Most people (by definition, or there would be riots) have a good experience with the NHS. We have had five years of Tory/Cons oversight and so most people will presumably have had five years of good NHS experiences.
The danger for Lab is that if they bang on about how dreadful or imperiled it is under the Tories most people will look to their own experiences and say to themselves: nah, it's been fine.
I'm sorry but I totally disagree. On the contrary, I would suggest that such is the collective brainwashing that the NHS is a national treasure, that even people who have had horriffic experiences on the NHS still feel that their experience is the exception and that the rest of the service must be great.
The polling data is pretty clear - most people by a large margin have positive experiences from the NHS, and IIRC most people think it's got a bit worse under the Coalition. It was noticeable last week that when Miliband asked all the questions on the NHS, people here said "Ah, yeah, home issue, a bit desperate to fall back on that".
You might be right that people who do have horrid experiences think they must be an exception, just as people who don't get burgled think they've been lucky, not that burglary is now relatively rare. But it's difficult to argue that people aren't (a) broadly satisfied (b) very interested (c) somewhat concerned about the trend and (d) inclined to think Labour is more unambiguously in favour of improving it. We can argue about whether they're right, but that's a separate issue.
Before I reply, I want to say thank you for voting against the Iraq war. I just felt it ought to be mentioned when I read it yesterday.
Returning to topic, I don't think we're disagreeing. I'm sure most people feel they've had a broadly positive experience; whether or not their experience could and should have been a world better for the tax they pay is another matter. Also, no-one polls the dead, do they?
There are many problems with the NHS (as well as many positives), but I think the biggest problem is the name. There is far too much worship of "the NHS" as something that must be protected/saved/wondered at, with rarely a thought about the patients. I don't think progress will really be made (or sense talked) until the name vanishes. The worst example recently of this is Stafford - it's fairly clear that the hospital was failing large numbers of patients and at least some were dying unnecessarily. There were big protests - not complaining about the poor care but about plans to rationalise the services. The original whistle- blower was hounded from the town! NHS worshippers everywhere remember: the patients matter more!
Cameron just needs to point to the current state of the Welsh and Scottish NHS under Labour and the SNP to prove who is best trusted to run the NHS at Westminster.
Cameron needs to decontaminate with some some kind of bold public gesture. Maybe ask Juncker to nominate Lansley as the next Commissioner For Dying By Firing Squad.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
With regard to the supposedly wasted £3billion, that should be laid entirely at Labour's feet for their idiocy in 1997. Back in the 1980s (I think) the governement realised that there needed to be a split between providers and purchasers within the NHS to have any hope of even finding out what worked/what was efficient. Then fundholding was brought in - the money followed the patients, patients could have some choice in where they went, some competitive pressure could be brought to bear (I am aware fundholding wasn't perfect). In come Labour with 24 hours to save the NHS (again, what about the patients?) and abolish fundholding. It then takes them about 10 years to realise that actually that was a bad idea and bring in Choose and Book, an overly bureaucratic, restricted version of fundholding, which then needs fixing by the coalition. If they hadn't messed things up in 97 a whole lot of time and money could have been saved.
With regard to the supposedly wasted £3billion, that should be laid entirely at Labour's feet for their idiocy in 1997. Back in the 1980s (I think) the governement realised that there needed to be a split between providers and purchasers within the NHS to have any hope of even finding out what worked/what was efficient. Then fundholding was brought in - the money followed the patients, patients could have some choice in where they went, some competitive pressure could be brought to bear (I am aware fundholding wasn't perfect). In come Labour with 24 hours to save the NHS (again, what about the patients?) and abolish fundholding. It then takes them about 10 years to realise that actually that was a bad idea and bring in Choose and Book, an overly bureaucratic, restricted version of fundholding, which then needs fixing by the coalition. If they hadn't messed things up in 97 a whole lot of time and money could have been saved.
'The solution to this lies in managing an economy so that it optimises growth at the same time as keeping total government spending falling as a percentage of GDP. This should allow spending on health to increase as a proportion of total spend. In other words the approach and achievements of Osborne in managing the economy effectively are the most feasible means of supporting the NHS's future funding needs.'
You are correct AveryLP. As the economy grows spending on the NHS can grow in proportion and the QIPP economies can continue. https://www.evidence.nhs.uk/qipp It was Labour who initiated and promised these 20 billion economies. Healthcare in 2010 was £117 billion, in 2015 its due to be £133 billion. All health care systems are struggling as the cost of medicine rises. It's no use pretending that there is an unlimited pot of money. The service has to manage with what it can get.
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
Before I reply, I want to say thank you for voting against the Iraq war. I just felt it ought to be mentioned when I read it yesterday.
Returning to topic, I don't think we're disagreeing. I'm sure most people feel they've had a broadly positive experience; whether or not their experience could and should have been a world better for the tax they pay is another matter. Also, no-one polls the dead, do they?
Iraq: Thanks, but I didn't, I'm afraid. I met numerous refugees who said we needed to save the country, and it seemed plausible that Saddam had WMD and would use them. I was wrong on the first count because the new lot turned out to be much of a muchness, and on the second count because he didn't. I'm now less interventionary than my party and opposed the Libyan intervention as well as Syria. I try to learn.
I agree about the polling. It's extraordinarily difficult to extrapolate from personal experience, though nearly everyone does. Personally I agree with Hurst that it's a curate's egg, but on the whole it's very good when one's got something serious and physical - not so much going from personal experience but from talking to a lot of voters under both governments. Mental health treatment is probably a bit better than 20 years ago butvery much a lottery.
At the risk of derailing the thread ("Down! Socrates") here is an interesting snippet of EU comment:
European Central Bank (ECB) member Benoit Coeure has said that Britain leaving the European Union would have an "enormous shock" on the region.
