If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
True, but a bottle from Molson-Coors, the world's third largest brewer, may not be the best example...
So Leon NOT (enough of) a beer snob? Always thought his pretensions somewhat suspect!
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
Heh, I often buy that here, from supermarkets. It is a nice one though.
But that’s the point. I wasn’t in a supermarket I bought that from a corner shop. They had a massive fridge with about 10-15 different craft beers. From IPAs to wheat beer to fruit beer and stout etc etc
You don’t get that selection, so ubiquitously, anywhere else in the world
Well, my local corner shop sells craft/real ale beers from the nearest town and at least one of the nearest cities. It doesn't sell US craft beers, as far as I know, but I doubt you find Selby bitter or BrewYork wares in a corner shop in the States.
But, I do agree with your substantive point that the US is right up there in the craft beer stakes.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Question is- why is this so?
Is it because of poor staff attitudes because patients can't take their custom elsewhere?
Or is it because as a nation we've always skimped a bit and tried to get away with that by pushing money into staff numbers rather than buildings and machines that might help staff work more efficiently?
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
True, but a bottle from Molson-Coors, the world's third largest brewer, may not be the best example...
So Leon NOT (enough of) a beer snob? Always thought his pretensions somewhat suspect!
By the way, have you been to Machine House brewery, in Seattle? Fine english-style ales and an interesting building.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Question is- why is this so?
Is it because of poor staff attitudes because patients can't take their custom elsewhere?
Or is it because as a nation we've always skimped a bit and tried to get away with that by pushing money into staff numbers rather than buildings and machines that might help staff work more efficiently?
Well to start with we've always skimped a bit. And we evidently don't want to spend more than we do on it, if that's the problem. But as I have said (a couple of times...) the culture of the NHS does not lend itself to individual responsibility and accountability because most sins apart from the most egregious can be hidden amongst the morass.
Does it matter if your granny isn't given a bedpan or water or her drugs for a couple of days? Not really. What's granny going to do and you're not there to shout about it. So it happens. Often. And no I don't have the stats but ask 10 of your friends and many of them will have had such experiences.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Sure we could have better a better NHS and therefore better healthcare if we were prepared to spend more per head on it.
Dr Jennifer Dixon, Chief Executive of the Health Foundation said: "Compared to the other 18 countries the UK has middling funding and middling performance overall."
Paul Johnson, Director of the Institute for Fiscal Studies said: "The truth about the NHS is that by international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost."
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Question is- why is this so?
Is it because of poor staff attitudes because patients can't take their custom elsewhere?
Or is it because as a nation we've always skimped a bit and tried to get away with that by pushing money into staff numbers rather than buildings and machines that might help staff work more efficiently?
Judging by recent experience it seems to be cultural. They could do better with what they have, but don't try very hard.
I don't know whether that is morale, leadership, lack of incentive, or what.
It would be great if they had top notch facilities everywhere but I fear that wouldn't fix the problem.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
As you are now in highlands of Virginia (I think) and as theology is currently hot PB topic, here is link to a great song greatly performed on the movie "Oh Brother Where Art Thou"
Made famous by the late, great Dr. Ralph Stanley, from the mountains of southwest VA.; the movie version by the "Soggy Mountain Boy" is a true tribute to Stanley and his band, the Clinch Mountain Boys".
Who was perhaps the most prominent member of the Primitive Bapist Universalist Church, a very small fundamentalist denomination notable for belief that there is no Hell for anyone after death, because Christ attoined for ALL, and "it's hell enough on earth.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Sure we could have better a better NHS and therefore better healthcare if we were prepared to spend more per head on it.
Dr Jennifer Dixon, Chief Executive of the Health Foundation said: "Compared to the other 18 countries the UK has middling funding and middling performance overall."
Paul Johnson, Director of the Institute for Fiscal Studies said: "The truth about the NHS is that by international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost."
The bullet points state specifically below average performance.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
Heh, I often buy that here, from supermarkets. It is a nice one though.
But that’s the point. I wasn’t in a supermarket I bought that from a corner shop. They had a massive fridge with about 10-15 different craft beers. From IPAs to wheat beer to fruit beer and stout etc etc
You don’t get that selection, so ubiquitously, anywhere else in the world
Well, my local corner shop sells craft/real ale beers from the nearest town and at least one of the nearest cities. It doesn't sell US craft beers, as far as I know, but I doubt you find Selby bitter or BrewYork wares in a corner shop in the States.
But, I do agree with your substantive point that the US is right up there in the craft beer stakes.
Bet you a dollar versus donut, that you COULD in fact find those beers (if their bottled) in some corner store (note terminology) somewhere in the Great Void from sea to shining sea.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
As you are now in highlands of Virginia (I think) and as theology is currently hot PB topic, here is link to a great song greatly performed on the movie "Oh Brother Where Art Thou"
Made famous by the late, great Dr. Ralph Stanley, from the mountains of southwest VA.; the movie version by the "Soggy Mountain Boy" is a true tribute to Stanley and his band, the Clinch Mountain Boys".
Who was perhaps the most prominent member of the Primitive Bapist Universalist Church, a very small fundamentalist denomination notable for belief that there is no Hell for anyone after death, because Christ attoined for ALL, and "it's hell enough on earth.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
Question is- why is this so?
Is it because of poor staff attitudes because patients can't take their custom elsewhere?
Or is it because as a nation we've always skimped a bit and tried to get away with that by pushing money into staff numbers rather than buildings and machines that might help staff work more efficiently?
I think the Spanish system is very similar to the NHS and is not without issues. However I think staff here are generally paid less than in the UK and for hospital stays the family/friends are generally expected to help with basic care. The GP system based on an app is very good indeed. A doctor callback within 24 hours is pretty much the norm.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
As you are now in highlands of Virginia (I think) and as theology is currently hot PB topic, here is link to a great song greatly performed on the movie "Oh Brother Where Art Thou"
Made famous by the late, great Dr. Ralph Stanley, from the mountains of southwest VA.; the movie version by the "Soggy Mountain Boy" is a true tribute to Stanley and his band, the Clinch Mountain Boys".
Who was perhaps the most prominent member of the Primitive Bapist Universalist Church, a very small fundamentalist denomination notable for belief that there is no Hell for anyone after death, because Christ attoined for ALL, and "it's hell enough on earth.
The views of the PBUC are quite common in modern times in mainstream traditions, though often without their theological flavour. It's always seemed sensible to me. If it were true that JC has died for the sins of all, ie to put them away in the eyes of God, then if it works, all are saved. FWIW St Paul taught it pretty clearly (though sometimes he didn't). Quite warm on earth today.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
Yep - let's look at a single failure (of a single doctor who has not sent a letter) and generalize
I get it you don't like the NHS but we are where we are and given current government finances and the general public view of the NHS making wholesale changes is permanent electoral suicide.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
The vast majority of the NHS staff I’ve worked with, and, more recently experienced, have ‘cared’. Very much. Again, I’ve found drawing PALS attention to something to get results.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
TripAdvisor? That's surely an argument against consumer-led systems.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Are you saying then that a 2010 King's Fund study would find the NHS as top (top quartile?) performer vs its international peers?
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Knowing how things work it's as likely to be your GP as anyone else. The time at my GP for a paper record to get into their systems for someone to access it is 7 working days - and that's regardless of whether the transport mechanism is personal, postman or electronic.
You end up asking why everything is still on paper and then remember that the NHS data projects cost billions, got nowhere and because of that the NHS was still buying fax machines in 2019.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
As you are now in highlands of Virginia (I think) and as theology is currently hot PB topic, here is link to a great song greatly performed on the movie "Oh Brother Where Art Thou"
Made famous by the late, great Dr. Ralph Stanley, from the mountains of southwest VA.; the movie version by the "Soggy Mountain Boy" is a true tribute to Stanley and his band, the Clinch Mountain Boys".
