Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
MAGA is about a fictional hero who will Save America. They project this onto Donald Trump. The actual Donald Trump is almost irrelevant. See the bizarre fan art that portrays him as various types of hero - and even Jesus. These are attempts to reconcile the reality with the myth.
This is a common feature of these kind of populist leader cults. Any negative is taken as a positive - proof that The Conspiracy will do Anything to stop The Hero.
What does this mean for the debates? The problem is that it is virtually impossible for Trump to “break” the lock he has on 45% of the electorate. They aren’t voting for him, anyway, they are voting for The Legend.
If he collapses into complete carehome grade dementia on stage that will become “The Hero was poisoned by Democrats and Ukrainians to steal the election”.
Trump will get 45% of the vote (more or less). He and Harris are fighting over less than 10%
So the debates might move the needle a bit - but not much. No matter what actually happens.
It's worse than that. It all hinges on a percentage point here and there in less than ten swing states.
Kamala wins the popular vote comfortably, Trump probably wins the College by a whisker.
I suspect that is what the markets are telling us.
That may be what the markets are telling us but whether the markets have a clue is another question.
I try to ignore the market when making betting decisions. No, really.
I try and work out what the actual odds are. Then look at the market, afterwards, to see if there is value there.
Political betting is interesting because there are so many people betting with their hearts and not their heads. AKA suckers. Less than there used to be - there was that thing in the U.K. in the early 2000s of politicians and supporters betting to move the market. As if the odds would somehow help them on election day…
The price in the market is of no use in primary decision making.
Good morning everyone. BBC says it's raining here; no, it isn't, nor has it been. In fact we've had good sunny spells.
That's the beauty of coming on here to discuss politics isn't it? People bet with their heads, not their hearts, and, more importantly, discuss their reasons for so doing.
The BBC weather forecasts say rain pretty much constantly, everywhere. They were always more pessimistic than other forecasts but they have become detached from reality, like some miserable pensioner telling everyone the worst will happen. Ignore.
I've stuck with the Met Office, but it is still often the case that the 15 minutes time forecast is very obviously based on a forward projection from a few hours ago and doesn't tally up at all well with an eyeballing of the latest radar.
So to see whether to put the washing out is a comparative scan of a couple of charts and looking out the window.
A national poll of likely voters by The New York Times and Siena College found Mr. Trump leading Ms. Harris, 48 percent to 47 percent, within the poll’s three-percentage-point margin of error and largely unchanged from a Times/Siena poll taken in late July just after President Biden dropped his re-election bid.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
Is that possible? A controversial point... The NHS now treats more people in more ways than it ever did.
Well, there are more people in the UK!
In particular we have 11 million over 65s, up from 9.2 million in 2011. That's where the biggest expansion of the population has been, and also the highest users. These are also people who rightly argue that they have paid in for decades and are entitled to timely treatment.
Of course, the problem with the "But I paid my taxes!" Brigade is that there are more of them than ever, and on average they are richer than ever, expecting all this medical care, social care and endless inflation busting pension hikes to be fully funded by the put upon, tottering base of working age taxpayers.
The proper funding of immensely expensive healthcare services that are primarily used by the aged is more taxation of the aged, through the soaking of assets (mainly via higher property taxes and death duties.) And up with that the oldies will not put. They've paid their taxes so must now have everything for free. Just look at the burning bales and pitchforks we've had over the partial withdrawal of one small handout.
The young can't afford to support the old and the old don't want to help support themselves. So on we all go, circling the plughole together.
Labour had a slogan in my young days, promising that they would look after their people from the cradle to the grave. I suppose too many of us believed it and still hold them to it. Unreasonable, I agree.
MAGA is about a fictional hero who will Save America. They project this onto Donald Trump. The actual Donald Trump is almost irrelevant. See the bizarre fan art that portrays him as various types of hero - and even Jesus. These are attempts to reconcile the reality with the myth.
This is a common feature of these kind of populist leader cults. Any negative is taken as a positive - proof that The Conspiracy will do Anything to stop The Hero.
What does this mean for the debates? The problem is that it is virtually impossible for Trump to “break” the lock he has on 45% of the electorate. They aren’t voting for him, anyway, they are voting for The Legend.
If he collapses into complete carehome grade dementia on stage that will become “The Hero was poisoned by Democrats and Ukrainians to steal the election”.
Trump will get 45% of the vote (more or less). He and Harris are fighting over less than 10%
So the debates might move the needle a bit - but not much. No matter what actually happens.
It's worse than that. It all hinges on a percentage point here and there in less than ten swing states.
Kamala wins the popular vote comfortably, Trump probably wins the College by a whisker.
I suspect that is what the markets are telling us.
That may be what the markets are telling us but whether the markets have a clue is another question.
Yes markets are excellent at predicting the current state of play but lousy at forecasting the outturn.
Options and futures markets are the same - the strike price is an excellent predictor of the current price, but bears little relation to the price when the contract expires.
Financial and betting markets are as influenced by the current mood as people they like to despise as less sophisticated, and it needs huge courage and perspicacity to set yourself against that.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Europe (and the UK) really ought to be collaborating to rebuild a genuinely competitive manufacturing base. It's not as though they don't have the capability.
The whole drama around semiconductors is driven by people who don't understand how they are used and by figures in the industry happy to milk that ignorance for big piles of tax payer's money.
Chips are not a commodity like oil, gas or steel. The sheer incredible range of semiconductors available means no nation is ever going to be able to produce but a small fraction of them, the US CHIPS act, or Europe's equivalent, will not alter that uncomfortable fact to any useful degree.
The distributor I buy from lists over 600,000 different chips. How do you on-shore the design, fabrication and packaging of even a fraction of those? You can't. No government has that kind of money, no nation has the required pool of engineers. No country has all the resources required to completely run a semi fab without importing at least a few critical minerals or other materials.
Semiconductors stopped being a national endeavour in the 80s. The only way to achieve independence is to do a North Korea, wall off your economy from the outside world and force designers to use only internally produced parts. I really don't have to explain how that would end...
MAGA is about a fictional hero who will Save America. They project this onto Donald Trump. The actual Donald Trump is almost irrelevant. See the bizarre fan art that portrays him as various types of hero - and even Jesus. These are attempts to reconcile the reality with the myth.
This is a common feature of these kind of populist leader cults. Any negative is taken as a positive - proof that The Conspiracy will do Anything to stop The Hero.
What does this mean for the debates? The problem is that it is virtually impossible for Trump to “break” the lock he has on 45% of the electorate. They aren’t voting for him, anyway, they are voting for The Legend.
If he collapses into complete carehome grade dementia on stage that will become “The Hero was poisoned by Democrats and Ukrainians to steal the election”.
Trump will get 45% of the vote (more or less). He and Harris are fighting over less than 10%
So the debates might move the needle a bit - but not much. No matter what actually happens.
It's worse than that. It all hinges on a percentage point here and there in less than ten swing states.
Kamala wins the popular vote comfortably, Trump probably wins the College by a whisker.
I suspect that is what the markets are telling us.
It more than likely all comes down to Pennsylvania, just as it all came down to Florida in 2000,
Let’s hope it’s a little more decisive, one way or another, than that race.
Both teams have already spent millions on lawyers, and no doubt will be spending tens of millions more over the next four months.
What is totally alien to those watching from abroad, is just how much control local political leaders have on the actual process of elections. There are very few Federal rules, so States, counties, and cities all have a huge amount of discretion over how the elections are conducted, and the politicians in charge can and do push the limits of what’s allowed for their own political benefit and that of their party.
It really is odd. Electoral services officers in uk councils are the least political people you could ever encounter.
Oh indeed. In the US, the city mayor will be deciding where to put the polling stations, what hours they are open, will they allow early voting stations, where will they be and when will they be open, postal voting eligibility and timescale etc etc. Decisions that are all made for nakedly partisan reasons, trying to make it as easy as possible to get ‘your’ votes but as difficult as possible to get ‘their’ votes. Decisions which of course get challenged by opponents and end up in court for the weeks and months leading up to the election. Don’t forget that judges are either political appointees or directly elected too.
There’s even lawsuits over the eligibility of candidates themselves, for example the Dems spent a lot of money trying to get RFK Jr off ballots in a number of states, only to then spend a lot more money trying to stop him withdrawing his name when he got behind Trump.
The UK system of actually running the election is better in every single way.
Yep, 100%, "The world's greatest democracy", my arse.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
Is that possible? A controversial point... The NHS now treats more people in more ways than it ever did.
Well, there are more people in the UK!
In particular we have 11 million over 65s, up from 9.2 million in 2011. That's where the biggest expansion of the population has been, and also the highest users. These are also people who rightly argue that they have paid in for decades and are entitled to timely treatment.
Of course, the problem with the "But I paid my taxes!" Brigade is that there are more of them than ever, and on average they are richer than ever, expecting all this medical care, social care and endless inflation busting pension hikes to be fully funded by the put upon, tottering base of working age taxpayers.
The proper funding of immensely expensive healthcare services that are primarily used by the aged is more taxation of the aged, through the soaking of assets (mainly via higher property taxes and death duties.) And up with that the oldies will not put. They've paid their taxes so must now have everything for free. Just look at the burning bales and pitchforks we've had over the partial withdrawal of one small handout.
The young can't afford to support the old and the old don't want to help support themselves. So on we all go, circling the plughole together.
Labour had a slogan in my young days, promising that they would look after their people from the cradle to the grave. I suppose too many of us believed it and still hold them to it. Unreasonable, I agree.
