyber warfare, for instance - but even that wouldn't be possible without Taiwan.
I hope you are right about Russia’s defeat. Ukraine has certainly shown it’s not the power many assumed it to be. That said, I am less inclined to write them off just yet, given the size of the country and the natural resources it has. Let’s get through next winter first.
It seems to me that the best way for Europe to do its bit in containing China is to do more of the heavy lifting to contain Russia.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
The NHS’s priorities are democratically chosen: I don’t know why you say we have “no choice”.
People in France, Germany and Switzerland are, on average, paying more for their healthcare than we are. If you’re suggesting we should increase UK healthcare spending to match German levels, then I agree with you.
Yes, but I'm arguing that should not be done through central taxation and a monolithic model.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
I think it's a mistake to see spending on healthcare as strangling the economy. In a very real way - it supports the economy because it keeps people healthy enough to work.
Although I don't fully buy John Burn-Murdoch's analysis on this - it's striking how the UK is the only developed country where the share of working age people outside the labour force has kept rising after the initial pandemic shock.
When you look at the number of long-term sick going up... at least part of the reason has got to be the pressure the NHS is under, and the fact that there aren't the staff to cope.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Yes, it would. The US will do all it can to ensure it doesn’t happen - including diverting resources from Europe to the Asia-Pacific. So where does that leave us?
Needing to divert resources to the Asia Pacific for the exact same reason.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Our key weakness is that we have traded strategic resilience to save pennies. Globalisation has made the western economic system very fragile indeed, as we are now seeing. And in many cases, we have outsourced key components of our economic system to a country which defines itself as our adversary, whether we wish to acknowledge that or not.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
Is it really Tony Blair's fault that Conservative governments both before and since have decimated Britain's armed forces while taking money from oligarchs and hostile powers?
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
Cars are the real culprit. I'm always shocked when I leave London how fat everyone is elsewhere. The main difference is people in London walk places.
You need to walk a long way to make up for all the cakes people eat.
Perhaps those Bake Off programs should come with a health warning.
So do Londoners eat less cake? Maybe aversion to Johnsonian cakeism explains why we didn't vote for Brexit.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
Yes, the NHS is a single purchaser and can use its market leverage to negotiate lower purchase prices, where it choses to do so. It doesn't have the governance or financing overheads that come with a mixed model system, so that makes it "efficient" in terms of bang per buck.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
The NHS’s priorities are democratically chosen: I don’t know why you say we have “no choice”.
People in France, Germany and Switzerland are, on average, paying more for their healthcare than we are. If you’re suggesting we should increase UK healthcare spending to match German levels, then I agree with you.
Yes, but I'm arguing that should not be done through central taxation and a monolithic model.
Why does spending a smaller amount on health through the NHS 'strangle the economy' more than spending a larger % of GDP via a mixed model would?
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Our key weakness is that we have traded strategic resilience to save pennies. Globalisation has made the western economic system very fragile indeed, as we are now seeing. And in many cases, we have outsourced key components of our economic system to a country which defines itself as our adversary, whether we wish to acknowledge that or not.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
Is it really Tony Blair's fault that Conservative governments both before and since have decimated Britain's armed forces while taking money from oligarchs and hostile powers?
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
Currently we have 18.6% of the pop over 65. By 2050 that's 25.3% By 2100 30%.
We'll hit the steady state at some point, but it's a long way in the future.
How does Japan structure their healthcare, they're already at our ~ 2090 point in terms of age pyramid (28.6% 65+)
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
I'm afraid it is that bad.
The NHS took barely a quarter of government spending a decade ago. It now takes well over a third.
It's a % of Department Expenditure Limits (DEL) - health was £193bn of £566.2bn DEL in 2021.
DEL is only about half of total managed expenditure (TME). The other component is annually managed expenditure (AME), things like welfare spending which are less amenable to the multi year budgeting framework used in DEL.
It would be better if Tories took some ownership of their poor record, rather than blaming others. The unedifying leadership contest is not pointing he way forward for them. We’re staring down the barrel of two years of chaos just when we need some leadership.
Meanwhile the NHS is in trouble, which impact peoples lives. It’s not a religion, it’s more important than that. The NHS represents life and death (or a pain free existence) for many thousands of people. A serious conversation about short and long term remedies is required. We need to get operations done now.
I am trying to have that serious conversation.
You want to talk about The Tories.
Trust me, if we never had to talk about Tories ever again I would be delighted. The brutal truth is that we are stuck with them for at least two years,
The NHS needs help now, not just yet another reorg or ideological driven campaign. I would like solutions that deal with real problems, such as stopping people I care about having to wait 18 months in pain.