Who was perhaps the most prominent member of the Primitive Bapist Universalist Church, a very small fundamentalist denomination notable for belief that there is no Hell for anyone after death, because Christ attoined for ALL, and "it's hell enough on earth.
The views of the PBUC are quite common in modern times in mainstream traditions, though often without their theological flavour. It's always seemed sensible to me. If it were true that JC has died for the sins of all, ie to put them away in the eyes of God, then if it works, all are saved. FWIW St Paul taught it pretty clearly (though sometimes he didn't). Quite warm on earth today.
Concur.
Interestingly, my own first exposure to the notion that hell is here on earth, that we torment our selves and each other here and now, more than plenty. That's what "Hell" is NOT in afterlife.
Was my uncle who told me this, a devout Catholic who eventually became a monk. A papist No-Heller?!?
Betya he and Dr. Ralph are currently having some interesting theological discussions and jam sessions.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
Yep - let's look at a single failure (of a single doctor who has not sent a letter) and generalize
I get it you don't like the NHS but we are where we are and given current government finances and the general public view of the NHS making wholesale changes is permanent electoral suicide.
If you have not had a bad experience with the NHS then you and your family must live a charmed life.
Are we prepared to fund it? Is it just money? @bondegezou seems to think so. And he does research on it. I'm not so sure for many of the reasons that @Selebian points out in terms of ingrained attitudes. Plus if we paid for a personal bodyguard for everyone then muggins would fall dramatically.
The whole structure is so unwieldy with no accountability. You'd have to be superhuman really to care in amongst all that.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
Yep - let's look at a single failure (of a single doctor who has not sent a letter) and generalize
I get it you don't like the NHS but we are where we are and given current government finances and the general public view of the NHS making wholesale changes is permanent electoral suicide.
If you have not had a bad experience with the NHS then you and your family must live a charmed life.
Are we prepared to fund it? Is it just money? @bondegezou seems to think so. And he does research on it. I'm not so sure for many of the reasons that @Selebian points out in terms of ingrained attitudes. Plus if we paid for a personal bodyguard for everyone then muggins would fall dramatically.
The whole structure is so unwieldy with no accountability. You'd have to be superhuman really to care in amongst all that.
muggins (countable and uncountable, plural mugginses)
A fool or idiot (especially as an ironic way of referring to oneself). I suppose muggins here will have to do all the work, as usual.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Glad to hear you are fighting it. We have established (via anecdote and perhaps your research) that people don't care and that surely must lead to bad health outcomes and bad experiences.
And so does it all come down to money? What did they say the definition of madness is? I mean if you are saying the NHS was fine and dandy under Lab from 1997-2010 and then over the past 13 years it has been totally destroyed (and yes I've seen the stats on funding) then that itself shows that something needs to change because the country is prone to voting in Conservative governments, if not perhaps for the next 10 or 20 years, that said.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Are you saying then that a 2010 King's Fund study would find the NHS as top (top quartile?) performer vs its international peers?
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
I think you can go to any country and find examples of poor healthcare, depersonalised staff etc. It’s tremendously simplistic to think that the model of funding is responsible for all the ills in a healthcare system. Your obsession with this issue and your apparent view that a different funding model would be a panacea is risible.
There is definitely a cultural/organisational problem in the NHS. I'm open-minded as to whether it's been created as a result of being a state monolith, or as a result of being run perpetually on (or beyond) the edge of a state of crisis.
My wife recently went to see the GP in Ireland for the first time since we moved, having had terrible experiences with the NHS in helping her manage her chronic condition, she put it off as long as possible. They've diagnosed a vitamin B12 deficiency, and taking a supplement has reduced her tiredness noticeably.
The NHS didn't do a blood test. A patient would have to ask for one, and convince the GP to order it. In the NHS patients are always troublemakers who have to be shoved out of the door as quickly as possible so that the next patient in the queue can be seen to. So they are always trying to fob patients off. The NHS told me I was tired because of depression (turned out I had an iron deficiency).
I was always made to feel like I had to apologise for troubling NHS staff, unsure whether I might be getting in the way of people who needed treatment more urgently. I didn't realise how bad that low-level aggression from NHS staff was until I had a different experience to compare it to. And, given that my new experience is in Ireland, which has major issues with capacity and underfunding of its own, then that only demonstrates how badly the NHS compares.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
TripAdvisor? That's surely an argument against consumer-led systems.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
Yep - let's look at a single failure (of a single doctor who has not sent a letter) and generalize
I get it you don't like the NHS but we are where we are and given current government finances and the general public view of the NHS making wholesale changes is permanent electoral suicide.
If you have not had a bad experience with the NHS then you and your family must live a charmed life.
Are we prepared to fund it? Is it just money? @bondegezou seems to think so. And he does research on it. I'm not so sure for many of the reasons that @Selebian points out in terms of ingrained attitudes. Plus if we paid for a personal bodyguard for everyone then muggins would fall dramatically.
The whole structure is so unwieldy with no accountability. You'd have to be superhuman really to care in amongst all that.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
TripAdvisor? That's surely an argument against consumer-led systems.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Are you saying then that a 2010 King's Fund study would find the NHS as top (top quartile?) performer vs its international peers?
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
The problem is that British voters have let themselves be persuaded that they can have something approaching European levels of public services while paying something approaching American levels of tax.
It's not entirely the fault of voters. Winning politicians throughout my life have made that promise, and by various kludges and shortcuts made it work for a bit. That Bus in 2016 was only the most recent example of promising to spend more on health without raising taxes.
Unfortunately, you can only get something for nothing for a while. The remarkable thing is that the UK has got away with it for so long.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Are you saying then that a 2010 King's Fund study would find the NHS as top (top quartile?) performer vs its international peers?
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
Now, I don't know whether that equates to top quartile, but 'well' suggests to me at least above average. They also reference a report putting the NHS at no. 2 out of 11, but I think that's the analysis that puts some weight on paperclip counting!
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Someone I know had an episode that was suspected* as being a stroke. They were in the hospital and being triaged in under 25 minutes. Doctor was with them before the hour was was up.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
TripAdvisor? That's surely an argument against consumer-led systems.
The NHS allows you to leave "ratings and reviews" of its local non-specialist medics' services ("GP surgeries"), clinics, hospitals, etc., at its website. Fat lot of good it will do you.
"Inappropriate remarks", even when not offensive or abusive, are banned. Nonetheless, most of the reviews I've read that look as though they were written by someone without cack for brains (i.e. excluding contributions akin to "very gd would use again - thank u") have been negative. No surprise there. The NHS is crap.
There's nothing stopping you printing leaflets and putting them through doors in an area, even naming medics or administrators who've bullsh*tted, lied, or b*llocksed up your health worse than it was already, if that's what you want to do.
No big company or institution gives a sh*t about user comments on the internet. It's never a case of oh dear, are we keeping prole customers waiting 25 minutes on the phone listening to muzak? Well we never realised. We'll improve our services forthwith.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Absolutely. They treat millions every year so if their "success" rate is 99.7% that still leaves plenty of people who have unsuccessful outcomes. But that's still not good enough - look at the King's Fund headline bullet points. And in particular read @Selebian's anecdote about their (!) mother.
We should definitely try to make healthcare better, NHS or private, in the UK or beyond. I do health research: this is my job.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
Are you saying then that a 2010 King's Fund study would find the NHS as top (top quartile?) performer vs its international peers?
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
Now, I don't know whether that equates to top quartile, but 'well' suggests to me at least above average. They also reference a report putting the NHS at no. 2 out of 11, but I think that's the analysis that puts some weight on paperclip counting!