The "But I paid my taxes" brigade have consistently voted for lower taxes, though. Income tax was 30% when I graduated in 1982.
OT Last day of the Paralympics so the medals table won't change much. We will still be second best under Keir Starmer.
1. China 94 gold medals 2. Dear Old Blighty 47 3. Land of the Free (except healthcare) 36 4. ex-Holland 26 5. Pizza and pasta 24 6. The beautiful game 23 7. Slava Ukraini 21 8. Aux Armes (& gilets jaunes) Citoyens 19 9. Land down under, girt by sea 18 10. Japan 14
The sad position being Ukraine. They have so many people who qualify for the Paralympics these days.
OT Last day of the Paralympics so the medals table won't change much. We will still be second best under Keir Starmer.
1. China 94 gold medals 2. Dear Old Blighty 47 3. Land of the Free (except healthcare) 36 4. ex-Holland 26 5. Pizza and pasta 24 6. The beautiful game 23 7. Slava Ukraini 21 8. Aux Armes (& gilets jaunes) Citoyens 19 9. Land down under, girt by sea 18 10. Japan 14
The sad position being Ukraine. They have so many people who qualify for the Paralympics these days.
Jimmy Carr had a great joke about that in the aftermath of the Iraq War, for which he got a load a crap in the media but a standing ovation when it told it in the veterans’ rehab facility. And then they did exactly that, and went and got a load of Paralympic medals.
What did he say?
Basically that war was sh!t, but you end up with a great Paralympics team as a result.
On topic, this is the only debate scheduled this year, and I think it does have the potential to cause a couple of points’ swing in either direction.
There’s been lots of discussion and argument between the camps over the format, but no changes ended up being made from the previous agreement between Trump and Biden.
I think that Harris wants to stick as closely to the script as possible, while Trump is much happier down in the off script swamp, and wants Harris down there too wrestling with the proverbial pig.
Either of them could end up saying something totally outrageous.
Unlike the last debate with Biden, and irrespective of what actually occurs at the debate, what’s not going to happen is all of the liberal media doing anything other than calling it a brilliant victory for Veep. The two sides now have their own media that talk straight past each other, and can agree on little more than that today is Sunday.
As many commentators have said in the past few days, no-one is going to change their mind, so it’s now all about the turnout - first getting people registered to vote, and then actually voting.
I wonder if it is true that it's all about turnout.
20% of the US population live in the seven swing states. About 160 million US citizens vote, so let's say 32 million voters in the swing states. Latest Redfield had average 7% "Don't Know" in the swing states. Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance. GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
Europe (and the UK) really ought to be collaborating to rebuild a genuinely competitive manufacturing base. It's not as though they don't have the capability.
The whole drama around semiconductors is driven by people who don't understand how they are used and by figures in the industry happy to milk that ignorance for big piles of tax payer's money.
Chips are not a commodity like oil, gas or steel. The sheer incredible range of semiconductors available means no nation is ever going to be able to produce but a small fraction of them, the US CHIPS act, or Europe's equivalent, will not alter that uncomfortable fact to any useful degree.
The distributor I buy from lists over 600,000 different chips. How do you on-shore the design, fabrication and packaging of even a fraction of those? You can't. No government has that kind of money, no nation has the required pool of engineers. No country has all the resources required to completely run a semi fab without importing at least a few critical minerals or other materials.
Semiconductors stopped being a national endeavour in the 80s. The only way to achieve independence is to do a North Korea, wall off your economy from the outside world and force designers to use only internally produced parts. I really don't have to explain how that would end...
You have a point, but it's both more complex, and simpler, than you state. The 'different' chips are somewhat irrelevant; what matters are the different processes, as different designs can be made in the same fab using the same process, or even on the same wafer using multi-project wafers.
You design chips for a set process, and for cutting-edge chips, for a specific foundry.
So to be 'independent', you would need one fab for cutting-edge chips, and a two- or three- previous gen for dishwasher chips and memory chips. That'd only cost... oh, a few tens of billion.
But where it gets more complex, as you state, is in the stuff a fab requires; from raw materials to machines from the likes of ASML.
I've mentioned this before, but years ago we had a chip that was fabbed in China; the wafers were sent to Switzerland for packaging (the wafers cut up and chips put into their ceramic or plastic cases); then some of the chips were sent to the UK for more stringent testing, whilst the rest went to the US. It can truly be an international business.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
The test clinic system in France is a model of efficiency. The doctor enters the required tests into the system. You turn up at one of the several private clinics in every small city or larger, normally get processed in and out in less than an hour and pay a very reasonable fee mostly subsidised by the insurance scheme. Doctor reviews the results within 48 hours of requesting the tests.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
Europe (and the UK) really ought to be collaborating to rebuild a genuinely competitive manufacturing base. It's not as though they don't have the capability.
The whole drama around semiconductors is driven by people who don't understand how they are used and by figures in the industry happy to milk that ignorance for big piles of tax payer's money.
Chips are not a commodity like oil, gas or steel. The sheer incredible range of semiconductors available means no nation is ever going to be able to produce but a small fraction of them, the US CHIPS act, or Europe's equivalent, will not alter that uncomfortable fact to any useful degree.
The distributor I buy from lists over 600,000 different chips. How do you on-shore the design, fabrication and packaging of even a fraction of those? You can't. No government has that kind of money, no nation has the required pool of engineers. No country has all the resources required to completely run a semi fab without importing at least a few critical minerals or other materials.
Semiconductors stopped being a national endeavour in the 80s. The only way to achieve independence is to do a North Korea, wall off your economy from the outside world and force designers to use only internally produced parts. I really don't have to explain how that would end...
You have a point, but it's both more complex, and simpler, than you state. The 'different' chips are somewhat irrelevant; what matters are the different processes, as different designs can be made in the same fab using the same process, or even on the same wafer using multi-project wafers.
You design chips for a set process, and for cutting-edge chips, for a specific foundry.
So to be 'independent', you would need one fab for cutting-edge chips, and a two- or three- previous gen for dishwasher chips and memory chips. That'd only cost... oh, a few tens of billion.
But where it gets more complex, as you state, is in the stuff a fab requires; from raw materials to machines from the likes of ASML.
I've mentioned this before, but years ago we had a chip that was fabbed in China; the wafers were sent to Switzerland for packaging (the wafers cut up and chips put into their ceramic or plastic cases); then some of the chips were sent to the UK for more stringent testing, whilst the rest went to the US. It can truly be an international business.
Indeed. Remember the panic/horror as various countries realised that vaccines were passing through their territory as part of the finishing process, during COVID?
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
On topic, this is the only debate scheduled this year, and I think it does have the potential to cause a couple of points’ swing in either direction.
There’s been lots of discussion and argument between the camps over the format, but no changes ended up being made from the previous agreement between Trump and Biden.
I think that Harris wants to stick as closely to the script as possible, while Trump is much happier down in the off script swamp, and wants Harris down there too wrestling with the proverbial pig.
Either of them could end up saying something totally outrageous.
Unlike the last debate with Biden, and irrespective of what actually occurs at the debate, what’s not going to happen is all of the liberal media doing anything other than calling it a brilliant victory for Veep. The two sides now have their own media that talk straight past each other, and can agree on little more than that today is Sunday.
As many commentators have said in the past few days, no-one is going to change their mind, so it’s now all about the turnout - first getting people registered to vote, and then actually voting.
I wonder if it is true that it's all about turnout.
20% of the US population live in the seven swing states. About 160 million US citizens vote, so let's say 32 million voters in the swing states. Latest Redfield had average 7% "Don't Know" in the swing states. Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance. GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
We know US voter turnout makes even our sub 70% turnout this year look good.
Pollsters here were poor at predicting who actually will go and vote, and clearly overestimated the likelihood of lukewarm Labour voters doing so, particularly in what were perceived as safe Labour seats.
In France this summer the pollsters for the second round underestimated the Left vote turnout to block RN.
Most electoral surprises for pollsters seem to originate in this domain, rather than unexpected switchers. The key is to look at whose supporters are enthused and whose are apathetic or resigned.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
Is that possible? A controversial point... The NHS now treats more people in more ways than it ever did.
Well, there are more people in the UK!
Yes, of course that is true, but mostly of young people who make marginal calls on local health services. Sometimes data would be really good, but I suspect the number of procedures, appointments etc are a good 30% to 70% more now than they were fifteen years ago.
Most UK population growth is not young people, it’s old people.
“The 85+ age group is the fastest growing and is set to double to 3.2 million by mid-2041 and treble by 2066”
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
On supply chains - autarky failed in the early Middle Ages. The majority of the staves for making longbows were imported….
When I was at Baxi I used to have to go to a plant in France quite regularly. They claimed to have had manufacturing on that site going back to the 1600’s making cannonballs. From the state of the factory I can quite believe it.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
On supply chains - autarky failed in the early Middle Ages. The majority of the staves for making longbows were imported….
When I was at Baxi I used to have to go to a plant in France quite regularly. They claimed to have had manufacturing on that site going back to the 1600’s making cannonballs. From the state of the factory I can quite believe it.
Henry VIII was so worried about import of gunpowder and cannon that he spent a fair chunk of money on the issue.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
On topic, this is the only debate scheduled this year, and I think it does have the potential to cause a couple of points’ swing in either direction.
There’s been lots of discussion and argument between the camps over the format, but no changes ended up being made from the previous agreement between Trump and Biden.
I think that Harris wants to stick as closely to the script as possible, while Trump is much happier down in the off script swamp, and wants Harris down there too wrestling with the proverbial pig.
Either of them could end up saying something totally outrageous.