Nice political rhetoric - "help now", "solutions to deal with real problems".
What are your solutions?
Step one, install some actual political leadership focussed less on scoring points in identity politics (I do not care what ear rings or shoes someone has) and narrow ideological gimmicks designed to delight geriatric members.
Get out the chequebook where money can make a difference now. We did it during covid, we can do it again. Tax wealth if necessary. We are all in this together after all.
Stop wasting money on Boris pet projects and stop asking doctors and nurses to pay for training. If necessary up the fees for less practical courses to pay for it (I’m thinking PPE in Oxford).
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
The only answer is to stop treating a healthcare system as a national religion, and encourage everyone in work to have private insurance.
Also a massive increase in university places in medical fields, to back up overseas recruitment.
As part of Labour's plan to reboot growth, Sir Keir will announce that his government would establish an Industrial Strategy Council, which will hold government to account and be a "permanent part of the landscape" that sets out strategic national priorities "beyond the political cycle".
He will also say it is possible to see economic growth while achieving the UK's target to hit net-zero - where the amount of greenhouse gas emitted into the atmosphere is balanced by the amount removed.
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
Where’s your evidence that the French, German or Swiss systems are more efficient? The usual international comparisons put the UK as being more efficient.
The healthcare outcomes they deliver for their populations in cancer survival rates, diabetes, stroke and post-op mortality:
I've seen reports that need a sanity check before but that has a great one
The last bullet point in the summary reads
The UK ranked second out of 15 countries in terms of households who faced catastrophic health spending (latest year)
Which sounds like a complete disaster until you look at what the data actually says which is that we are second (to Ireland) for having the lowest number of households with such issues (1.6%)
I suspect if I looked at the other points a few others with be very similar...
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Our key weakness is that we have traded strategic resilience to save pennies. Globalisation has made the western economic system very fragile indeed, as we are now seeing. And in many cases, we have outsourced key components of our economic system to a country which defines itself as our adversary, whether we wish to acknowledge that or not.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
Is it really Tony Blair's fault that Conservative governments both before and since have decimated Britain's armed forces while taking money from oligarchs and hostile powers?
"Decimated". Not really.
But you know, vast amounts of treasure were spent on Iraq, which hurt both our military's standing and finances.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
@BartholomewRoberts is right though. While Russia may threaten invasion, it's unlikely to actually carry it out. Its armed forces are in such a sorry state it couldn't even take Kiev. The odds of it trying to capture Warsaw are less than the odds of Mogg saying something vaguely intelligent.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Yes, it would. The US will do all it can to ensure it doesn’t happen - including diverting resources from Europe to the Asia-Pacific. So where does that leave us?
Needing to divert resources to the Asia Pacific for the exact same reason.
I think these questions are all deeply interconnected. Both Russia and China must be contained, and the western countries are better off working together on this. I think (to its credit) this is the position of the British government.
As part of Labour's plan to reboot growth, Sir Keir will announce that his government would establish an Industrial Strategy Council, which will hold government to account and be a "permanent part of the landscape" that sets out strategic national priorities "beyond the political cycle".
He will also say it is possible to see economic growth while achieving the UK's target to hit net-zero - where the amount of greenhouse gas emitted into the atmosphere is balanced by the amount removed.
Oh it really is possible to see both growth as we try and hit net-zero (it requires investment which may as a side effect improve productivity)
And done sensible it will give us whole new industries that we can export to the rest of the world.
Bullshit. That has bugger all to do with nationalism or patriotism, it is pure and unadulterated racism.
We all know that Orbán's approach is just Johnson/Patel etc. on steroids. Don't try to pretend that that's not where we are headed if the Tory membership get their way.
If you believe otherwise you really are deluded.
You'll be claiming Blair for the last 12 years of Tory misrule next. Oh...
We're going to get a worse PM than Boris, aren't we?
For me, no. He was the pits. I think Sunak or Truss will be better.
Sunak I can see being better than Bozo (let's be honest it's a really low bar). I'm not sure about Truss though - there are reasons why I think she may be worse.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
Currently we have 18.6% of the pop over 65. By 2050 that's 25.3% By 2100 30%.
We'll hit the steady state at some point, but it's a long way in the future.
Although a 70 year old now should be healthier than a 70 year old of previous generations.
Its the very old and sick which use up the health (and social care) resources.
Given that, in my experience at least, few of them still derive any pleasure from life whether that is the best use of limited resources seems doubtful.
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
Where’s your evidence that the French, German or Swiss systems are more efficient? The usual international comparisons put the UK as being more efficient.