But still not world class. Lab levels of spending on the NHS and they can't make it world class.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Yes.
The NHS model is far from perfect, but it does manage to get pretty much everyone covered at a reasonable cost.
The US Federal government, by contrast, spends more on healthcare than the British (on both a per person, and percentage of GDP basis), in return for which they get worse life outcomes and tens of millions of people without coverage. It is also the only country in the world where hundreds of thousands of people enter bankruptcy each year because of medical bills.
I'm all for improving the NHS, but I don't think the US model is one I'd choose to copy.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Someone I know had an episode that was suspected* as being a stroke. They were in the hospital and being triaged in under 25 minutes. Doctor was with them before the hour was was up.
*it wasn't, as it turns out
EDIT: Near Glasgow
Is very good to hear. Plus I realise the somewhat less than rigorous nature of "a friend's aunt".
If you say it happens in the UK then I am very happy. Can't see it, but your anecdote has convinced me.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Yet you don't have any evidence to back it up - you just throw the accusation around that it can't and doesn't happen..
Harry Cole @MrHarryCole · 20m Senior Tory source openly calling Nadine Dorries the "Mid Beds blocker".
Actually quite funny.
If Nads keeps up her 'Mid Beds blocker' given Adams has joined Boris and formally quit, will the LDs switch from Mid Beds to Selby for the time being while Labour stick with Uxbridge?
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Glad to hear you are fighting it. We have established (via anecdote and perhaps your research) that people don't care and that surely must lead to bad health outcomes and bad experiences.
And so does it all come down to money? What did they say the definition of madness is? I mean if you are saying the NHS was fine and dandy under Lab from 1997-2010 and then over the past 13 years it has been totally destroyed (and yes I've seen the stats on funding) then that itself shows that something needs to change because the country is prone to voting in Conservative governments, if not perhaps for the next 10 or 20 years, that said.
No, I'm not saying that. It improved from 1997-2010 in many areas, but there were still problems (Mid Staffs, many other service issues). It's not been totally destroyed since 2010; I've had a number of good experiences since then. But it has got worse.
My totally unscientific view is that it was batshit crazy for the coalition to implement their reforms at a point when there was a lack of money. Possibly batshit crazy to do it at any time, given it made GPs more of a pinch point for getting anything done and included a whole load of perverse incentives.
Sounds like Jenkins is in a bit of bother. Why Boris undermined that by lying that the committee voted to expel him, which is not in their power, I don't know.
It may shock the suds slurpers at the dawn of the 3rd millennium, but half a century ago, Coors beer was regarded as super-premium. No joke.
First time I encountered Coors, was when my family moved in early 1970s, and I lived for summer next to people who'd just moved from Colorado. Who were massive (in more ways than one) beer drinkers who were fervent, fanatical consumers AND proselytizers for Coors beer.
They raved about it's (alleged) purity from Rocky Mountain spring water, plus the funky pull-tab with small 2nd hole on top to open and drink this (allegedly) rich & rare perfection of the brewmaster's art.
Personally, tasted pretty much like any other cold, standard US beer. (Thought Rolling Rock AND Dixie were better). AND wasn't but few years later that pointy-headed liberals such as my self were boycotting Coors beer from coast to coast.
That boycott ended loooong ago. But reckon at most I've had two Coors (Lite or Not) in last half-century.
If we cut immigration significantly we wouldn't need so many new houses.
The UK birthrate is only 1.6 now, well below replacement level
Immigration is booming, nobody can stop it by any means the country would support. It will likely remain in the hundreds of thousands, as there's no reason to think people are going to stop migrating, especially as the world warms.
The UK will quite likely exceed a population of 70 million within a couple of years. 80 million by 2050 looks entirely plausible too.
WHERE ARE WE ALL GOING TO LIVE AND WORK IF WE DON'T BUILD ANYTHING?
Mummy and daddy's house (or mummy and mummy or daddy and daddy).
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Have you ever seen such a garbage service on such a scale "turned around" by "great leadership"? Not a local cafe or something, but a big outfit. Or are you arguing the logical fallacy that nothing's improving and there's sh*t leadership, therefore great leadership would lead to improvement?
Or maybe you're just saying bring in great leaders from the outside, with its being understood that they'd have to be paid more?
Nothing can be done. For almost anything other than A&E stuff, almost anyone who can afford to goes private.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Yes.
The NHS model is far from perfect, but it does manage to get pretty much everyone covered at a reasonable cost.
The US Federal government, by contrast, spends more on healthcare than the British (on both a per person, and percentage of GDP basis), in return for which they get worse life outcomes and tens of millions of people without coverage. It is also the only country in the world where hundreds of thousands of people enter bankruptcy each year because of medical bills.
I'm all for improving the NHS, but I don't think the US model is one I'd choose to copy.
Especially as it is as prone (if not worse) re: harmful errors of mal/mispractice highlighted by UK PBers.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
TripAdvisor? That's surely an argument against consumer-led systems.
The NHS allows you to leave "ratings and reviews" of its local non-specialist medics' services ("GP surgeries"), clinics, hospitals, etc., at its website. Fat lot of good it will do you.
"Inappropriate remarks", even when not offensive or abusive, are banned. Nonetheless, most of the reviews I've read that look as though they were written by someone without cack for brains (i.e. excluding contributions akin to "very gd would use again - thank u") have been negative. No surprise there. The NHS is crap.
There's nothing stopping you printing leaflets and putting them through doors in an area, even naming medics or administrators who've bullsh*tted, lied, or b*llocksed up your health worse than it was already, if that's what you want to do.
No big company or institution gives a sh*t about user comments on the internet. It's never a case of oh dear, are we keeping prole customers waiting 25 minutes on the phone listening to muzak? Well we never realised. We'll improve our services forthwith.
The NHS is for most of its consumers a monopoly.
You've touched on the reason I don't... ahem... rate ratings sites. It's because the mediocre experiences, the run of the mill "this thing happened and it went exactly as well as expected" experiences don't tend to make it into a review. Who can be arsed to say "this was ok"? So things are skewed towards the highly motivated, that is, very happy or very unhappy.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
I don't accept it, trust me. I was down at the surgery this afternoon with a copy of the discharge letter which I personally saw into the hand of her GP (and watched while he read it).
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Have you ever seen such a garbage service on such a scale "turned around" by "great leadership"? Not a local cafe or something, but a big outfit. Or are you arguing the logical fallacy that nothing's improving and there's sh*t leadership, therefore great leadership would lead to improvement?
Or maybe you're just saying bring in great leaders from the outside, with its being understood that they'd have to be paid more?
Nothing can be done. For almost anything other than A&E stuff, almost anyone who can afford to goes private.
I think it's about 1 in 9 people who have some level of private cover. not necessarily comprehensive. Is that almost all who can afford it? If so, that's a problem. If not, you're wrong.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Yes.
The NHS model is far from perfect, but it does manage to get pretty much everyone covered at a reasonable cost.
The US Federal government, by contrast, spends more on healthcare than the British (on both a per person, and percentage of GDP basis), in return for which they get worse life outcomes and tens of millions of people without coverage. It is also the only country in the world where hundreds of thousands of people enter bankruptcy each year because of medical bills.
I'm all for improving the NHS, but I don't think the US model is one I'd choose to copy.
Especially as it is as prone (if not worse) re: harmful errors of mal/mispractice highlighted by UK PBers.
No one, not even in the US, would start from the American model when designing a healthcare system. There are other countries in the world we can look at though. It’s striking that in this sub-thread the only two systems of which specifics are given are the U.K. and the US. The systems in other countries are implied but what we can learn is not mentioned.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
But JJ is absolutely right in spite of your glib response. Watson debases the honours list easily as much as any Johnson nominee, if not more. You only have to see @Cyclefree’s post earlier today about it to see why.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
Did you se how many boat migrants SKS allowed into the Uk yesterday?