Unlike the last debate with Biden, and irrespective of what actually occurs at the debate, what’s not going to happen is all of the liberal media doing anything other than calling it a brilliant victory for Veep. The two sides now have their own media that talk straight past each other, and can agree on little more than that today is Sunday.
As many commentators have said in the past few days, no-one is going to change their mind, so it’s now all about the turnout - first getting people registered to vote, and then actually voting.
I wonder if it is true that it's all about turnout.
20% of the US population live in the seven swing states. About 160 million US citizens vote, so let's say 32 million voters in the swing states. Latest Redfield had average 7% "Don't Know" in the swing states. Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance. GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
We know US voter turnout makes even our sub 70% turnout this year look good.
Pollsters here were poor at predicting who actually will go and vote, and clearly overestimated the likelihood of lukewarm Labour voters doing so, particularly in what were perceived as safe Labour seats.
In France this summer the pollsters for the second round underestimated the Left vote turnout to block RN.
Most electoral surprises for pollsters seem to originate in this domain, rather than unexpected switchers. The key is to look at whose supporters are enthused and whose are apathetic or resigned.
I assumed 66% turnout - the same as 2020.
I agree that turnout prediction is more difficult for pollsters than allegiance. Also US pollsters are not as good, in general, as UK pollsters. So there is a lot of uncertainty.
I think it would be a mistake for the Harris campaign to focus solely on turnout by motivating and doorknocking, important though that is. There is a herd effect for undecideds. Hence the importance of stakeboards.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
MAGA is about a fictional hero who will Save America. They project this onto Donald Trump. The actual Donald Trump is almost irrelevant. See the bizarre fan art that portrays him as various types of hero - and even Jesus. These are attempts to reconcile the reality with the myth.
This is a common feature of these kind of populist leader cults. Any negative is taken as a positive - proof that The Conspiracy will do Anything to stop The Hero.
What does this mean for the debates? The problem is that it is virtually impossible for Trump to “break” the lock he has on 45% of the electorate. They aren’t voting for him, anyway, they are voting for The Legend.
If he collapses into complete carehome grade dementia on stage that will become “The Hero was poisoned by Democrats and Ukrainians to steal the election”.
Trump will get 45% of the vote (more or less). He and Harris are fighting over less than 10%
So the debates might move the needle a bit - but not much. No matter what actually happens.
It's worse than that. It all hinges on a percentage point here and there in less than ten swing states.
Kamala wins the popular vote comfortably, Trump probably wins the College by a whisker.
I suspect that is what the markets are telling us.
Viewed from a UK perspective, and especially with their voting system similarly to ours tending to exaggerate any win, the remarkable thing in the US is that it’s been a while since they had a presidential election that wasn’t on a knife edge.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
I used Norway’s on my trip last year; OK it was only for an ear infection, but I just walked in off the street in two separate towns, and the service and speed and efficiency was stunning, and it only cost me £17 for the consultation and two prescriptions.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
I used Norway’s on my trip last year; OK it was only for an ear infection, but I just walked in off the street in two separate towns, and the service and speed and efficiency was stunning, and it only cost me £17 for the consultation and two prescriptions.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
Trouble is, a lot of people can look at those numbers and think "No way do I get £3000 worth of healthcare a year. The whole thing is a money pit and probably a scam."
Trouble is that we're all paying for a smallish number of expensive people, which will probably include most of us eventually but not for long.
And whilst we could kick those people of the sled and leave them to die in the snow... it would be cheaper, but we're not those sort of people. Are we? (At some point we are, hence pounds per QALY calculations, but I don't think we want to draw the line in a radically different place.)
On topic, this is the only debate scheduled this year, and I think it does have the potential to cause a couple of points’ swing in either direction.
There’s been lots of discussion and argument between the camps over the format, but no changes ended up being made from the previous agreement between Trump and Biden.
I think that Harris wants to stick as closely to the script as possible, while Trump is much happier down in the off script swamp, and wants Harris down there too wrestling with the proverbial pig.
Either of them could end up saying something totally outrageous.
Unlike the last debate with Biden, and irrespective of what actually occurs at the debate, what’s not going to happen is all of the liberal media doing anything other than calling it a brilliant victory for Veep. The two sides now have their own media that talk straight past each other, and can agree on little more than that today is Sunday.
As many commentators have said in the past few days, no-one is going to change their mind, so it’s now all about the turnout - first getting people registered to vote, and then actually voting.
I wonder if it is true that it's all about turnout.
20% of the US population live in the seven swing states. About 160 million US citizens vote, so let's say 32 million voters in the swing states. Latest Redfield had average 7% "Don't Know" in the swing states. Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance. GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
We know US voter turnout makes even our sub 70% turnout this year look good.
Pollsters here were poor at predicting who actually will go and vote, and clearly overestimated the likelihood of lukewarm Labour voters doing so, particularly in what were perceived as safe Labour seats.
In France this summer the pollsters for the second round underestimated the Left vote turnout to block RN.
Most electoral surprises for pollsters seem to originate in this domain, rather than unexpected switchers. The key is to look at whose supporters are enthused and whose are apathetic or resigned.
I assumed 66% turnout - the same as 2020.
I agree that turnout prediction is more difficult for pollsters than allegiance. Also US pollsters are not as good, in general, as UK pollsters. So there is a lot of uncertainty.
I think it would be a mistake for the Harris campaign to focus solely on turnout by motivating and doorknocking, important though that is. There is a herd effect for undecideds. Hence the importance of stakeboards.
Having been through something like nine states already, it is noticeable compared to my previous two US road trips - all at the same time of year - how few garden and field posters are up, yet. Those very few I have seen have been Trump ones, usually outside some decaying shack with rusted vehicles out the front. I don’t think I have seen any specifically for Harris/Walz yet, just a sprinkling of ones for Dems in other contests.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
That's fair enough, but I don't think we can get a command-healthcare system to behave like that. Perhaps I should have qualified to statement to read "As long as we have the NHS system...".
We bought a banana and the banana is going off. The trick is to apply banana preservative, not look longingly at apples nor complain that the banana is broken and we must make it green and spherical.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
The test clinic system in France is a model of efficiency. The doctor enters the required tests into the system. You turn up at one of the several private clinics in every small city or larger, normally get processed in and out in less than an hour and pay a very reasonable fee mostly subsidised by the insurance scheme. Doctor reviews the results within 48 hours of requesting the tests.
lol. I had some heart tests courtesy of the NHS, just before I left on my trip, and they said the waiting time before anyone even looks at them will be about five weeks ! And this was at Barts, not the island’s ramshackle health service.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
MAGA is about a fictional hero who will Save America. They project this onto Donald Trump. The actual Donald Trump is almost irrelevant. See the bizarre fan art that portrays him as various types of hero - and even Jesus. These are attempts to reconcile the reality with the myth.
This is a common feature of these kind of populist leader cults. Any negative is taken as a positive - proof that The Conspiracy will do Anything to stop The Hero.
What does this mean for the debates? The problem is that it is virtually impossible for Trump to “break” the lock he has on 45% of the electorate. They aren’t voting for him, anyway, they are voting for The Legend.
If he collapses into complete carehome grade dementia on stage that will become “The Hero was poisoned by Democrats and Ukrainians to steal the election”.
Trump will get 45% of the vote (more or less). He and Harris are fighting over less than 10%
So the debates might move the needle a bit - but not much. No matter what actually happens.
It's worse than that. It all hinges on a percentage point here and there in less than ten swing states.
Kamala wins the popular vote comfortably, Trump probably wins the College by a whisker.
I suspect that is what the markets are telling us.
That may be what the markets are telling us but whether the markets have a clue is another question.
Yes markets are excellent at predicting the current state of play but lousy at forecasting the outturn.
Options and futures markets are the same - the strike price is an excellent predictor of the current price, but bears little relation to the price when the contract expires.
Financial and betting markets are as influenced by the current mood as people they like to despise as less sophisticated, and it needs huge courage and perspicacity to set yourself against that.
Also a lot of betters take a position and then leave or forget about it, so there’s a big lag factor for the odds to swing round to reflect later changes, especially on Betfair where the odds are set by punters without any bookmaker judgement.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
That’s impressive - for health spending as a portion of GDP to reduce when in the same period our geriatric population has soared.
It suggests to me that at least part of the answer is more money.
Though I assume it jumped up a lot during and after Covid.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
Front line is starved. That is self-evident. And yet the money being spent goes up and up.
So the question isn’t “how much”, it’s “what on”.
Our problem - putting it bluntly - is that Tories don’t care about the front line and Labour don’t care what the bill is.
If we’re smarter about what we spend the money on we will both get better front line care and spend less. We need to divert funding from today’s waste into the things that count. But to do that we initially need to spend more money and then cut the money.
We can’t do that, because Tories say “more money isn’t the answer” whilst spending more money. And Labour say “cuts isn’t the answer” whilst cutting front line provision.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
That's fair enough, but I don't think we can get a command-healthcare system to behave like that. Perhaps I should have qualified to statement to read "As long as we have the NHS system...".
We bought a banana and the banana is going off. The trick is to apply banana preservative, not look longingly at apples nor complain that the banana is broken and we must make it green and spherical.
The apple costs 20% more. If you want the apple, pay 20% more.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
So to be 'independent', you would need one fab for cutting-edge chips, and a two- or three- previous gen for dishwasher chips and memory chips. That'd only cost... oh, a few tens of billion.