The healthcare outcomes they deliver for their populations in cancer survival rates, diabetes, stroke and post-op mortality:
I've seen reports that need a sanity check before but that has a great one
The last bullet point in the summary reads
The UK ranked second out of 15 countries in terms of households who faced catastrophic health spending (latest year)
Which sounds like a complete disaster until you look at what the data actually says which is that we are second (to Ireland) for having the lowest number of households with such issues (1.6%)
I suspect if I looked at the other points a few others with be very similar...
No, you have just jumped to the wrong interpretation. Read it a second time. They are saying the UK is the second best on that score!
We spend ever increasing sums on the NHS, and yet simultaneously end up with front line service provision being starved of funds and in some places for some care largely unavailable.
So it isn't how much money we are spending, its how we are spending it. Yes the population is getting older and that costs more. But we don't spend money on preventative medicine - the national obesity crisis being a prime example of how spending now could save far more in the future.
It's also desperately inefficient. The myriad providers all stacked on top of each other, all with separate management systems and contracts and people who are a cost to make the machine work as opposed to a cost of healthcare. There has to be a way to take an axe to much of this - having GPs running themselves as a CCG buying in healthcare contracts being one example of how to waste money.
“China is the biggest long-term threat to Britain, Rishi Sunak will say on Monday as he unveils plans to curb the country’s soft power by closing all of its 30 Confucius Institutes, which promote the teaching of Chinese language and culture, in the UK.”
China really isnt the biggest long term threat and quite a paranoid and insular thing to do
China is the biggest threat the US faces. Russia is the biggest threat Europe faces. That will become a much, much bigger problem for us if (when?) the Republicans win the presidency in 2024.
No, China is the biggest threat the entire world faces. The world is interconnected, markets are global, the notion you can worry about your corner of it is naivety in the extreme.
If China invades Taiwan, which supplies the chips that run the global economy, we would be plunged into a depression that could dwarf COVID and the GFC and Ukraine combined. China are without a doubt the 21st centuries greatest threat. That is another reason to aid Ukraine to defeat Russia. If China see Russia defeated that may aid deterrence for avoiding them invading Taiwan.
There’s plenty in that, though I think the Chinese are a lot more interested than the Russians in economic control rather than political control. Beyond Taiwan, that’s what motivates them. The issue for us is that it is likely the next Republican US president will not worry too much about Putin and so will give much less priority to thwarting him than Biden has. If Europe is not able to fill the gaps this creates, the Russian threat becomes ever greater and much more immediate than the Chinese one.
We should worry less about Chinese and Russian strength and more about our weakness. We might be able to do something about the latter if we focused on that.
Our key weakness is that we have traded strategic resilience to save pennies. Globalisation has made the western economic system very fragile indeed, as we are now seeing. And in many cases, we have outsourced key components of our economic system to a country which defines itself as our adversary, whether we wish to acknowledge that or not.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
Is it really Tony Blair's fault that Conservative governments both before and since have decimated Britain's armed forces while taking money from oligarchs and hostile powers?
"Decimated". Not really.
But you know, vast amounts of treasure were spent on Iraq, which hurt both our military's standing and finances.
"Decimated" is the right word to use and shows why it's all Tony Blair's fault.
When the Blair/Brown era of government came to an end systemic overspending meant the government was borrowing £1 for every £3 of spending.
So 25% of all spending was unaffordable.
If military spending was "decimated" (one tenth removed) then that is far better than one quarter removed which is what Blair/Brown should have led to.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
Cars are the real culprit. I'm always shocked when I leave London how fat everyone is elsewhere. The main difference is people in London walk places.
You need to walk a long way to make up for all the cakes people eat.
Perhaps those Bake Off programs should come with a health warning.
So do Londoners eat less cake? Maybe aversion to Johnsonian cakeism explains why we didn't vote for Brexit.
Seriously I think its a subject which needs research.
How eating habits vary for different demographics and its effect on public health.
Labour government would prioritise growth - Starmer
My initial response was "how?". OK I can see that he is talking about an Industrial Strategy Council, but that is the kind of toothless talking shop that gets a brief fanfare then gets ignored then gets abolished.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
I don't think the situation is that bad.
Developments in medical science should also be able to reduce the cost of existing treatments, equipment and medicine.
Staff wages only have to keep pace with the rest of the economy.
We're undergoing a demographic transition which is increasing the number of elderly people as a proportion of the population, but that will either reach a new steady state, or we will have bigger problems to worry about.
We have an existing methodology for rationing care according to the resources available based on NICE.
Currently we have 18.6% of the pop over 65. By 2050 that's 25.3% By 2100 30%.
We'll hit the steady state at some point, but it's a long way in the future.