Tom Whipple @whippletom · 2h . @Andrew_lilico has managed to say something on the covid inquiry that is thoughtful, new, and - vanishingly rare at this stage - impossible to categorise into a covid “tribe”.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
But JJ is absolutely right in spite of your glib response. Watson debases the honours list easily as much as any Johnson nominee, if not more. You only have to see @Cyclefree’s post earlier today about it to see why.
And he's back to "respecting what local communities want" when it comes to NIMBYism and the total lack of housing.
Sunak doesn't get it and will never get my vote.
The conservatives are squeezed between what the country needs (infrastructure, housing) & what their core vote wants (build absolutely nothing anywhere).
Not just their core vote, 59% of voters overall oppose allowing more homes to be built on the greenbelt.
If Starmer becomes PM and as he suggests he will do goes beyond building more houses on brownbelt land to allowing much more development in the greenbelt he will face huge opposition, especially in the South and outer London surbubs (even if he does win Bart's vote)
Do any of the 59% have a plan for where everyone is going to live in the decades ahead? Tent shanty-towns in Surrey I suppose.
If we cut immigration significantly we wouldn't need so many new houses.
The UK birthrate is only 1.6 now, well below replacement level
Cutting inflation doesn't reduce prices, it means prices remain high and continue to rise at a slower rate.
Cutting immigration wouldn't mean we'd need fewer houses, it'd mean we'd still having a housing shortage and we'd continue to need even more houses per annum but at a lower rate.
Though you have failed to understand maths or numbers as per usual.
Most recent data is from 2021.
2021 Live Births: 694,685 2021 Deaths: 666,659
694,65 - 666,659 = Natural population growth of 28,026
Birth rate has been below 'replacement level' in theory since 1973. In the past 50 years birth rate has exceeded death rate every single year except 2020 at the height of the pandemic and 1976, despite having a below replacement level birth rate that entire time.
Is it wrong to want another seven deaths?
Did you hear about the 666 bus to Hel?
@TOrynski · 4h So there is a town at the end of long Polish peninsula. It's called Hel.
For many years the bus line to there had number 666. It was a funny joke. But Catholics were not getting it.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
That wasn't what I'm saying.
But as you only have that sh*t response, I take it that you were perfectly happy with Watson getting a peerage?
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
A family member was mistreated at Stafford during Labour's years in powers.
The last thing we - the patients - need is to go back to the brain-dead "the NHS is always right" that occurred during that travesty, when whistle-blowers were hounded out of town. And one of the people responsible becomes a loudmouth mayor.
Reminds me of "the Post Office is always right" attitude that led to the Horizon fiasco.
Of course there are issues at private hospitals but ask anyone you know, perhaps you have experience yourself, and you will hear tales of routine neglect and low-level abuse in the NHS. Because as I say the structure of the NHS is such that there is no reason to care. Of course people care but they know that if someone dies then they were ill and there is likely to be no comeback or examination of the care provided. Not really. Unless someone like Letby goes off on one.
There is a lot more NHS healthcare than private healthcare in this country, so it’s no surprise that people have more stories of bad NHS care.
Loads of crap care in private Social Care, private children's homes, private psychiatric units, private companies doing GP services etc see multiple scandals passim.
A private system does not necessarily mean quality care, indeed it often combines the worst of poor customer care and profiteering.
And he's back to "respecting what local communities want" when it comes to NIMBYism and the total lack of housing.
Sunak doesn't get it and will never get my vote.
The conservatives are squeezed between what the country needs (infrastructure, housing) & what their core vote wants (build absolutely nothing anywhere).
Not just their core vote, 59% of voters overall oppose allowing more homes to be built on the greenbelt.
If Starmer becomes PM and as he suggests he will do goes beyond building more houses on brownbelt land to allowing much more development in the greenbelt he will face huge opposition, especially in the South and outer London surbubs (even if he does win Bart's vote)
Do any of the 59% have a plan for where everyone is going to live in the decades ahead? Tent shanty-towns in Surrey I suppose.
If we cut immigration significantly we wouldn't need so many new houses.
The UK birthrate is only 1.6 now, well below replacement level
Cutting inflation doesn't reduce prices, it means prices remain high and continue to rise at a slower rate.
Cutting immigration wouldn't mean we'd need fewer houses, it'd mean we'd still having a housing shortage and we'd continue to need even more houses per annum but at a lower rate.
Though you have failed to understand maths or numbers as per usual.
Most recent data is from 2021.
2021 Live Births: 694,685 2021 Deaths: 666,659
694,65 - 666,659 = Natural population growth of 28,026
Birth rate has been below 'replacement level' in theory since 1973. In the past 50 years birth rate has exceeded death rate every single year except 2020 at the height of the pandemic and 1976, despite having a below replacement level birth rate that entire time.
Is it wrong to want another seven deaths?
Did you hear about the 666 bus to Hel?
@TOrynski · 4h So there is a town at the end of long Polish peninsula. It's called Hel.
For many years the bus line to there had number 666. It was a funny joke. But Catholics were not getting it.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Someone I know had an episode that was suspected* as being a stroke. They were in the hospital and being triaged in under 25 minutes. Doctor was with them before the hour was was up.
*it wasn't, as it turns out
EDIT: Near Glasgow
Is very good to hear. Plus I realise the somewhat less than rigorous nature of "a friend's aunt".
If you say it happens in the UK then I am very happy. Can't see it, but your anecdote has convinced me.
Yes, many big hospitals run such 24 hour stroke services. Not viable in smaller hospitals due to personnel and infrastructure.
Always have your stroke near a major teaching hospital rather than St Elsewheres.
And he's back to "respecting what local communities want" when it comes to NIMBYism and the total lack of housing.
Sunak doesn't get it and will never get my vote.
The conservatives are squeezed between what the country needs (infrastructure, housing) & what their core vote wants (build absolutely nothing anywhere).
Not just their core vote, 59% of voters overall oppose allowing more homes to be built on the greenbelt.
If Starmer becomes PM and as he suggests he will do goes beyond building more houses on brownbelt land to allowing much more development in the greenbelt he will face huge opposition, especially in the South and outer London surbubs (even if he does win Bart's vote)
Do any of the 59% have a plan for where everyone is going to live in the decades ahead? Tent shanty-towns in Surrey I suppose.
If we cut immigration significantly we wouldn't need so many new houses.
The UK birthrate is only 1.6 now, well below replacement level
Cutting inflation doesn't reduce prices, it means prices remain high and continue to rise at a slower rate.
Cutting immigration wouldn't mean we'd need fewer houses, it'd mean we'd still having a housing shortage and we'd continue to need even more houses per annum but at a lower rate.
Though you have failed to understand maths or numbers as per usual.
Most recent data is from 2021.
2021 Live Births: 694,685 2021 Deaths: 666,659
694,65 - 666,659 = Natural population growth of 28,026
Birth rate has been below 'replacement level' in theory since 1973. In the past 50 years birth rate has exceeded death rate every single year except 2020 at the height of the pandemic and 1976, despite having a below replacement level birth rate that entire time.
Is it wrong to want another seven deaths?
Did you hear about the 666 bus to Hel?
@TOrynski · 4h So there is a town at the end of long Polish peninsula. It's called Hel.
For many years the bus line to there had number 666. It was a funny joke. But Catholics were not getting it.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
If they were paid more maybe not but if the staffing were better then the service would definitely be more caring. If you're on the twelfth hour of your shift and you're juggling five urgent things to do already then your brain does allow you to not hear the patient who is desperate to be helped to the toilet. Maybe in 30 years time we'll have robot nurses that don't ever get tired and are cheap enough that every patient gets individualised attention, but right now it's only human beings and we're not good enough to be great all the time or even most of the time.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I'm sure Keir Starmer must now resign, after all, he's clearly as bad if not worse than Boris Johnson
That wasn't what I'm saying.