Probably quite a bit more, I'd imagine. Those 'dishwasher chips', for example, may have wildly different requirements that require a variety of fab processes to meet. A microcontroller may need a mixed-use process that runs optimally at a low voltage and can handle logic, SRAM and flash on the same die. Whereas the I/O drivers that attach it to more industrial parts of the system need a lower-density, more robust process cable of tolerating relatively high voltages.
One of my designs employs FRAM memory, which requires a specialist process node that is, as far as I'm aware, is only used by a grand total of two fabs.
My guess is to be able to produce a usefully competitive range of semiconductors a country would need 30-40 different process nodes. Of course one fab can handle several of those, but that's still a colossal amount of investment.
And, yes, as you say keeping those fabs running is not something easily done from purely national resources. There was a panic a few years ago when pretty much every major fab house found they were using a specific gas only made by a single supplier (in Germany if I recall correctly) who was having issues and had to stop production temporarily. The supply chain is both complex and incredibly fragile.
On supply chains - autarky failed in the early Middle Ages. The majority of the staves for making longbows were imported….
When I was at Baxi I used to have to go to a plant in France quite regularly. They claimed to have had manufacturing on that site going back to the 1600’s making cannonballs. From the state of the factory I can quite believe it.
I think the big advantage of the French test clinic system is that it is self organising. All the doctor has to do is specify the tests and review them. They don't need to arrange, request, make appointments, manage payment etc. The patient does that. The clinics themselves are super efficient production lines.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
The cue for me to do the Sunday Rawnsley, while I am still in bed waiting for the sun to come up:
It was an Anyone But The Conservatives election back in July. Labour won it by being the most preferred of the Anyones and secured its victory with a mammoth parliamentary majority because its campaign was very well targeted and support was efficiently distributed. So it is not accurate to say that the country has already fallen out of love with Labour; the country was never in love with Labour in the first place.
One of the reasons that this [fuel] furore has become potent is that left, right and centre can all find reasons to oppose the cut.
[After Rishi], Sir Ed Davey was the more piercing when the Lib Dem leader showcased a real-life example of what it would mean for the family finances of a carer whose income was just a few hundred pounds above the cut-off for continuing to qualify for the payment. Sir Ed received an unrebarbative response from Sir Keir. His emollient tone to his fellow knight had me wondering whether the prime minister is already preparing himself to move in the direction of a compromise. It is the mood among Labour MPs that is being anxiously monitored by their whips.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer. The saving to the exchequer will be around £1.5bn, not a trivial sum, but only about a hundredth of the total spend on pensioner benefits in the last financial year.
Many now think that we are heading towards some kind of U-turn, probably not immediately, but more likely when Ms Reeves unveils the budget at the end of October. The question then becomes how a retreat can be conducted without weakening the authority of the chancellor and the prime minister.
She won’t cancel the cut. My hunch is that she will eventually make a partial retreat which assuages the impact on the group about whom Labour MPs are most bothered: pensioners who don’t qualify or claim the credit and for whom this change will mean hardship. Then she and the prime minister will have to figure out how to make the U-turn elegant rather than embarrassing.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
That's fair enough, but I don't think we can get a command-healthcare system to behave like that. Perhaps I should have qualified to statement to read "As long as we have the NHS system...".
We bought a banana and the banana is going off. The trick is to apply banana preservative, not look longingly at apples nor complain that the banana is broken and we must make it green and spherical.
The apple costs 20% more. If you want the apple, pay 20% more.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
If you want Statista and a nice graph, see https://www.statista.com/statistics/236541/per-capita-health-expenditure-by-country/ That's per capita spend in 2022. France, which has been much praised in this thread, were on $6517. Switzerland has been mentioned: they're on $8049. Norway is $7898. The UK is $5493, although that is more than Japan on $5251.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
The basic DGH structure is the problem. They have tinkered around the edges but never really done it properly.
Simple things (to say, not do!)
- get triage out of A&E. possibly have a Co-located facility for out of hours GP services - Go for full scale specialist hospitals. Patients families hate this because it makes visiting more challenging, but complex diseases are increasingly complex - Recreate convalescent facilities to deal with bed blockers - Integrate social care with the NHS (take out of council budgets) but run as a parallel organisation, with the same strategic oversight but not 1 CEO - Sweat the assets more - all too often theatres are dark for NHS (although they do get used by firms like Medinet) - Train more people: the NHS should be running at 85% capacity (F**k off Treasury) not 97% -
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
Front line is starved. That is self-evident. And yet the money being spent goes up and up.
So the question isn’t “how much”, it’s “what on”.
Our problem - putting it bluntly - is that Tories don’t care about the front line and Labour don’t care what the bill is.
If we’re smarter about what we spend the money on we will both get better front line care and spend less. We need to divert funding from today’s waste into the things that count. But to do that we initially need to spend more money and then cut the money.
We can’t do that, because Tories say “more money isn’t the answer” whilst spending more money. And Labour say “cuts isn’t the answer” whilst cutting front line provision.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Nothing gets a Lefty to shit quicker than Maggie Thatcher.
Many years ago, my Mum, a GP, got a patient to quit smoking by hanging a picture of Thatcher in his loo and getting him to think that whenever he smoked, he was giving money to Thatcher's government. Worked a treat.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
The basic DGH structure is the problem. They have tinkered around the edges but never really done it properly.
Simple things (to say, not do!)
- get triage out of A&E. possibly have a Co-located facility for out of hours GP services - Go for full scale specialist hospitals. Patients families hate this because it makes visiting more challenging, but complex diseases are increasingly complex - Recreate convalescent facilities to deal with bed blockers - Integrate social care with the NHS (take out of council budgets) but run as a parallel organisation, with the same strategic oversight but not 1 CEO - Sweat the assets more - all too often theatres are dark for NHS (although they do get used by firms like Medinet) - Train more people: the NHS should be running at 85% capacity (F**k off Treasury) not 97% -
The first one we used to have, when I first moved to the island - a 24/7 GP service, co-located with A&E, which NHS direct or the old phone service could book you into if you had something minor, or potentially but maybe not serious. The one time I was sent there, I walked straight in and was seen right away (very similar to my Norway experience, where they have ‘first aid’ centres, essentially an A&E for anything potentially urgent but not life threatening).
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
The basic DGH structure is the problem. They have tinkered around the edges but never really done it properly.
Simple things (to say, not do!)
- get triage out of A&E. possibly have a Co-located facility for out of hours GP services - Go for full scale specialist hospitals. Patients families hate this because it makes visiting more challenging, but complex diseases are increasingly complex - Recreate convalescent facilities to deal with bed blockers - Integrate social care with the NHS (take out of council budgets) but run as a parallel organisation, with the same strategic oversight but not 1 CEO - Sweat the assets more - all too often theatres are dark for NHS (although they do get used by firms like Medinet) - Train more people: the NHS should be running at 85% capacity (F**k off Treasury) not 97% -
The first one we used to have, when I first moved to the island - a 24/7 GP service, co-located with A&E, which NHS direct or the old phone service could book you into if you had something minor, or potentially but maybe not serious. The one time I was sent there, I walked straight in and was seen right away (very similar to my Norway experience, where they have ‘first aid’ centres, essentially an A&E for anything potentially urgent but not life threatening).
But the NHS shut it down some years back, sadly.
People generally thought they were a good thing, but there wasn't enough money for them, so they got shut down.
Europe (and the UK) really ought to be collaborating to rebuild a genuinely competitive manufacturing base. It's not as though they don't have the capability.
Collaboration isn't the way to achieve it. We need to compete with each other.
We need to compete full stop. Manufacturing of anything other than food in Britain is not viable, mainly due to the cost of energy, but also the cost of Labour, and taxation. The businesses that are doing it viably are heritage brands where people expect to pay over the odds anyway and want their cartridge bag made in Britain from English leather or their suit from British tweed.
We have two choices - accept that everything will be made in China, or don't accept it.
We can't compete with China on costs, so the inference of your post that we pay working people less and tax rich people less doesn't solve the problem. Nor does paying people less help the economy as they then have less money to circulate buing products & services which means businesses close and jobs are lost.
We cannot 'accept that everything gets made in China' because once everything is made in China, they own all the means of production, can dictate the price, and we are economic slaves. Switzerland, France, Germany - these countries do not 'accept that everything gets made in China' - the idea is certifiably insane.
The 'inference' of my post is that: 1. We need to ditch our economically suicidal energy policy. It was bad enough with the Tories, now giving Ed Milliband billions of pounds to produce zero energy and ensure the price continues to rise - FUCK OFF. It's killing the economy. We need to ensure a plentiful and cheap supply of energy - if it's zero or low carbon energy, great. If it's clean but carbon-producing energy for the time-being, jfdi, and stop boasting about how well you're doing because you've effectively deindustrialised the country - literally NO other countries are looking at us and wishing they'd followed suit. As part of this we also need to get more of our own oil and gas out, as well as coal where appropriate.
That's alongside tax-cuts and other measures aimed at making it easier to do business here.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Depends on how much healthcare you think we should have, especially remembering that neither of us sees where most of the money is going.
Alternatively, how much should healthcare cost?
That’s a great question and who knows ? I doubt any politician on any side would face up to,that..
All I know is whatever we spend it never seems to be enough and the solution always seems to be more money.
I think what I want to see from Starmer on this and on the other complex difficult problems (e.g. planning and infrastructure building) is a statement of what his strategy for fixing things is. Maybe that's "we spend 20% less on the NHS than comparable European countries, so we're investing in XYZ", maybe it's "we need ABC reforms which we can see work in other countries", I don't actually care that much. I just want to see a coherent plan and a start made on that plan. I'm all for a bit of competent technocratic managerialist government for a change, just show me the competence and something that's a bit more long term planned out than "gets through an immediate crisis"...