How does Japan structure their healthcare, they're already at our ~ 2090 point in terms of age pyramid (28.6% 65+)
Some of that increase is due to expected increases in life expectancy. If people live longer they should expect the extra years to be shared between working years and retirement years.
So an increase in the pension age means that the increase in the dependent elderly population shouldn't be so large.
However, given that future expected change in the age structure we should expect our healthcare to cost more, and we should plan on that basis, rather than delude ourselves that we can double our elderly population and expect to pay the same amount for healthcare.
What makes Truss potentially so dangerous is that, unlike Johnson, she: 1. Actually believes what she says 2. Is not bone idle Put those two together and the damage she could do is pretty sizeable.
You say damage, I say progress.
Worth a roll of the dice.
All I know for certain is that if it goes wrong Truss’s supporters will blame everyone but her (and themselves).
All I know for certain is the unhinged Tory/Brexit haters will stay unhinged Tory/Brexit haters regardless of who the new PM is and what they do or don't do.
We spend ever increasing sums on the NHS, and yet simultaneously end up with front line service provision being starved of funds and in some places for some care largely unavailable.
So it isn't how much money we are spending, its how we are spending it. Yes the population is getting older and that costs more. But we don't spend money on preventative medicine - the national obesity crisis being a prime example of how spending now could save far more in the future.
It's also desperately inefficient. The myriad providers all stacked on top of each other, all with separate management systems and contracts and people who are a cost to make the machine work as opposed to a cost of healthcare. There has to be a way to take an axe to much of this - having GPs running themselves as a CCG buying in healthcare contracts being one example of how to waste money.
You need investment to create the conditions where it is possible to deal with those inefficiencies and thereby unlock that hidden potential.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
The notion of the NHS as a drag on the economy comes from the (common) misconception that the private sector creates wealth and the public sector consumes it. This is not true. It wrongly conflates wealth creation with fiscal cashflow. They aren't the same. Whether an activity creates wealth or not depends on the nature of the activity not which sector of the economy it resides in.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The US "healthcare" system is a corruption system with some healthcare attached. They have many laws literally to prevent competition and efficiencies in the healthcare system.
Nobody rational compares to them.
Which is why I don’t understand why some people think the solution to the NHS’s problems is to move closer to a US system.
I don't think anyone does. I think some critics love to claim that though.
More competition isn't a US system, it's worth looking at systems all over the Continent to see systems more competitive than either the UK or the USA. It's one area they can do well in. 👍
Fishing was suggesting that the NHS is strangling the economy. How would a French or German system where a higher proportion of GDP is spent on healthcare be any less of a stranglehold on the economy? CR notes they have (somewhat) lower state spending, with more private money, but that money still ultimately comes from the same economy… indeed, ultimately, people are still paying, just through mandated private insurance rather than through tax.
We do spend a lot on healthcare, but isn’t being hale and hearty a central part of enjoying living? The NHS is very efficient by international comparisons. Most of the G7 manage to spend more on healthcare than us and still have thriving economies. Why don’t we spend a little more? It’s not going to destroy the economy. It is going to deliver better outcomes.
Longer term a core part of the answer is better fitness at the individual level. Really tackling obesity. Fund and subsidise sports and activities. Taxes on unhealthy food and subsidies on healthy food. Rebalance the relative value of leaving education with a university degree vs coming out fit and with a healthy lifestyle. The latter is more important, but many of us do not realise that until much later, when it is harder to change.
Cars are the real culprit. I'm always shocked when I leave London how fat everyone is elsewhere. The main difference is people in London walk places.
You need to walk a long way to make up for all the cakes people eat.
Perhaps those Bake Off programs should come with a health warning.
So do Londoners eat less cake? Maybe aversion to Johnsonian cakeism explains why we didn't vote for Brexit.
Seriously I think its a subject which needs research.
How eating habits vary for different demographics and its effect on public health.
We are down in the South West this week and people here are seriously overweight. Mind you I just had a scone with clotted cream and jam for breakfast so maybe I am about to join them.
What makes Truss potentially so dangerous is that, unlike Johnson, she: 1. Actually believes what she says 2. Is not bone idle Put those two together and the damage she could do is pretty sizeable.
You say damage, I say progress.
Worth a roll of the dice.
All I know for certain is that if it goes wrong Truss’s supporters will blame everyone but her (and themselves).
All I know for certain is the unhinged Tory/Brexit haters will stay unhinged Tory/Brexit haters regardless of who the new PM is and what they do or don't do.
I don’t think there’s anything unhinged in disliking the mess this government has caused. We’ll just have to disagree on that.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
The only answer is to stop treating a healthcare system as a national religion, and encourage everyone in work to have private insurance.