But as you only have that sh*t response, I take it that you were perfectly happy with Watson getting a peerage?
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Which hasn't worked. Private healthcare providers, meanwhile, give a great service. Which is a result of them having to provide a service to consumers. If eg Private Health Provider A began to kill people, or provide sub-standard levels of healthcare then it would soon go out of business. Not so the NHS which does both of these things with alarming frequency.
“We found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% (95% CI 0·22–0·55; p=0·0016) or 0·29 (95% CI 0·09–0·49; p=0·0041) deaths per 100 000 population in the following year. This finding was robust to matching on background characteristics, adjusting for possible confounding factors, and measurement error in our dataset. Changes to for-profit outsourcing since 2014 were associated with an additional 557 (95% CI 153–961) treatable deaths across the 173 CCGs.”
It's Topping - best to just ignore his bullshit or ask him to provide the evidence to back it up...
Obviously we're trying to be polite on this forum but you are a fucking twat.
"The UK’s NHS performs worse than the average in the treatment of 8 out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
It is the third poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’).
It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): 7 in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries."
But then again on the bright side it "has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent." Whatever the fuck that means.
I dislike the NHS because it is bad at what it does and it is bad at what it does compared with other healthcare systems.
Tosser.
So let's show the things you editted out
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries. The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries). It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent. It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
Mate, it's supposed to save lives and improve health outcomes. And it is not succeeding at that vs its peers.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
Read the actual report - in some areas its not succeeding against it's peers. In others such as long term conditions it does very well.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
A friend's aunt in Australia had some kind of a stroke. The healthcare services arrived almost immediately , took her off to the hospital to do something or other that you need to do with a suspected stroke within one hour. As such she is on her way to a full recovery.
The thought that in the UK all that would have happened within an hour is scarily laughable.
Someone I know had an episode that was suspected* as being a stroke. They were in the hospital and being triaged in under 25 minutes. Doctor was with them before the hour was was up.
*it wasn't, as it turns out
EDIT: Near Glasgow
Is very good to hear. Plus I realise the somewhat less than rigorous nature of "a friend's aunt".
If you say it happens in the UK then I am very happy. Can't see it, but your anecdote has convinced me.
Yes, many big hospitals run such 24 hour stroke services. Not viable in smaller hospitals due to personnel and infrastructure.
Always have your stroke near a major teaching hospital rather than St Elsewheres.
In mid-1980s when I was ostensibly studying Magyar one summer in Hungary, one of my fellow foreign students suddenly needed her appendix removed. FORTUNATELY the school was being held at leading university, with Hungary's leading medical school.
She was lucky, as she'd been traveling for several months previous . . . in Kosovo.
After the operation, they asked her, "Are you an American?" "Hell, no! I'm a Canadian!"
Good answer - because Canadians were covered for medical expenses in Hungary, and visa versa thanks to socialized medicine. Whereas Americans were NOT, nor were Hungarians in USA.
Of course, back then the monetary bill for her operation and several days in hospital would have come to less than $500 US. Whereas a Hungarian in US hospital would have been on the hook for WAY more.
Sam Freedman had posted a good article, based on a detailed investigation, on what’s wrong with the NHS.
In large part, we just don’t bother investing in capital infrastructure (beds, CT machines, computer systems). We are strikingly out of sync with global norms.
But rather, it's such a large institution with no proper management or accountability that many of its employees don't really care about the level of service that is dispensed to its "customers". If they lose a few patients here and there unless they have been unplugging the life support machine to do the hoovering they know that no one will really know or care.
Apart from the family, obvs, but they, together with the patients, are the least important part of the NHS as far as the NHS is concerned.
OK. Did you read the article?
Of course not. I relied on you to precis it for me. We can't go around reading all the articles posted on PB. That is why we have posters posting posts.
Fair.
Low levels of capital investment was one of three issues cited. The others were loss of experienced staff and replacement with inexperienced ones, probably exacerbated by Brexit; and poor and under-resourced management, confounded by pisspoor target-setting by central government.
When you add the above to the massive backlog created by Covid, you get the current collapse.
The NHS's issues are the same as most public sector body's issues - a perverse incentive flow. Money comes from the Government. More money comes when the service is seen to be in need, even more comes when it is in crisis. If the money came instead from the end users, who were able to choose which treatment providers to patronise, medical treatment would be more like food shopping, and the better for it. The same goes for schools.
If you want to see perverse incentives, check out the US health system.
Indeed, but again there, the incentive flow is f-d up, because most US policies are designed for someone to make a vast profit.
The US health system is effectively a massive tax on the US economy. It likely flatters US GDP figures (in total and per capita), and takes money away from US consumers who would be even RICHER than European counterparts.
I don't know enough about it to really comment, but I can well believe you. The USA system is usually held up as the bogeyman to those against the 'privatisation' of the NHS. But that's really a false choice. What the NHS needs is the empowerment of the health consumer. Health budget allotment should follow the user and be paid upon their successful departure from the system, alive and well. That would completely remove the need to battle all the dragons - waste, lack of attentiveness, lack of appropriate facilities - all of it.
Giving end users choice can be an effective way to allocate resources, but you need people to make some sort of informed choice. Healthcare is very, very technical. Most people do not have the requisite knowledge to make many of the choices. We should listen to service users more, both at an individual level and in terms of planning, but I am sceptical of these claims that if only we had individual health budgets, everything would suddenly work.
I think things are a good deal simpler than we give them credit for. Bad hospitals kill lots of people, for a start. Yes, there are nuances, but in a consumer-led system, you would have something like TripAdvisor for hospitals.
We don't want everyone shopping around for healthcare as if it were clothes or groceries. You'd get a system full of fraud and manipulation and profiteering (look at energy and water), with a lower overall level of efficiency (measured as good outcomes per money spent), and an enormous correlation between how rich you are and how well you get treated. This fetishization of choice is unhelpful. It's about provision.
Colour me non-surprised that the concept of people being empowered to make their own choices over their own healthcare has got you clutching your pearls. You think the British food sector is inefficient? I'd ask your political fellow traveller Rochdale Pioneers if that's true. And actually, it isn't true that there's a vast gulf between the diet that can be afforded by the rich and that afforded by those of modest income. The sector is brilliant at providing nutritious and delicious food to everyone. Abuses and frauds are low - the system is well regulated and choices clear. 'Unhelpful fetishization of choice' - beyond parody. The poor should suck up dying of c-diff or thirst in a shitty hospital and carry on voting Labour!
If they want shitty hospitals, the public should carry on voting Tory! For all Labour's faults - PFI! - there were real improvements in the NHS under 1997-2010 government.
And fantastically bad value for money. Lab spaffs money up the wall on everything including hospitals and of course the tide rises but the waste is so phenomenal that when the Cons come in they have to cut everything and round we go again. If Lab spent less and the Cons spent more it would be a happy compromise with fewer peaks and troughs.
It's quite good value for money and in many ways a bit shit. Kind of like the Iceland of healthcare. We'd perhaps be happier if it was the Lidl or Aldi, but such efficiencies would require a similar model of doing only a few things and doing them well. It's perhaps not surprising that acute care is where the better experiences of the NHS are generally found.
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
There you go. You are seeing at first hand the problems with your mother. No one cares. How very true.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
If they were paid more maybe not but if the staffing were better then the service would definitely be more caring. If you're on the twelfth hour of your shift and you're juggling five urgent things to do already then your brain does allow you to not hear the patient who is desperate to be helped to the toilet. Maybe in 30 years time we'll have robot nurses that don't ever get tired and are cheap enough that every patient gets individualised attention, but right now it's only human beings and we're not good enough to be great all the time or even most of the time.