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Nothing gets a Lefty to shit quicker than Maggie Thatcher.
Many years ago, my Mum, a GP, got a patient to quit smoking by hanging a picture of Thatcher in his loo and getting him to think that whenever he smoked, he was giving money to Thatcher's government. Worked a treat.
I sold several people on electric cars with the following - “Each time you plug in, you are punching the Chancellor in the gut”.
Anyhow, breakfast calls, so I will drop a photo from yesterday with Mr Dog looking less impressed than he should have been that we finally found a Rocky Mountain cable car that not only allows dogs to travel on it, but is actually free…
“Knife attacks happen almost daily, 2 gang rapes happen every day on average, the majority of the perpetrators are young migrants who are entirely disrespectful of women. "This is the reality and we must end it."
Nigel Farage? Mme Le Pen?
No, the likely next Chancellor of Germany
These are huge shifts and the British government will soon look very exposed on the crumbling Woke left
The cue for me to do the Sunday Rawnsley, while I am still in bed waiting for the sun to come up:
It was an Anyone But The Conservatives election back in July. Labour won it by being the most preferred of the Anyones and secured its victory with a mammoth parliamentary majority because its campaign was very well targeted and support was efficiently distributed. So it is not accurate to say that the country has already fallen out of love with Labour; the country was never in love with Labour in the first place.
One of the reasons that this [fuel] furore has become potent is that left, right and centre can all find reasons to oppose the cut.
[After Rishi], Sir Ed Davey was the more piercing when the Lib Dem leader showcased a real-life example of what it would mean for the family finances of a carer whose income was just a few hundred pounds above the cut-off for continuing to qualify for the payment. Sir Ed received an unrebarbative response from Sir Keir. His emollient tone to his fellow knight had me wondering whether the prime minister is already preparing himself to move in the direction of a compromise. It is the mood among Labour MPs that is being anxiously monitored by their whips.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer. The saving to the exchequer will be around £1.5bn, not a trivial sum, but only about a hundredth of the total spend on pensioner benefits in the last financial year.
Many now think that we are heading towards some kind of U-turn, probably not immediately, but more likely when Ms Reeves unveils the budget at the end of October. The question then becomes how a retreat can be conducted without weakening the authority of the chancellor and the prime minister.
She won’t cancel the cut. My hunch is that she will eventually make a partial retreat which assuages the impact on the group about whom Labour MPs are most bothered: pensioners who don’t qualify or claim the credit and for whom this change will mean hardship. Then she and the prime minister will have to figure out how to make the U-turn elegant rather than embarrassing.
Having put great store in making cuts to get its sums to add up, the Government can't finesse its way out of this (say, by redefining the group who will still get the payment and thus allowing more oldies to keep it,) without funding the shift with higher taxes or more cuts elsewhere.
Now, who is going to be made to suffer worse so that the axe on the Winter fuel payment only affects those people who were planning on using it to cover the drinks budget for their next cruise to Madeira? My guess is that pensioner homeowners and the very wealthy will be let off and some means will be discovered to soak younger families instead. Continuity Conservatism, with a translucent veneer of social democracy delicately smeared over it as a less than convincing disguise. As if such a thing could not have been predicted in advance.
On topic, this is the only debate scheduled this year, and I think it does have the potential to cause a couple of points’ swing in either direction.
There’s been lots of discussion and argument between the camps over the format, but no changes ended up being made from the previous agreement between Trump and Biden.
I think that Harris wants to stick as closely to the script as possible, while Trump is much happier down in the off script swamp, and wants Harris down there too wrestling with the proverbial pig.
Either of them could end up saying something totally outrageous.
Unlike the last debate with Biden, and irrespective of what actually occurs at the debate, what’s not going to happen is all of the liberal media doing anything other than calling it a brilliant victory for Veep. The two sides now have their own media that talk straight past each other, and can agree on little more than that today is Sunday.
As many commentators have said in the past few days, no-one is going to change their mind, so it’s now all about the turnout - first getting people registered to vote, and then actually voting.
I wonder if it is true that it's all about turnout.
20% of the US population live in the seven swing states. About 160 million US citizens vote, so let's say 32 million voters in the swing states. Latest Redfield had average 7% "Don't Know" in the swing states. Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance. GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
We know US voter turnout makes even our sub 70% turnout this year look good.
Pollsters here were poor at predicting who actually will go and vote, and clearly overestimated the likelihood of lukewarm Labour voters doing so, particularly in what were perceived as safe Labour seats.
In France this summer the pollsters for the second round underestimated the Left vote turnout to block RN.
Most electoral surprises for pollsters seem to originate in this domain, rather than unexpected switchers. The key is to look at whose supporters are enthused and whose are apathetic or resigned.
I assumed 66% turnout - the same as 2020.
I agree that turnout prediction is more difficult for pollsters than allegiance. Also US pollsters are not as good, in general, as UK pollsters. So there is a lot of uncertainty.
I think it would be a mistake for the Harris campaign to focus solely on turnout by motivating and doorknocking, important though that is. There is a herd effect for undecideds. Hence the importance of stakeboards.
Having been through something like nine states already, it is noticeable compared to my previous two US road trips - all at the same time of year - how few garden and field posters are up, yet. Those very few I have seen have been Trump ones, usually outside some decaying shack with rusted vehicles out the front. I don’t think I have seen any specifically for Harris/Walz yet, just a sprinkling of ones for Dems in other contests.
The Harris campaign needs to get the boards and posters up to amplify the herd effect for those who don't follow politics. "Kamala winning here". A LibDem tip.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
Yes that’s the most pernicious myth of all.
No-one who’s lived in another OECD country thinks that the NHS is better than the health system there.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Donald Trump on Saturday floated changing the 25th Amendment to allow Congress to impeach a vice president for covering up a president’s incapacity less than two months after President Joe Biden exited the 2024 contest amid concerns about his age and acuity.
“I will support modifying the 25th Amendment to make clear that if a vice president lies or engages in a conspiracy to cover up the incapacity of the president of the United States — if you do that with a cover-up of the president of the United States, it’s grounds for impeachment immediately and removal from office, because that’s what they did,” the former president said during a rally in Mosinee, Wisconsin.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The worse aspect of the May/Johnson/Sunak government was the unconservative belief that a problem could be solved by throwing money at it. The NHS has been soaked in money.
We spend less on healthcare than most of the OECD and budgets have gone up less than under New Labour. The NHS has not been “soaked” in money.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
If you want Statista and a nice graph, see https://www.statista.com/statistics/236541/per-capita-health-expenditure-by-country/ That's per capita spend in 2022. France, which has been much praised in this thread, were on $6517. Switzerland has been mentioned: they're on $8049. Norway is $7898. The UK is $5493, although that is more than Japan on $5251.
What you have to remember is that the private health system runs in parallel with the NHS. Company schemes, private BPA membership, one off operation such as hernia Ops at £4,000+ per operation, etc. So, the total spend is much higher than suggested.
“Knife attacks happen almost daily, 2 gang rapes happen every day on average, the majority of the perpetrators are young migrants who are entirely disrespectful of women. "This is the reality and we must end it."
Nigel Farage? Mme Le Pen?
No, the likely next Chancellor of Germany
These are huge shifts and the British government will soon look very exposed on the crumbling Woke left
One of the key misconceptions in Western politics is that the baby boomers are the drivers of reactionary politics and that as they die off, we'll bask in a progressive utopia. In reality it's almost exactly the reverse, particularly on the continent.
"Today's disasters aren't caused by lack of regulation, but simple dishonesty Trust is the single most important ingredient in a successful country, and we have thrown it to the wolves"
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Health spending follows the law of diminishing returns.
We could double health spending but would we get any more than a few extra weeks of poor quality life in our 80s and 90s.
And there's an opportunity cost to that extra spending.
Increasing health spending to a French or German or American level now might help the oldies but it isn't much use for the younger generations.
For them that extra health spending would be better used on education, training or housing.
Is that true? Or is it more of an inverted u-shape?
Given we have millions out of work for health-related reasons, contributing no tax and costing us billions in welfare, I'd have guessed the marginal return on more health spending is actually quite high at the moment.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
And for all the noise, the plan remains Repulsive... But Right. The recent above-inflation increases in the basic pension ought to render the WFA redundant as a separate payment. The pension credit line isn't perfect as a cutoff, but it's the only one that's readily available. Oppositions should oppose things, but governments should mostly ignore them.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Health spending follows the law of diminishing returns.
We could double health spending but would we get any more than a few extra weeks of poor quality life in our 80s and 90s.
And there's an opportunity cost to that extra spending.
Increasing health spending to a French or German or American level now might help the oldies but it isn't much use for the younger generations.
For them that extra health spending would be better used on education, training or housing.
Is that true? Or is it more of an inverted u-shape?
Given we have millions out of work for health-related reasons, contributing no tax and costing us billions in welfare, I'd have guessed the marginal return on more health spending is actually quite high at the moment.
It depends what you spend the money on. If you want to get people back into work, put money into mental health and musculoskeletal conditions as those are by far the main reasons for economic inactivity. We need psychotherapists and physiotherapists.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
And for all the noise, the plan remains Repulsive... But Right. The recent above-inflation increases in the basic pension ought to render the WFA redundant as a separate payment. The pension credit line isn't perfect as a cutoff, but it's the only one that's readily available. Oppositions should oppose things, but governments should mostly ignore them.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
Stuff like this makes it difficult to make tough decisions, this is less tough, more stupid in the harm it does to credibility vs the savings it achieves. It was a rookie mistake to preannounce, it a mistake to try and make the saving mid year, a mistake to facilitate the conflation with train driver increases.