Also a massive increase in university places in medical fields, to back up overseas recruitment.
If people can afford private health insurance then they can afford an increase in tax.
This is an argument about whether to pay for health via general taxation - proportional to ability to pay - or by private insurance - a flat rate for those who can afford to do so and tough luck for anyone else.
It's not about NHS as a religion. It's a pure left v right the rich don't want to pay for the poor's healthcare issue.
We spend ever increasing sums on the NHS, and yet simultaneously end up with front line service provision being starved of funds and in some places for some care largely unavailable.
So it isn't how much money we are spending, its how we are spending it. Yes the population is getting older and that costs more. But we don't spend money on preventative medicine - the national obesity crisis being a prime example of how spending now could save far more in the future.
It's also desperately inefficient. The myriad providers all stacked on top of each other, all with separate management systems and contracts and people who are a cost to make the machine work as opposed to a cost of healthcare. There has to be a way to take an axe to much of this - having GPs running themselves as a CCG buying in healthcare contracts being one example of how to waste money.
You need investment to create the conditions where it is possible to deal with those inefficiencies and thereby unlock that hidden potential.
So 'give us more money and everything will get better' ?
Which the NHS has been saying since 1948.
You're more likely to lock in those inefficiencies than unlock hidden potential by providing more 'investment'.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
There are lots of answers, but they all involve ditching the Bevanite delusion of free health care for all all the time, so we won't implement them until we really have to.
I just hope we do before the NHS strangles the economy. Already, unkind but accurate foreigners describe us as a health service with a country attached.
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
One of Maggie Thatcher’s Destructions Of The NHS (I think it was the 18th or 19th complete destruction), was that, where possible, generics should be used instead of the more expensive branded drugs.
What makes Truss potentially so dangerous is that, unlike Johnson, she: 1. Actually believes what she says 2. Is not bone idle Put those two together and the damage she could do is pretty sizeable.
You say damage, I say progress.
Worth a roll of the dice.
All I know for certain is that if it goes wrong Truss’s supporters will blame everyone but her (and themselves).
All I know for certain is the unhinged Tory/Brexit haters will stay unhinged Tory/Brexit haters regardless of who the new PM is and what they do or don't do.
I always parse your name as "Driver, but only on the LHS of the road, none of this continental nonsense." It is stupid, lazy and bad mannered to call your opponents in an argument unhinged haters. Brexit may have been an OK idea, but are you seriously claiming its implementation has not been a shitshower? And it is probably natural Tories who have most reason to distrust and despise Johnson and his cronies and successors.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
The only answer is to stop treating a healthcare system as a national religion, and encourage everyone in work to have private insurance.
Also a massive increase in university places in medical fields, to back up overseas recruitment.
If people can afford private health insurance then they can afford an increase in tax.
This is an argument about whether to pay for health via general taxation - proportional to ability to pay - or by private insurance - a flat rate for those who can afford to do so and tough luck for anyone else.
It's not about NHS as a religion. It's a pure left v right the rich don't want to pay for the poor's healthcare issue.
The religion is exactly the problem. Having healthcare centrally planned by the government makes it such a political football.
There needs to be a mixed provision in order to encourage investment, because taxes are at a record high and people are living longer than ever.
Ask anyone who’s ever lived overseas, what they think of the NHS. The only countries with similar state-run systems are former communist countries, everywhere else has a mixed public and private system.
Kate Ferguson @kateferguson4 · 1h Rachel Reeves says Labour has ditched its plans to renationalise industries
“They were plans in a manifesto that led us to our worst election defeat in nearly a century” #today
I suspect we will see that argument used to ditch anything vaguely awkward for the Labour Party - who are now utterly focussed on winning the next election..
There is no point winning elections if you are not proposing to actually do anything when you have won! A party that said it would take us back into the single market and add to the existing nationalisation of roads (except the M6 toll) and defence by nationalising trains and water for a start and consider adding other vital services might just clean up!
So Truss spent six times the price of a pint of milk on crap jewellery?
That. Is. A. Disgrace.
£4.50 is more than a prawn sandwich from Pret...
So, members of the conservative party are slagging off other members because they are wealthy? Have I got this right? This is the Conservative party right?
We are no longer in Kansas, Toto.
I'm not usually a fan of Guardian opinion pieces, but I think this one has it right about the two candidates' "absurd class cosplay".
So much is obvious. Less obvious is why and how they think it works for them. And, if it does, why?
Similar things happen on the left of course. In a sense it is more recent on the centre right. AD-H and Macmillan seemed to feel no need to dumb down.