Also, the point of paying more wouldn't be so much to reward or improve the the current staff as to increase the competition for jobs so that hospitals etc can be selective about who they appoint rather than being forced to take anyone who applies and has a functioning pulse.
But yes, caring bedside manner is something of a luxury at the moment.
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
Harry Cole @MrHarryCole · 20m Senior Tory source openly calling Nadine Dorries the "Mid Beds blocker".
Actually quite funny.
If Nads keeps up her 'Mid Beds blocker' given Adams has joined Boris and formally quit, will the LDs switch from Mid Beds to Selby for the time being while Labour stick with Uxbridge?
I would think that the Lib Dems couldcope with both?
Do you not remember Rochdale, Ripon and the Isle of Ely? Three Liberal gains all fought at the same time.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I have some very solid anecdotal evidence from the time (1980s) to suggest Carl Beech was not entirely wrong. Beech took allegations that were already in the public domain and embellished them as his own experience which was patently untrue.
The evidence I have is about someone now dead so I can comfortably share my story, but I won't. One of Beech's greatest disservices from being exposed as a 24 carat bullshitter was that those who probably still had questions to answer (even if they were now dead) have been given a clean bill of health.
Watson, by taking Beech's bait was very unwise, not just for his harassment of the innocent but for his inadvertent exoneration of the guilty.
Jessops believes the Watson parry was a magnificent win for Sunak today so who am I to rain on his parade?
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
If the Tories get the blame for the fallout, the person who bears most of the responsibility is George Osborne. When the coalition first came to power he had an opportunity to fix the housing market but instead chose to inflate the bubble even more.
Tom Whipple @whippletom · 2h . @Andrew_lilico has managed to say something on the covid inquiry that is thoughtful, new, and - vanishingly rare at this stage - impossible to categorise into a covid “tribe”.
Good to see Tom Watson's getting a little attention.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
I have some very solid anecdotal evidence from the time (1980s) to suggest Carl Beech was not entirely wrong. Beech took allegations that were already in the public domain and embellished them as his own experience which was patently untrue.
The evidence I have is about someone now dead so I can comfortably share my story, but I won't. One of Beech's greatest disservices from being exposed as a 24 carat bullshitter was that those who probably still had questions to answer (even if they were now dead) have been given a clean bill of health.
Watson, by taking Beech's bait was very unwise, not just for his harassment of the innocent but for his inadvertent exoneration of the guilty.
Jessops believes the Watson parry was a magnificent win for Sunak today so who am I to rain on his parade?
Your last line rather makes the rest of your rant a bit sus.
I've not said it was a magnificent 'win' for Sunak. I've not mentioned anything like that. All I said was that Starmer was being hypocritical with his criticism.
My story about McAlpine: back in 1997, I got an invite into parliament. Whilst there, the guy who invited me mentioned the rumours about McAlpine (because I was interested in engineering). The allegations about McAlpine were in the 'public domain'; that does not make them true. He had to live with rumours and tittle-tattle behind his back - until people were stupid enough to actually put it down in writing.
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
I don't think they imagined the interest rate would be eternally low, just that the choice was borrow now or borrow 10% more next year. It was especially pernicious as since the 90s incomes have never risen with house prices so buy now or rent forever was the meme.
If the first three people to actually catch the newly pathogenic novel bat coronavirus were the three scientists working on pathologising a novel bat coronavirus in the special "pathogenic novel bat coronavirus lab" then, I submit, the evidence that it came from a fucking pangolin stew in a random market begins to look a tiny bit thin
“‘Oh, my God, there’s been an outbreak of chocolaty goodness near Hershey, Pa. What do you think happened?’ “Like, ‘Oh I don’t know, maybe a steam shovel mated with a cocoa bean?’ Or it’s the f…ing chocolate factory! Maybe that’s it?” - Jon Stewart.
I have tasted what Hershey make. It cannot be described as “chocolaty goodness”. Certainly not “goodness”. I’m not that convinced about “chocolaty”.
Very true, but he was talking to a mostly American audience, whose experience of ‘chocolate’ most likely emanates from that factory in Pennsylvania.
It is a sad country in many ways (and a wonderful one in others).
Life with shit chocolate and shit cheese. Unbearable.
Beer not too bad, mind. Had some very nice ones when over there a couple of times. But not enough to make me move.
Actually, I’d say American beer - in variety and innovation and ubiquity - is now the best in the world
You can walk into even the tiniest 7/11 in some backwoods non place and find a really decent selection of ice cold bottled craft beers, often excellent, sometimes superb
I had one just yesterday on my hike in Shenandoah
From Colorado
True, but a bottle from Molson-Coors, the world's third largest brewer, may not be the best example...
So Leon NOT (enough of) a beer snob? Always thought his pretensions somewhat suspect!
Leon never seems to stick around anywhere long enough to learn anything.
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
I don't think they imagined the interest rate would be eternally low, just that the choice was borrow now or borrow 10% more next year. It was especially pernicious as since the 90s incomes have never risen with house prices so buy now or rent forever was the meme.
Not so much about people being reckless or ill-advised, just desperate. Because that's the corner of the graph that the UK has consistently decided to put itself in.
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
I don't think they imagined the interest rate would be eternally low, just that the choice was borrow now or borrow 10% more next year. It was especially pernicious as since the 90s incomes have never risen with house prices so buy now or rent forever was the meme.
It’s not entirely the borrowers fault. I remortgaged last year, partly as I could see the rate rise coming, partly to finance an extension. At the interviews there was never a question - could you cope if the rates did X? We chose a 10 year fix, so are feeling happy enough, but I think the recent static and very low rates have fooled more than just borrowers.
Harry Cole @MrHarryCole · 20m Senior Tory source openly calling Nadine Dorries the "Mid Beds blocker".
Actually quite funny.
If Nads keeps up her 'Mid Beds blocker' given Adams has joined Boris and formally quit, will the LDs switch from Mid Beds to Selby for the time being while Labour stick with Uxbridge?
I would think that the Lib Dems couldcope with both?
Do you not remember Rochdale, Ripon and the Isle of Ely? Three Liberal gains all fought at the same time.
That was a very long time ago, Rochdale in 1972, Ripon and Isle of Ely both in 1973. I wonder what by-election the commenters first recollection is of; mine is Liverpool Edge Hill (David Alton, just before the 1979 general election)
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
I don't think they imagined the interest rate would be eternally low, just that the choice was borrow now or borrow 10% more next year. It was especially pernicious as since the 90s incomes have never risen with house prices so buy now or rent forever was the meme.
It’s not entirely the borrowers fault. I remortgaged last year, partly as I could see the rate rise coming, partly to finance an extension. At the interviews there was never a question - could you cope if the rates did X? We chose a 10 year fix, so are feeling happy enough, but I think the recent static and very low rates have fooled more than just borrowers.
One difference from previous housing crashes is that a much higher proportion of people now have fixed rate loans. Even someone with a fix that expires in 2-3 years has some additional breathing space to consider their options properly.
Did I miss the big reveal about where @Leon is staying?
I was looking for an interesting small town in Virginia with some history, on my roadtrip back to Cincinnati. And I found Staunton. End of Shenandoah valley. Beautiful landscapes and quaint little downtown
Most good hotels are really pricey. Even average ones costly. America is expensive. Then I found one which is cheap. REALLY cheap. AND it’s beautiful.