Pensioners dont easily forget. A former MP was telling me that right up until the end he would get regular emails from angry retired people about losing the free TV license, that decision by the BBC was taken in 2020.
Most MPs are not fully up and running yet, but I'm pretty sure they'll have been inundated by phone calls (if they have lines yet), emails and letters about this. And it wont stop. If we have a bad winter this will bit them on the bum hard.
If they really wanted to make a series of tough decisions like this, they should have a list of all the really hard ones they want to make and rip that plaster off on the floor of the commons in the budget statement.
Rookie mistake, and one that they've doubled down on.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
The rest of the world is so envious of our sainted NHS who else has one ?
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
Health spending follows the law of diminishing returns.
We could double health spending but would we get any more than a few extra weeks of poor quality life in our 80s and 90s.
And there's an opportunity cost to that extra spending.
Increasing health spending to a French or German or American level now might help the oldies but it isn't much use for the younger generations.
For them that extra health spending would be better used on education, training or housing.
Is that true? Or is it more of an inverted u-shape?
Given we have millions out of work for health-related reasons, contributing no tax and costing us billions in welfare, I'd have guessed the marginal return on more health spending is actually quite high at the moment.
How many of these 'millions' want to work and are easily curable ?
And what proportion of any extra health spending would be directed towards them.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
And for all the noise, the plan remains Repulsive... But Right. The recent above-inflation increases in the basic pension ought to render the WFA redundant as a separate payment. The pension credit line isn't perfect as a cutoff, but it's the only one that's readily available. Oppositions should oppose things, but governments should mostly ignore them.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
Stuff like this makes it difficult to make tough decisions, this is less tough, more stupid in the harm it does to credibility vs the savings it achieves. It was a rookie mistake to preannounce, it a mistake to try and make the saving mid year, a mistake to facilitate the conflation with train driver increases.
Pensioners dont easily forget. A former MP was telling me that right up until the end he would get regular emails from angry retired people about losing the free TV license, that decision by the BBC was taken in 2020.
Most MPs are not fully up and running yet, but I'm pretty sure they'll have been inundated by phone calls (if they have lines yet), emails and letters about this. And it wont stop. If we have a bad winter this will bit them on the bum hard.
If they really wanted to make a series of tough decisions like this, they should have a list of all the really hard ones they want to make and rip that plaster off on the floor of the commons in the budget statement.
Rookie mistake, and one that they've doubled down on.
Pensioners only remember for so long, and can only vote Conservative once each time. And now have more disposable income, on average, than working people. Which can’t be right.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
And for all the noise, the plan remains Repulsive... But Right. The recent above-inflation increases in the basic pension ought to render the WFA redundant as a separate payment. The pension credit line isn't perfect as a cutoff, but it's the only one that's readily available. Oppositions should oppose things, but governments should mostly ignore them.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
Stuff like this makes it difficult to make tough decisions, this is less tough, more stupid in the harm it does to credibility vs the savings it achieves. It was a rookie mistake to preannounce, it a mistake to try and make the saving mid year, a mistake to facilitate the conflation with train driver increases.
Pensioners dont easily forget. A former MP was telling me that right up until the end he would get regular emails from angry retired people about losing the free TV license, that decision by the BBC was taken in 2020.
Most MPs are not fully up and running yet, but I'm pretty sure they'll have been inundated by phone calls (if they have lines yet), emails and letters about this. And it wont stop. If we have a bad winter this will bit them on the bum hard.
If they really wanted to make a series of tough decisions like this, they should have a list of all the really hard ones they want to make and rip that plaster off on the floor of the commons in the budget statement.
Rookie mistake, and one that they've doubled down on.
Pensioners only remember for so long, and can only vote Conservative once each time. And now have more disposable income, on average, than working people. Which can’t be right.
The other thing is that people who are no longer of working age have more time to write cross letters to their MP, so an MP's mailbox is a pretty unrepresentative measure of true feelings on a subject. See also: planning objections.
“Knife attacks happen almost daily, 2 gang rapes happen every day on average, the majority of the perpetrators are young migrants who are entirely disrespectful of women. "This is the reality and we must end it."
Nigel Farage? Mme Le Pen?
No, the likely next Chancellor of Germany
These are huge shifts and the British government will soon look very exposed on the crumbling Woke left
One of the key misconceptions in Western politics is that the baby boomers are the drivers of reactionary politics and that as they die off, we'll bask in a progressive utopia. In reality it's almost exactly the reverse, particularly on the continent.
Indeed. As I’ve been predicting on this site for some time, we are about to see an epochal move to the right on migration/asylum/culture
Because the alternative, if you are a democrat politician, is actual Nazis in power. As we see in Thuringia
“Knife attacks happen almost daily, 2 gang rapes happen every day on average, the majority of the perpetrators are young migrants who are entirely disrespectful of women. "This is the reality and we must end it."
Nigel Farage? Mme Le Pen?
No, the likely next Chancellor of Germany
These are huge shifts and the British government will soon look very exposed on the crumbling Woke left
One of the key misconceptions in Western politics is that the baby boomers are the drivers of reactionary politics and that as they die off, we'll bask in a progressive utopia. In reality it's almost exactly the reverse, particularly on the continent.
Merz's speech also emphasises that most migrants are fine and welcome in Germany, and that this among other distinguishes his views from the AfD, who are critical of migration in general.
I'm not sure you''d find anyone on the Woke left in Britain or anywhere else who was tolerant of gang rape.
"Sir Keir Starmer removed a portrait of Margaret Thatcher from a No10 study because he doesn't like people 'staring down at me' from the wall, he revealed today.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
Starmer is a short arse at only 5ft 7 ish... everyone looks down at him. if you look at the picture of him in a chair with his toes pointing up (in the BBC interview ) he looks like a marionette...
The cue for me to do the Sunday Rawnsley, while I am still in bed waiting for the sun to come up:
It was an Anyone But The Conservatives election back in July. Labour won it by being the most preferred of the Anyones and secured its victory with a mammoth parliamentary majority because its campaign was very well targeted and support was efficiently distributed. So it is not accurate to say that the country has already fallen out of love with Labour; the country was never in love with Labour in the first place.
One of the reasons that this [fuel] furore has become potent is that left, right and centre can all find reasons to oppose the cut.
[After Rishi], Sir Ed Davey was the more piercing when the Lib Dem leader showcased a real-life example of what it would mean for the family finances of a carer whose income was just a few hundred pounds above the cut-off for continuing to qualify for the payment. Sir Ed received an unrebarbative response from Sir Keir. His emollient tone to his fellow knight had me wondering whether the prime minister is already preparing himself to move in the direction of a compromise. It is the mood among Labour MPs that is being anxiously monitored by their whips.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer. The saving to the exchequer will be around £1.5bn, not a trivial sum, but only about a hundredth of the total spend on pensioner benefits in the last financial year.
Many now think that we are heading towards some kind of U-turn, probably not immediately, but more likely when Ms Reeves unveils the budget at the end of October. The question then becomes how a retreat can be conducted without weakening the authority of the chancellor and the prime minister.
She won’t cancel the cut. My hunch is that she will eventually make a partial retreat which assuages the impact on the group about whom Labour MPs are most bothered: pensioners who don’t qualify or claim the credit and for whom this change will mean hardship. Then she and the prime minister will have to figure out how to make the U-turn elegant rather than embarrassing.
Just interested in the interest of political fairness, why did you edit out this part out
Adopting a hitherto concealed persona as a champion of the poor, Rishi Sunak drew a little blood at the most recent prime minister’s questions by demanding where was the justice in giving a pay rise of almost £10,000 to well-remunerated train drivers and removing the fuel support for low-income pensioners living on just £13,000 a year. Tory MPs, who don’t have much to smile about these days, enjoyed themselves, baying “Shame!”.
Sir Ed Davey was the more piercing ............................................................
Why all the confected outrage about the Thatch portrait? It’s a bloody awful painting and few in their right mind would want it glaring down on them when they are trying to work. Stick it in the garage.
OT Last day of the Paralympics so the medals table won't change much. We will still be second best under Keir Starmer.
1. China 94 gold medals 2. Dear Old Blighty 47 3. Land of the Free (except healthcare) 36 4. ex-Holland 26 5. Pizza and pasta 24 6. The beautiful game 23 7. Slava Ukraini 21 8. Aux Armes (& gilets jaunes) Citoyens 19 9. Land down under, girt by sea 18 10. Japan 14
The sad position being Ukraine. They have so many people who qualify for the Paralympics these days.
With Taliban IEDs increasing the pool of talent that Team GB and Team USA get to draw from.
I was never a fan of personal injury work and one of the reasons was that it seemed to positively reward negative behaviour and disincentivise positive steps. When I was training as an advocate I had a claim for a female soldier who had lost most of her right leg in an accident in Afghanistan. There was some negligence involved. She had been an ambitious soldier and may well have lost a great career with a significant loss of earnings claim.
Instead she just got on with life. She qualified as a rower for the disability Olympics and medalled. She went back to school and used her intellect to build a new career for herself in the army. This cost her at least a couple of hundred thousand pounds in damages. She was crystal clear it was worth every penny. I was lost in admiration.
Why all the confected outrage about the Thatch portrait? It’s a bloody awful painting and few in their right mind would want it glaring down on them when they are trying to work. Stick it in the garage.