Liz Truss is contrasting her background with her posh opponents' (plural, to include Boris, Jeremy Hunt and others besides Rishi) but now mainly Rishi, the out-of-touch squillionaire.
Rishi Sunak is leaning into a sort of Anglo-Indian multi-generational version of the American dream, while drawing vague parallels to Mrs Thatcher. His grandmother had nothing; his parents were middle-class professionals and he might be prime minister; he helped his mum by doing the accounts for her shop (pharmacy).
But Boris did not downplay his posh background and nor did David Cameron, although the latter did sometimes seem embarrassed. As I've said before, I doubt most voters care very much.
"The large number of unfilled NHS job vacancies is posing a serious risk to patient safety, a report by MPs says.
It found England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives, calling this the worst workforce crisis in NHS history."
I expect the biggest real terms pay cut in decades will sort that out.
The problem is that the NHS has to run to stand still, and that challenge gets worse every year - more people live for longer with more chronic conditions all of whom require more people treating them for longer with more new (and expensive) drugs coming on the market all the time that make more things treatable too. And so on.
Of course, all those staff want real-terms salary increases each year too (who doesn't?) and so the NHS needs to consume an ever greater proportion of national income each and every year - it probably needs a budget increase of 9-10% every year just to stop it getting worse - just to deliver its decidedly average service.
This isn't sustainable. I don't see any party with answers.
The only answer is to stop treating a healthcare system as a national religion, and encourage everyone in work to have private insurance.
Also a massive increase in university places in medical fields, to back up overseas recruitment.
If people can afford private health insurance then they can afford an increase in tax.
This is an argument about whether to pay for health via general taxation - proportional to ability to pay - or by private insurance - a flat rate for those who can afford to do so and tough luck for anyone else.
It's not about NHS as a religion. It's a pure left v right the rich don't want to pay for the poor's healthcare issue.
The religion is exactly the problem. Having healthcare centrally planned by the government makes it such a political football.
There needs to be a mixed provision in order to encourage investment, because taxes are at a record high and people are living longer than ever.
Ask anyone who’s ever lived overseas, what they think of the NHS. The only countries with similar state-run systems are former communist countries, everywhere else has a mixed public and private system.
And even those communist countries will have a private health care system on top - with many people bypassing the public system unless its an emergency..
Bulgaria's private insurance schemes (I know this as I had to redo the CRM solution of their largest insurance firm) were sold as "Best Doctor" so it's very much a replacement health service rather than a top up (quicker operation) scheme.
Comments
eg Something as basic as insulin. 2018 prices.
USA: average price for a vial
- $98.70
UK: average price for a vial
- $7.52
https://worldpopulationreview.com/country-rankings/cost-of-insulin-by-country
The NHS is really, really excellent at some things.
On this one it's worth noting that out of 35+ Western countries, including all of Europe, UK are the 7th most cost effective, after Tk, Po, Hu, Oz, Slovakia, Slovenia.
https://www.theguardian.com/commentisfree/2022/jul/25/rishi-sunak-liz-truss-britain-class-tory-leadership
I note that old Truss piece about cutting Government spending proposed cutting funding to public health programmes that encourage healthier eating, so unfortunately it looks like our next PM doesn’t agree with us.
Larry Hogan has referred to Dan Cox as a “QAnon whack job.”
https://www.politico.com/news/2022/07/24/hogan-cox-maryland-governor-election-00047602
At some point the population stops aging, or there are no young people left at all - which would be a slightly more serious problem.
At that point the NHS funding situation should stabilise.
So there's a one-off increase in the cost of the NHS due to the change in the population structure, and we should be looking at things like the pension age to help pay for it, as well as recognising that it's a price worth paying.
Meanwhile, even a failed attempt to take Taiwan by China would upend the entire world economy, destabilise countless governments, paralyse food movement, wreck healthcare systems and cause chaos in power generation.
Because Taiwan produces the microchips on which all of those things depend, and the first thing to happen in the event of a Chinese invasion is that supply would stop.
We've already been having chip shortages due to the drought they've had, coupled with a fire, that cut supply significantly. It's one factor in recent inflation and supply chain disruption, although it has been dwarfed by the Russian invasion of Ukraine. A Chinese invasion would make that look like a picnic.
Although I don't fully buy John Burn-Murdoch's analysis on this - it's striking how the UK is the only developed country where the share of working age people outside the labour force has kept rising after the initial pandemic shock.
When you look at the number of long-term sick going up... at least part of the reason has got to be the pressure the NHS is under, and the fact that there aren't the staff to cope.
https://www.ft.com/content/c333a6d8-0a56-488c-aeb8-eeb1c05a34d2
This is a direct legacy of the likes of Johnson and Trump. Problems are to be ignored especially if they are complex. Scapegoats and dead cats are much easier to deliver than solutions.