So I thought. Something is up. Why is it so cheap? A beautiful 1820s mansion designed by a protege of Jefferson? Turns out it was a lunatic asylum and a prison. And it really was. Doors are cell doors
Then I arrived here and found that the atmosphere was even creepier and weirder than I expected. And I sat down on the hotel terrace in the dusk and did some research and discovered this
Basically the whole place was run by a Nazi doctor who forcibly sterilised and lobotomised thousands of poor white hillbilly girls who were forced out of Shenandoah national park
It’s like staying in a SS laboratory complex. That’s why suites are £70 not £500
I do not fucking believe it. I posted a link to an Atun-Shei films YouTube essay on that exact same hotel last night, just before you asked "you'll never guess which hotel I'm staying in" or similar again. You were presumably pissed.
What did people expect would happen? People have had years of almost zero interest and they thought this would last forever and could borrow vast sums, in some cases on interest-only mortgages. The interest rates we had were way below historical norms and there would always be a moment when interest rates would rise.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
The thing with a mortgage is that when you remortgage you should be remortgaging on a smaller capital amount than whatever you first borrowed - so a higher mortgage rate on a smaller amount isn't as bad as it could have been and should have always been expected at some point.
A capital-repayment mortgage typically has almost always cost less than renting the same property, so anyone who hasn't been repaying capital when interest-rates were effectively non-existent and inevitably going to rise has made a very foolish decision - but even still will be in a comparable position to someone who has been renting anyway so not the end of the world despite their foolishness.
Comments
But, I do agree with your substantive point that the US is right up there in the craft beer stakes.
Is it because of poor staff attitudes because patients can't take their custom elsewhere?
Or is it because as a nation we've always skimped a bit and tried to get away with that by pushing money into staff numbers rather than buildings and machines that might help staff work more efficiently?
I'm not obsessed with the present NHS model, happy to switch it for one of the decent European ones, of which there are many. But they do also cost a bit more to deliver the better services some of them deliver.
(I'm currently battling the NHS on behalf of my parents, so I'm far from in love with it - my mother has a nonspecific and as yet undiagnosed condition and has been passed from specialist to specialist, ward to ward and no one cares - or perhaps no one has the time to care. Presently, the GP or the hospital have manged to lose/not send the discharge letter from her latest stay, which had instructions for further investigations which, as of yet, have not happened)
Does it matter if your granny isn't given a bedpan or water or her drugs for a couple of days? Not really. What's granny going to do and you're not there to shout about it. So it happens. Often. And no I don't have the stats but ask 10 of your friends and many of them will have had such experiences.
Dr Jennifer Dixon, Chief Executive of the Health Foundation said:
"Compared to the other 18 countries the UK has middling funding and middling performance overall."
Paul Johnson, Director of the Institute for Fiscal Studies said:
"The truth about the NHS is that by international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost."
I don't know whether that is morale, leadership, lack of incentive, or what.
It would be great if they had top notch facilities everywhere but I fear that wouldn't fix the problem.
But heaven help you if you criticise the NHS.
We are a big, thirsty country.
Now if the nurses were paid more, or there were fewer of your mothers to care about would they all of a sudden start caring? My proposition is probably not. The institution allows them not to care because apart from you getting frustrated (have you been to PALS?) so what? What are you going to do, criticise the angels? You a good leftwing, right (small "r") thinking person? You hesitate to and accept it. Don't accept it. Get furious.
You have your own warped perspective on this, I have mine. You can keep yours safely tucked up your . . .
The NHS has a lower than average number of staff for all professional groups except midwives: in the UK there is one doctor for every 356 people, compared to one for every 277 people on average across the comparator countries.
The UK has very low levels of hospital beds and the lowest levels of both CT and MRI scanners: it has fewer beds per person than 16 of the 18 other countries.
It provides unusually good financial protection to the public from the consequences of ill health. For example it has the lowest proportion of people who skipped medicine due to cost (2.3 per cent in 2016 compared to an average of 7.2 per cent across the comparator countries).
It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84 per cent in 2015 compared to an average of 50 per cent.
It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.
And it's cheaper than any other model you can think of.
But it does have the largest share of generic prescribing of all comparator countries. Thank heavens.
I can talk about bad experiences I’ve had and my family has had. I can also talk about good experiences. I can talk about some of the research on when things go wrong.
I think the evidence suggests that this is a multifaceted problem. There’s no quick fix. However, better funding would solve a lot of the problems and I see no evidence for your theories around NHS culture.
I get it you don't like the NHS but we are where we are and given current government finances and the general public view of the NHS making wholesale changes is permanent electoral suicide.
Would the same people do better? Not sure. Not all of them. Many probably too jaded, some wrong'uns to start with, possibly. I've known people who have left the NHS because the only way to survive is to stop caring, because otherwise all the things you can't do and can't deliver break you. Others stay and stop caring. I'm not sure how easy that is to reverse. I've seen it first hand in other industries. It takes great leadership to turn that kind of situation around.
But with better conditions (more than better pay, from the people I speak to*) I do think that fewer would get to that stage. Fewer of the good ones would leave. It would be easier to only recruit the good people because the vancancies would be fewer and competition for places better.
*I work, on research projects, with many clinicians, although mostly doctors rather than nurses, from FY2 to consultants
Again, I’ve found drawing PALS attention to something to get results.
If there's no "quick fix" - and presumably 1997-2020 would count as quick - doesn't it suggest that the model is broken. Because the country voted not to continue funding at that level so if that ain't going to change something else has to.
You say evidence suggests it is a multi-faceted problem which at least shows that you realise there is a problem. And I'm not sure the problems emerged over the past 10 years.
You end up asking why everything is still on paper and then remember that the NHS data projects cost billions, got nowhere and because of that the NHS was still buying fax machines in 2019.
All changed in about 30-40 years. I remember Sam Adams coming out in about 1985. An ancient German recipe (from Cincinnati!) reimagined in Boston
That’s probably when their beer revolution began
Interestingly, my own first exposure to the notion that hell is here on earth, that we torment our selves and each other here and now, more than plenty. That's what "Hell" is NOT in afterlife.
Was my uncle who told me this, a devout Catholic who eventually became a monk. A papist No-Heller?!?
Betya he and Dr. Ralph are currently having some interesting theological discussions and jam sessions.
Are we prepared to fund it? Is it just money? @bondegezou seems to think so. And he does research on it. I'm not so sure for many of the reasons that @Selebian points out in terms of ingrained attitudes. Plus if we paid for a personal bodyguard for everyone then muggins would fall dramatically.
The whole structure is so unwieldy with no accountability. You'd have to be superhuman really to care in amongst all that.
A fool or idiot (especially as an ironic way of referring to oneself).
I suppose muggins here will have to do all the work, as usual.
But that's the nature of all league tables - some countries will (for various reasons do well in some areas and worse in others). And things will change - Stroke care is way better than it used to be because the issue was identified and fixes implemented to ensure appropriate rapid care is available.
And so does it all come down to money? What did they say the definition of madness is? I mean if you are saying the NHS was fine and dandy under Lab from 1997-2010 and then over the past 13 years it has been totally destroyed (and yes I've seen the stats on funding) then that itself shows that something needs to change because the country is prone to voting in Conservative governments, if not perhaps for the next 10 or 20 years, that said.
My wife recently went to see the GP in Ireland for the first time since we moved, having had terrible experiences with the NHS in helping her manage her chronic condition, she put it off as long as possible. They've diagnosed a vitamin B12 deficiency, and taking a supplement has reduced her tiredness noticeably.
The NHS didn't do a blood test. A patient would have to ask for one, and convince the GP to order it. In the NHS patients are always troublemakers who have to be shoved out of the door as quickly as possible so that the next patient in the queue can be seen to. So they are always trying to fob patients off. The NHS told me I was tired because of depression (turned out I had an iron deficiency).