I expect Starmer has an inferiority complex wrt Mrs T.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
The amount the NHS spends on bureaucracy is low compared to international comparators (way lower than the US). Any debate on the NHS would benefit from facts rather than oft-repeated myths.
I would suggest - from having done OR, and seen the NHS as a customer and talked to people working in it - that it needs *modern* management.
I think there’s plenty you can do to reform how the NHS and wider health ecosystem works. (I do research on digital health start-ups: we’ve published a number of pieces on this topic.)
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
You seem to have forgotten the most pernicious myth:
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
Yes that’s the most pernicious myth of all.
No-one who’s lived in another OECD country thinks that the NHS is better than the health system there.
I've lived much of my life in Switzerland, Austria and Denmark. The Swiss system works better than the NHS, but they spend much more money on it. I wouldn't say the systems in Denmark or Austria were obviously better. "The grass is always greener", etc. Obviously the NHS is under strain and parts are clearly underffunded, but we shouldn't assume that massiveky changing the system will give benefits.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
And for all the noise, the plan remains Repulsive... But Right. The recent above-inflation increases in the basic pension ought to render the WFA redundant as a separate payment. The pension credit line isn't perfect as a cutoff, but it's the only one that's readily available. Oppositions should oppose things, but governments should mostly ignore them.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
Gordon Brown handed pensioners a 75p per week rise and it stayed with him
You can be certain the media will focus on the elderly shivering in their homes this winter, and of course labour will win the vote next week but the optics of taking WFA away from pensioners and giving it to train drivers is terrible
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
France spends a lot more on healthcare than the UK. So, if they’re doing better, is that how they’re organised and that they’re spending more?
Not that much more. And I am afraid that it is certain that no matter how much more money we spend on healthcare in this country we will never approach the standards of many of our European neighbours under the current system. Blair threw money at the system and although there was some marginal improvement in specific targets we still didn't get anywhere near the standards of France or Norway.
Re the Starmer interview - I am a little relieved to hear him talk about reform for the NHS rather than just the spending trap (though he did allude to that also). This is the sort of thinking he does need to be getting out there. I am still, from his early actions, very unconvinced he has what it takes to really take on some of the vested interests and get meaningful reform through - but at least the topic is on the table.
The only caveat I would have about NHS reform is that until 2011 or thereabouts we lived in a constant state of reform, and it wasn't good for services or the morale of service providers. As a service user now I don't think I want to see a root and breach reform; I want to see the present system properly funded and staffed. And it's not 'just' seeing a GP or consultant; I want to be able to contact a physiotherapist or district nurse without an interminable wait on the phone, and a recorded voice telling me the service is 'experiencing a high volume of calls'.
The NHS receives vast amounts of funding. It needs to wean itself off the view that money alone will help it. It is a vast bureaucracy with significant inefficiencies. Until we target some of those weak points and think about how we can deliver things better, it will never improve to the level that it should. You are absolutely correct that staffing is one part of that and on that there needs to be more thought put into recruitment and retention - that will be a long term process.
If I may politely disagree. As a rough rule of thumb the UK population has increased by a million people every two years for the last ten years. The stress on the system is down to demand. We need to stop thinking there is some magical NHS reorganisation that will enable us to deliver more for less, because we have been doing that for decades now and it hasn't worked. In short, @OldKingCole is right: increase funding and staffing to run the existing system and stop using agency workers to fill the gap. If you want to decrease NHS spending, calve off categories of conditions to the private sector and stop funding them. My nomination is disorders that we can't fix and don't prevent people from working, but I assume there'll be others.
On the matter of Starmer, this is one of the reasons why I don't like him. The large bulge of Boomers working thru their final days in the next 15 years will break the system unless it's properly funded. Him talking hard does not help this and in fact makes things worse
I disagree. As I have said many times before we need to look at the way Continental Health systems are organised and how they work so much better than the NHS.
One anecdotal example (ignoring the slightly hyperbolic headline) but it matches well with my experiences in France, Norway, the Netherlands and Germany, all of which are light years better than the UK when it comes to front end service.
That's fair enough, but I don't think we can get a command-healthcare system to behave like that. Perhaps I should have qualified to statement to read "As long as we have the NHS system...".
We bought a banana and the banana is going off. The trick is to apply banana preservative, not look longingly at apples nor complain that the banana is broken and we must make it green and spherical.
Nope, the trick is to accept that banana has gone rotten and put it in the compost (Or preferably put it out for the butterflies and moths!). If we want fresh fruit then we have to buy it not moan about how everyone elses fruit bowl looks so much better than ours.
Comments
NY Times
Trump+1
https://www.270towin.com/polls/latest-2024-presidential-election-polls/
https://scri.siena.edu/2024/09/08/__trashed/
Options and futures markets are the same - the strike price is an excellent predictor of the current price, but bears little relation to the price when the contract expires.
Financial and betting markets are as influenced by the current mood as people they like to despise as less sophisticated, and it needs huge courage and perspicacity to set yourself against that.
No 10 announced that it would be rehung in a 'first floor meeting room' because the Labour Prime Minister found it 'unsettling'."
https://www.dailymail.co.uk/news/article-13826371/Keir-Starmer-defends-removing-portrait-Margaret-Thatcher-No10.html
Chips are not a commodity like oil, gas or steel. The sheer incredible range of semiconductors available means no nation is ever going to be able to produce but a small fraction of them, the US CHIPS act, or Europe's equivalent, will not alter that uncomfortable fact to any useful degree.
The distributor I buy from lists over 600,000 different chips. How do you on-shore the design, fabrication and packaging of even a fraction of those? You can't. No government has that kind of money, no nation has the required pool of engineers. No country has all the resources required to completely run a semi fab without importing at least a few critical minerals or other materials.
Semiconductors stopped being a national endeavour in the 80s. The only way to achieve independence is to do a North Korea, wall off your economy from the outside world and force designers to use only internally produced parts. I really don't have to explain how that would end...
https://www.bbc.com/news/magazine-18670966
20% of the US population live in the seven swing states.
About 160 million US citizens vote, so let's say 32 million voters in the swing states.
Latest Redfield had average 7% "Don't Know" in the swing states.
Well over half of these won't vote. Let's assume 2% of the 7% actually vote, that is 600,000 actual voters that can be swung.
A 1% differential in turnout on 16 million voters for each candidate is worth 160,000 votes. 2% is worth 320,000.
I think GOTV and convert the don't knows are of roughly equal importance.
GOTV is probably easier as the "Don't Knows" may not follow politics much and will vote like their neighbours.
I'm hopeful that some of the "Don't Knows" are the Democrat wives of MAGA husbands who don't want to declare their hand.
https://x.com/DougJBalloon/status/1832496460329263283
You design chips for a set process, and for cutting-edge chips, for a specific foundry.
So to be 'independent', you would need one fab for cutting-edge chips, and a two- or three- previous gen for dishwasher chips and memory chips. That'd only cost... oh, a few tens of billion.
But where it gets more complex, as you state, is in the stuff a fab requires; from raw materials to machines from the likes of ASML.
I've mentioned this before, but years ago we had a chip that was fabbed in China; the wafers were sent to Switzerland for packaging (the wafers cut up and chips put into their ceramic or plastic cases); then some of the chips were sent to the UK for more stringent testing, whilst the rest went to the US. It can truly be an international business.
Pollsters here were poor at predicting who actually will go and vote, and clearly overestimated the likelihood of lukewarm Labour voters doing so, particularly in what were perceived as safe Labour seats.
In France this summer the pollsters for the second round underestimated the Left vote turnout to block RN.
Most electoral surprises for pollsters seem to originate in this domain, rather than unexpected switchers. The key is to look at whose supporters are enthused and whose are apathetic or resigned.
“The 85+ age group is the fastest growing and is set to double to 3.2 million by mid-2041 and treble by 2066”
https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf
“In the year to mid-2022, the median age of the population was 40.7 years, up from 39.6 years in 2011.”
https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2022
However, any sensible discussion is held back by people repeating myths (the NHS is “soaked” in money, the French system is better because of how it’s organised while ignoring their bigger expenditure, the NHS is inefficient, no other country has a system like the NHS).
I agree that turnout prediction is more difficult for pollsters than allegiance. Also US pollsters are not as good, in general, as UK pollsters. So there is a lot of uncertainty.
I think it would be a mistake for the Harris campaign to focus solely on turnout by motivating and doorknocking, important though that is. There is a herd effect for undecideds. Hence the importance of stakeboards.
In 2017, the UK spent £2,989 per person on healthcare […]
of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
The NHS is the envy of the world
And it is possible for the NHS to be 'soaked' in money while still spending less than in some other countries.
After all, soaking the oldies in money (of which health spending is a major part) is a standard feature of the developed world.
Trouble is that we're all paying for a smallish number of expensive people, which will probably include most of us eventually but not for long.
And whilst we could kick those people of the sled and leave them to die in the snow... it would be cheaper, but we're not those sort of people. Are we? (At some point we are, hence pounds per QALY calculations, but I don't think we want to draw the line in a radically different place.)
People tend to exaggerate the immorality of their political opponents
We bought a banana and the banana is going off. The trick is to apply banana preservative, not look longingly at apples nor complain that the banana is broken and we must make it green and spherical.
https://www.statista.com/statistics/301992/health-spending-uk/
As for starved of cash. Well the facts show massive,increases in govt expenditure
Where does it stop ?