But, that makes us entirely behoven to what it's chosen priorities are - with no choice. It is also entirely unconstrained by demand, inefficient at pre-screening or preventative care, uninnovative in adopting new treatments, technologies and methods, heavily unionised, and rations care using a queuing system - rather than incentivising quick reductions of queuing using pricing.
I note that you are yet another person desperate to compare the NHS to the US.
Why are you so afraid to talk about what France, Germany and Switzerland do?
I agree with increasing the pension age. I also think personal healthcare accounts need to be looked at by government on top, and I like @Foxy proposals on this.
France, Germany and Switzerland all have mixed systems but it's only 50-60% public as opposed to our 79%.
Why is that good do you ask?
Because it (a) gets more money into the system more quickly and (b) more efficiently allocates and deals with risk, whilst delivering better outcome for all.
You want to talk about The Tories.
The legacy of Blair looms large. Labour historically was a proud party of national security, strategic interest and patriotism but no more. Corbyn very nearly finished the job! In turn the Tories have become increasingly complacent on national security and adopted a purely managerial approach to foreign affairs, with foreign autocrats first and foremost a backdoor source of party funding and off balance sheet government borrowing. I struggle quite a lot with certain prominent posters continued adoration for George Osborne given his relationships with the oligarchs and abject nativity in pursuing the Chinese to help run our nuclear industry.
I desperately hope Tugendhat gets a big job in Cabinet so he can make the case for strategic resilience from inside government.
Health spending is about 20% of total spending.
https://ifs.org.uk/taxlab/key-questions/what-does-government-spend-money
I am, though pleased to be able to report that I've managed to get a GP appointment this morning; and I phoned just after 8 o'clock!
So China remains the greater threat to Europe. That's not to say Russia isn't a threat - we need to be upping our capacity to both counter and conduct cyber warfare, for instance - but even that wouldn't be possible without Taiwan.
The NHS needs help now, not just yet another reorg or ideological driven campaign. I would like solutions that deal with real problems, such as stopping people I care about having to wait 18 months in pain.
People in France, Germany and Switzerland are, on average, paying more for their healthcare than we are. If you’re suggesting we should increase UK healthcare spending to match German levels, then I agree with you.
Similar things happen on the left of course. In a sense it is more recent on the centre right. AD-H and Macmillan seemed to feel no need to dumb down.
@kateferguson4
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1h
Rachel Reeves says Labour has ditched its plans to renationalise industries
“They were plans in a manifesto that led us to our worst election defeat in nearly a century” #today
Sandy Domingos-Shipley has three children, aged 15, 13 and eight, who are all Leeds United supporters.
Normally she would buy them the new kit as soon as it was released before the start of the season but this year she hasn't been able to, with the club saying it won't be on sale until late August.
Although Sandy said she would still be buying the kit when it was available, she added: "The season will be four weeks in and for the kids it kind of ruined the moment because it became our own tradition.
"It makes no sense because that's when you know that you're gonna get lots of people to buy."
https://www.bbc.co.uk/news/business-62256634
Perhaps those Bake Off programs should come with a health warning.
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.civitas.org.uk/content/files/International-Health-Care-Outcomes-Index-FINAL.pdf&ved=2ahUKEwjopKHwyZP5AhWEg1wKHfKkBosQFnoECD0QAQ&usg=AOvVaw16Mc5vqNQ1OiHKtupFiHYv
What are your solutions?
The one system I have a vague clue about is Bulgaria because I replaced the IT systems of one of their biggest insurance firms.
But there private medical care isn't sold as private care it's sold as Better Care which makes comparing it with elsewhere really awkward.
It seems to me that the best way for Europe to do its bit in containing China is to do more of the heavy lifting to contain Russia.
https://www.theguardian.com/society/2022/jul/25/disabled-uk-drivers-told-blue-badges-may-not-be-accepted-in-eu-due-to-brexit
https://www.theguardian.com/world/2022/jul/24/viktor-orban-against-race-mixing-europe-hungary
By 2050 that's 25.3%
By 2100 30%.
We'll hit the steady state at some point, but it's a long way in the future.
How does Japan structure their healthcare, they're already at our ~ 2090 point in terms of age pyramid (28.6% 65+)
Get out the chequebook where money can make a difference now. We did it during covid, we can do it again. Tax wealth if necessary. We are all in this together after all.
Stop wasting money on Boris pet projects and stop asking doctors and nurses to pay for training. If necessary up the fees for less practical courses to pay for it (I’m thinking PPE in Oxford).