I was always made to feel like I had to apologise for troubling NHS staff, unsure whether I might be getting in the way of people who needed treatment more urgently. I didn't realise how bad that low-level aggression from NHS staff was until I had a different experience to compare it to. And, given that my new experience is in Ireland, which has major issues with capacity and underfunding of its own, then that only demonstrates how badly the NHS compares.
The thought that in the UK all that would have happened within an hour is scarily laughable.
1
It's not entirely the fault of voters. Winning politicians throughout my life have made that promise, and by various kludges and shortcuts made it work for a bit. That Bus in 2016 was only the most recent example of promising to spend more on health without raising taxes.
Unfortunately, you can only get something for nothing for a while. The remarkable thing is that the UK has got away with it for so long.
https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-performance
"The evidence shows that the NHS is performing well compared to other countries' health systems, although there is still room for improvement in some areas."
Now, I don't know whether that equates to top quartile, but 'well' suggests to me at least above average. They also reference a report putting the NHS at no. 2 out of 11, but I think that's the analysis that puts some weight on paperclip counting!
Harry Cole
@MrHarryCole
·
20m
Senior Tory source openly calling Nadine Dorries the "Mid Beds blocker".
Actually quite funny.
*it wasn't, as it turns out
EDIT: Near Glasgow
"Inappropriate remarks", even when not offensive or abusive, are banned. Nonetheless, most of the reviews I've read that look as though they were written by someone without cack for brains (i.e. excluding contributions akin to "very gd would use again - thank u") have been negative. No surprise there. The NHS is crap.
There's nothing stopping you printing leaflets and putting them through doors in an area, even naming medics or administrators who've bullsh*tted, lied, or b*llocksed up your health worse than it was already, if that's what you want to do.
No big company or institution gives a sh*t about user comments on the internet. It's never a case of oh dear, are we keeping prole customers waiting 25 minutes on the phone listening to muzak? Well we never realised. We'll improve our services forthwith.
The NHS is for most of its consumers a monopoly.
The NHS model is far from perfect, but it does manage to get pretty much everyone covered at a reasonable cost.
The US Federal government, by contrast, spends more on healthcare than the British (on both a per person, and percentage of GDP basis), in return for which they get worse life outcomes and tens of millions of people without coverage. It is also the only country in the world where hundreds of thousands of people enter bankruptcy each year because of medical bills.
I'm all for improving the NHS, but I don't think the US model is one I'd choose to copy.
If you say it happens in the UK then I am very happy. Can't see it, but your anecdote has convinced me.
My totally unscientific view is that it was batshit crazy for the coalition to implement their reforms at a point when there was a lack of money. Possibly batshit crazy to do it at any time, given it made GPs more of a pinch point for getting anything done and included a whole load of perverse incentives.
I guess he cannot help lying.
First time I encountered Coors, was when my family moved in early 1970s, and I lived for summer next to people who'd just moved from Colorado. Who were massive (in more ways than one) beer drinkers who were fervent, fanatical consumers AND proselytizers for Coors beer.
They raved about it's (alleged) purity from Rocky Mountain spring water, plus the funky pull-tab with small 2nd hole on top to open and drink this (allegedly) rich & rare perfection of the brewmaster's art.
Personally, tasted pretty much like any other cold, standard US beer. (Thought Rolling Rock AND Dixie were better). AND wasn't but few years later that pointy-headed liberals such as my self were boycotting Coors beer from coast to coast.
That boycott ended loooong ago. But reckon at most I've had two Coors (Lite or Not) in last half-century.
Or maybe you're just saying bring in great leaders from the outside, with its being understood that they'd have to be paid more?
Nothing can be done. For almost anything other than A&E stuff, almost anyone who can afford to goes private.
Is that almost all who can afford it? If so, that's a problem. If not, you're wrong.
Starmer's a teensy weensy (*) hypocritical in going on about Johnson's list, when Starmer put Watson's name forward after it had initially been rejected by the committee.
(*) Actually, a lot.
@whippletom
·
2h
.
@Andrew_lilico
has managed to say something on the covid inquiry that is thoughtful, new, and - vanishingly rare at this stage - impossible to categorise into a covid “tribe”.
Very much worth reading.
Three questions the Covid inquiry must answer
https://www.telegraph.co.uk/news/2023/06/14/the-questions-the-covid-inquiry-must-answer/
https://twitter.com/DoubleDownNews/status/1668888187966455811
Homeowners turn their backs on the Tories, poll shows – piling new pressure on Sunak
BJO please explain
@TOrynski
·
4h
So there is a town at the end of long Polish peninsula. It's called Hel.
For many years the bus line to there had number 666. It was a funny joke. But Catholics were not getting it.
So from now it's bus number 669 that goes to Hel.
Because you can't have fun in Poland.
https://twitter.com/TOrynski/status/1668978005153030146
But as you only have that sh*t response, I take it that you were perfectly happy with Watson getting a peerage?
https://www.youtube.com/watch?v=nhMaGv4i6Po
A private system does not necessarily mean quality care, indeed it often combines the worst of poor customer care and profiteering.
Always have your stroke near a major teaching hospital rather than St Elsewheres.
There are more new build houses with No. 14 than No. 13. In an apparent age of reason.
Shells delivered to Ruasian troops in Luhansk....
I don't want to stand near the artillery using those
https://twitter.com/PStyle0ne1/status/1669034142061797411
Virginia State Route 666 - courtesy of Disciple Christian Motorcycle Club
https://www.youtube.com/watch?v=3M14oLQwVb8
Next
@EdConwaySky
·
2h
It’s not totally implausible that the squeeze for those with mortgages could actually be WORSE than in the 1990s.
https://twitter.com/EdConwaySky/status/1668987423643119623
She was lucky, as she'd been traveling for several months previous . . . in Kosovo.
After the operation, they asked her, "Are you an American?" "Hell, no! I'm a Canadian!"
Good answer - because Canadians were covered for medical expenses in Hungary, and visa versa thanks to socialized medicine. Whereas Americans were NOT, nor were Hungarians in USA.
Of course, back then the monetary bill for her operation and several days in hospital would have come to less than $500 US. Whereas a Hungarian in US hospital would have been on the hook for WAY more.
But yes, caring bedside manner is something of a luxury at the moment.
The rate rises are going to punish the reckless and ill-advised. Unfortunately, there are vast numbers of these. The housing market has a big correction coming its way. Good news at least for those who have not yet been able to get on the housing ladder.
Do you not remember Rochdale, Ripon and the Isle of Ely? Three Liberal gains all fought at the same time.
The evidence I have is about someone now dead so I can comfortably share my story, but I won't. One of Beech's greatest disservices from being exposed as a 24 carat bullshitter was that those who probably still had questions to answer (even if they were now dead) have been given a clean bill of health.
Watson, by taking Beech's bait was very unwise, not just for his harassment of the innocent but for his inadvertent exoneration of the guilty.
Jessops believes the Watson parry was a magnificent win for Sunak today so who am I to rain on his parade?
I've not said it was a magnificent 'win' for Sunak. I've not mentioned anything like that. All I said was that Starmer was being hypocritical with his criticism.
My story about McAlpine: back in 1997, I got an invite into parliament. Whilst there, the guy who invited me mentioned the rumours about McAlpine (because I was interested in engineering). The allegations about McAlpine were in the 'public domain'; that does not make them true. He had to live with rumours and tittle-tattle behind his back - until people were stupid enough to actually put it down in writing.
A capital-repayment mortgage typically has almost always cost less than renting the same property, so anyone who hasn't been repaying capital when interest-rates were effectively non-existent and inevitably going to rise has made a very foolish decision - but even still will be in a comparable position to someone who has been renting anyway so not the end of the world despite their foolishness.