How much will the NHS consume. Will it ever have enough money ?
https://www.statista.com/statistics/301992/health-spending-uk/
Interesting piece in the Guardian on the winter fuel allowance and the politics
https://www.theguardian.com/commentisfree/article/2024/sep/08/rachel-reeves-winter-fuel-payment-pensioners?CMP=Share_AndroidApp_Other
It suggests to me that at least part of the answer is more money.
Though I assume it jumped up a lot during and after Covid.
Alternatively, how much should healthcare cost?
So the question isn’t “how much”, it’s “what on”.
Our problem - putting it bluntly - is that Tories don’t care about the front line and Labour don’t care what the bill is.
If we’re smarter about what we spend the money on we will both get better front line care and spend less. We need to divert funding from today’s waste into the things that count. But to do that we initially need to spend more money and then cut the money.
We can’t do that, because Tories say “more money isn’t the answer” whilst spending more money. And Labour say “cuts isn’t the answer” whilst cutting front line provision.
One of my designs employs FRAM memory, which requires a specialist process node that is, as far as I'm aware, is only used by a grand total of two fabs.
My guess is to be able to produce a usefully competitive range of semiconductors a country would need 30-40 different process nodes. Of course one fab can handle several of those, but that's still a colossal amount of investment.
And, yes, as you say keeping those fabs running is not something easily done from purely national resources. There was a panic a few years ago when pretty much every major fab house found they were using a specific gas only made by a single supplier (in Germany if I recall correctly) who was having issues and had to stop production temporarily. The supply chain is both complex and incredibly fragile.
All I know is whatever we spend it never seems to be enough and the solution always seems to be more money.
It was an Anyone But The Conservatives election back in July. Labour won it by being the most preferred of the Anyones and secured its victory with a mammoth parliamentary majority because its campaign was very well targeted and support was efficiently distributed. So it is not accurate to say that the country has already fallen out of love with Labour; the country was never in love with Labour in the first place.
One of the reasons that this [fuel] furore has become potent is that left, right and centre can all find reasons to oppose the cut.
[After Rishi], Sir Ed Davey was the more piercing when the Lib Dem leader showcased a real-life example of what it would mean for the family finances of a carer whose income was just a few hundred pounds above the cut-off for continuing to qualify for the payment. Sir Ed received an unrebarbative response from Sir Keir. His emollient tone to his fellow knight had me wondering whether the prime minister is already preparing himself to move in the direction of a compromise. It is the mood among Labour MPs that is being anxiously monitored by their whips.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer. The saving to the exchequer will be around £1.5bn, not a trivial sum, but only about a hundredth of the total spend on pensioner benefits in the last financial year.
Many now think that we are heading towards some kind of U-turn, probably not immediately, but more likely when Ms Reeves unveils the budget at the end of October. The question then becomes how a retreat can be conducted without weakening the authority of the chancellor and the prime minister.
She won’t cancel the cut. My hunch is that she will eventually make a partial retreat which assuages the impact on the group about whom Labour MPs are most bothered: pensioners who don’t qualify or claim the credit and for whom this change will mean hardship. Then she and the prime minister will have to figure out how to make the U-turn elegant rather than embarrassing.
"Average day-to-day health spending in the UK between 2010 and 2019 was £3,005 per person – 18% below the EU14 average of £3,655." https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade
"For the UK, health spending equated to 9.6% of GDP, which was ranked as the second-lowest of the Group of Seven (G7), a group of the world’s largest developed economies" https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29
If you want Statista and a nice graph, see https://www.statista.com/statistics/236541/per-capita-health-expenditure-by-country/ That's per capita spend in 2022. France, which has been much praised in this thread, were on $6517. Switzerland has been mentioned: they're on $8049. Norway is $7898. The UK is $5493, although that is more than Japan on $5251.
Nothing gets a Lefty to shit quicker than Maggie Thatcher.
Simple things (to say, not do!)
- get triage out of A&E. possibly have a Co-located facility for out of hours GP services
- Go for full scale specialist hospitals. Patients families hate this because it makes visiting more challenging, but complex diseases are increasingly complex
- Recreate convalescent facilities to deal with bed blockers
- Integrate social care with the NHS (take out of council budgets) but run as a parallel organisation, with the same strategic oversight but not 1 CEO
- Sweat the assets more - all too often theatres are dark for NHS (although they do get used by firms like Medinet)
- Train more people: the NHS should be running at 85% capacity (F**k off Treasury) not 97%
-
UK healthcare admin costs are not high.
But the NHS shut it down some years back, sadly.
The 'inference' of my post is that:
1. We need to ditch our economically suicidal energy policy. It was bad enough with the Tories, now giving Ed Milliband billions of pounds to produce zero energy and ensure the price continues to rise - FUCK OFF. It's killing the economy. We need to ensure a plentiful and cheap supply of energy - if it's zero or low carbon energy, great. If it's clean but carbon-producing energy for the time-being, jfdi, and stop boasting about how well you're doing because you've effectively deindustrialised the country - literally NO other countries are looking at us and wishing they'd followed suit. As part of this we also need to get more of our own oil and gas out, as well as coal where appropriate.
That's alongside tax-cuts and other measures aimed at making it easier to do business here.
It is only since the election that it has been clocked that a commitment to protect the payment, made in the four previous Labour manifestos, was absent from the one put to the country this summer.
…suggests (confirms!) that the Tory election machine wasn’t much good. When the manifesto came out someone in their HQ should have been line-checking it against the previous one, looking for issues like this, which could have been used effectively during the campaign.
"This is the reality and we must end it."
Nigel Farage? Mme Le Pen?
No, the likely next Chancellor of Germany
These are huge shifts and the British government will soon look very exposed on the crumbling Woke left
https://x.com/bopanc/status/1831684596699726112?s=46&t=bulOICNH15U6kB0MwE6Lfw
Now, who is going to be made to suffer worse so that the axe on the Winter fuel payment only affects those people who were planning on using it to cover the drinks budget for their next cruise to Madeira? My guess is that pensioner homeowners and the very wealthy will be let off and some means will be discovered to soak younger families instead. Continuity Conservatism, with a translucent veneer of social democracy delicately smeared over it as a less than convincing disguise. As if such a thing could not have been predicted in advance.
And if it's a cold one...
No-one who’s lived in another OECD country thinks that the NHS is better than the health system there.
We could double health spending but would we get any more than a few extra weeks of poor quality life in our 80s and 90s.
And there's an opportunity cost to that extra spending.
Increasing health spending to a French or German or American level now might help the oldies but it isn't much use for the younger generations.
For them that extra health spending would be better used on education, training or housing.
Donald Trump on Saturday floated changing the 25th Amendment to allow Congress to impeach a vice president for covering up a president’s incapacity less than two months after President Joe Biden exited the 2024 contest amid concerns about his age and acuity.
“I will support modifying the 25th Amendment to make clear that if a vice president lies or engages in a conspiracy to cover up the incapacity of the president of the United States — if you do that with a cover-up of the president of the United States, it’s grounds for impeachment immediately and removal from office, because that’s what they did,” the former president said during a rally in Mosinee, Wisconsin.
https://www.politico.com/news/2024/09/07/trump-25th-amendment-kamala-harris-biden-00177868
"Today's disasters aren't caused by lack of regulation, but simple dishonesty
Trust is the single most important ingredient in a successful country, and we have thrown it to the wolves"
https://www.thetimes.com/article/bad0394e-5227-4842-9413-3820b4ccf849?shareToken=2046774b1c61c4bbb18efd00d775ffd8
https://x.com/matthewsyed/status/1832675430450516394
Given we have millions out of work for health-related reasons, contributing no tax and costing us billions in welfare, I'd have guessed the marginal return on more health spending is actually quite high at the moment.
Harry Yorke in the Sunday Times has the rebellion at less than two dozen abstentions, no votes against, smaller than the rebellion on the two child benefit cap. Which, frankly, was a meaner way to save a similar amount of money.
https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/risingillhealthandeconomicinactivitybecauseoflongtermsicknessuk/2019to2023 has details.
Dog for scale…
Pensioners dont easily forget. A former MP was telling me that right up until the end he would get regular emails from angry retired people about losing the free TV license, that decision by the BBC was taken in 2020.
Most MPs are not fully up and running yet, but I'm pretty sure they'll have been inundated by phone calls (if they have lines yet), emails and letters about this. And it wont stop. If we have a bad winter this will bit them on the bum hard.
If they really wanted to make a series of tough decisions like this, they should have a list of all the really hard ones they want to make and rip that plaster off on the floor of the commons in the budget statement.
Rookie mistake, and one that they've doubled down on.
And what proportion of any extra health spending would be directed towards them.
Because the alternative, if you are a democrat politician, is actual Nazis in power. As we see in Thuringia
The voters are speaking, plainly
I'm not sure you''d find anyone on the Woke left in Britain or anywhere else who was tolerant of gang rape.
Adopting a hitherto concealed persona as a champion of the poor, Rishi Sunak drew a little blood at the most recent prime minister’s questions by demanding where was the justice in giving a pay rise of almost £10,000 to well-remunerated train drivers and removing the fuel support for low-income pensioners living on just £13,000 a year. Tory MPs, who don’t have much to smile about these days, enjoyed themselves, baying “Shame!”.
Sir Ed Davey was the more piercing ............................................................
Instead she just got on with life. She qualified as a rower for the disability Olympics and medalled. She went back to school and used her intellect to build a new career for herself in the army. This cost her at least a couple of hundred thousand pounds in damages. She was crystal clear it was worth every penny. I was lost in admiration.
You can be certain the media will focus on the elderly shivering in their homes this winter, and of course labour will win the vote next week but the optics of taking WFA away from pensioners and giving it to train drivers is terrible