Also a massive increase in university places in medical fields, to back up overseas recruitment.
Labour government would prioritise growth - Starmer
He will also say it is possible to see economic growth while achieving the UK's target to hit net-zero - where the amount of greenhouse gas emitted into the atmosphere is balanced by the amount removed.
The last bullet point in the summary reads
The UK ranked second out of 15 countries in terms of households who faced
catastrophic health spending (latest year)
Which sounds like a complete disaster until you look at what the data actually says which is that we are second (to Ireland) for having the lowest number of households with such issues (1.6%)
I suspect if I looked at the other points a few others with be very similar...
But you know, vast amounts of treasure were spent on Iraq, which hurt both our military's standing and finances.
And as for taking money form Russian oligarchs:
https://www.telegraph.co.uk/news/politics/tony-blair/8787049/Tony-Blair-linked-to-Libyan-deal-with-Russian-oligarch.html
https://www.investigate-europe.eu/en/2022/londongrad-a-citys-addiction-to-russian-oligarchs-and-easy-money/
+ many more.
And done sensible it will give us whole new industries that we can export to the rest of the world.
If you believe otherwise you really are deluded.
You'll be claiming Blair for the last 12 years of Tory misrule next. Oh...
Its the very old and sick which use up the health (and social care) resources.
Given that, in my experience at least, few of them still derive any pleasure from life whether that is the best use of limited resources seems doubtful.
So it isn't how much money we are spending, its how we are spending it. Yes the population is getting older and that costs more. But we don't spend money on preventative medicine - the national obesity crisis being a prime example of how spending now could save far more in the future.
It's also desperately inefficient. The myriad providers all stacked on top of each other, all with separate management systems and contracts and people who are a cost to make the machine work as opposed to a cost of healthcare. There has to be a way to take an axe to much of this - having GPs running themselves as a CCG buying in healthcare contracts being one example of how to waste money.
When the Blair/Brown era of government came to an end systemic overspending meant the government was borrowing £1 for every £3 of spending.
So 25% of all spending was unaffordable.
If military spending was "decimated" (one tenth removed) then that is far better than one quarter removed which is what Blair/Brown should have led to.
QED Blair (and Brown) caused decimation.
How eating habits vary for different demographics and its effect on public health.
So an increase in the pension age means that the increase in the dependent elderly population shouldn't be so large.
However, given that future expected change in the age structure we should expect our healthcare to cost more, and we should plan on that basis, rather than delude ourselves that we can double our elderly population and expect to pay the same amount for healthcare.
"Keir Starmer promises to abolish tuition fees and nationalise industries if he becomes PM"
https://inews.co.uk/news/politics/keir-starmer-labour-leadership-election-abolish-tuition-fees-nationalisation-396843
This is an argument about whether to pay for health via general taxation - proportional to ability to pay - or by private insurance - a flat rate for those who can afford to do so and tough luck for anyone else.
It's not about NHS as a religion. It's a pure left v right the rich don't want to pay for the poor's healthcare issue.
They're on losing ground on the economy, which I think Truss has accepted hence why she's trying to move away from 12 years of failure
Which the NHS has been saying since 1948.
You're more likely to lock in those inefficiencies than unlock hidden potential by providing more 'investment'.
It may work to win an election.
I'm just amused at seeing people who acted all outraged at Boris showing a lack of integrity lapping up and loving Keir doing the same.
There needs to be a mixed provision in order to encourage investment, because taxes are at a record high and people are living longer than ever.
Ask anyone who’s ever lived overseas, what they think of the NHS. The only countries with similar state-run systems are former communist countries, everywhere else has a mixed public and private system.
But clearly only Labour can deliver that now, being the alternative option
Liz Truss is contrasting her background with her posh opponents' (plural, to include Boris, Jeremy Hunt and others besides Rishi) but now mainly Rishi, the out-of-touch squillionaire.
Rishi Sunak is leaning into a sort of Anglo-Indian multi-generational version of the American dream, while drawing vague parallels to Mrs Thatcher. His grandmother had nothing; his parents were middle-class professionals and he might be prime minister; he helped his mum by doing the accounts for her shop (pharmacy).
But Boris did not downplay his posh background and nor did David Cameron, although the latter did sometimes seem embarrassed. As I've said before, I doubt most voters care very much.
Like the dying days of Tony Blair
Bulgaria's private insurance schemes (I know this as I had to redo the CRM solution of their largest insurance firm) were sold as "Best Doctor" so it's very much a replacement health service rather than a top up (quicker operation) scheme.
My test being - it must be possible to imagine the opposite being announced.