At a roundtable discussion in Athens, Coeure said: "The UK leaving would constitute an enormous shock and [be] very difficult to manage."
Coeure, who is is part of the six-member Executive Board of the Governing Council, added: "We are in effort to bring capital markets together, we don't need that kind of shock."
The comments relate to the UK's in-out referendum on EU membership planned for 2017, as Prime Minister David Cameron looks to change Britain's ties to the bloc if the Conservatives win the General Election in 2015.
Some Tories are making the case that Labour's sense of entitlement re the NHS was directly contributory to mid-Staffs.
In essence, if people raised concerns, the answer from Government was not "how can we fix it", but "we have a Labour Government, there can't be any problems in the NHS"
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
"we have a Labour Government, there can't be any problems in the NHS"
When a government invests enormous amounts of actual and political capital into something, in full view of its people, it can't be allowed to go wrong.
See collectivized farms in Maoist china. Grain production soaring (apparently) - 50 million dying of starvation.
@TogetherDarling: Debate STV 5 Aug. Alex Salmond will finally have to set out the true cost & answer the big unanswered questions about independence #indyref
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Big John, Do I read you correctly? In your view are too much of the enormous, but still insufficient, resources being devoted to the NHS being spent on other than front-line services?
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
The problem with that report (and there have been other similar ones) is that it places rather more emphasis on equality of access and rather less on whether the care is actually any good. This has the effect of improving the placing of the NHS, where everyone can access care equally - it just might take a while and then kill you. It also down ranks the American system, where some people can't get medical care, but if you can it's generally pretty good.
Having said that, the US health system (as far as I know) is not one anywhere should seek to copy.
Today we saw a brand new Ed Miliband. And a brand new campaign strategy. He’s given up trying to win the election. All he wants to do now is to enjoy losing it and to go down in style. This must be quite a relief to him. For the next 10 months he can ignore the grassroots and the business vote and the floaters and swingers in the key marginals. He can even dismiss the tedious views of his Manson Family shadow cabinet. What matters now is to raise a cheer from the die-hard loyalists. To put a spring in the step of the back-room boys. To hearten the SpAds and the ad-men and the sound-bite designers. And to make the Bubble burst with pride.
It’s an astonishing strategy. Almost a death-bed admission. The game’s up chaps. Let’s have a nice group hug and remind ourselves of a golden certainty. We lost the fight but at least we were right.
A further thought on NHS funding/£3billion wasted/etc:
The NHS has been brought to its knees because the evil Tories have wasted £3billion on top down re-organisation and only increased funding in line with inflation. Given that Labour were (as far as we could tell) planning cuts in NHS funding, how can they say the NHS would have been better with them in charge?
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
The problem with that report (and there have been other similar ones) is that it places rather more emphasis on equality of access and rather less on whether the care is actually any good. This has the effect of improving the placing of the NHS, where everyone can access care equally - it just might take a while and then kill you. It also down ranks the American system, where some people can't get medical care, but if you can it's generally pretty good.
Having said that, the US health system (as far as I know) is not one anywhere should seek to copy.
I'm sure the report has faults but even allowing for that it give the lie that somehow the NHS has gone to hell in a handcart under the Coalition.
The question for the future is how we effectively fund the NHS in the decades to come and which politician is brave enough to seek the inevitable truths and place the solutions before a wary electorate.
Today we saw a brand new Ed Miliband. And a brand new campaign strategy. He’s given up trying to win the election. All he wants to do now is to enjoy losing it and to go down in style. This must be quite a relief to him. For the next 10 months he can ignore the grassroots and the business vote and the floaters and swingers in the key marginals. He can even dismiss the tedious views of his Manson Family shadow cabinet. What matters now is to raise a cheer from the die-hard loyalists. To put a spring in the step of the back-room boys. To hearten the SpAds and the ad-men and the sound-bite designers. And to make the Bubble burst with pride.
It’s an astonishing strategy. Almost a death-bed admission. The game’s up chaps. Let’s have a nice group hug and remind ourselves of a golden certainty. We lost the fight but at least we were right.
There is only one book offering a price on a Labour minority government,Paddy Power currently at 11-2.I'm already on this at larger prices so am speaking with my wallet but Harriet Harman's recent intervention contained a further clue in that direction.The inference was that if Ed Miliband tries to replace her as Deputy Leader to accommodate any male,especially a Lib/Dem,Clegg particularly,she will explode and have an "over my dead body moment".She has her eyes on the Deputy PM role.Her new PM has an eye for unity and may find it extremely difficult to budge her. Another reason maybe,obviously depending on the maths,a Labour minority,as opposed to any formal coalition,is a bet worth considering,if only as a saver.
PBTories response to this thread just sums up why their Party is so toxic on the NHS.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Not for the first time you've taken one tiny part of my comment and blown it out of all proportion.
I didn't of course suggest that health education should be funded instead of proper medical care and treatment as you well know if you'd bothered to engage your brain before responding.
There is a counter-argument that valuable treatment resources are being wasted because people are making bad health choices through ignorance but I'm not sure about that. There is, I think, a role for public health education relating to areas like nutrition and exercise.
The main issue isn't really the NHS in isolation but how we care for an ageing population whose reliance on NHS-related and other State services is considerable. Do we treat our elderly population with the dignity they deserve ? Given we have a Government elected on the votes of the elderly, it's not surprising they are well looked after in policy terms.
It's also surprising to see a Spectator blog critical of and making fun of the Labour Party leader published on here by a Conservative supporter with the most damaging text thoughtfully cut and pasted - actually, it's about as surprising as the Sun rising in the east tomorrow morning.
The NHS is a religion for the left - Cam would have more luck trying to get jihadis to read Playboy than convince these zealots that it matters not whether central government is replonsible for printing the payslip of your nurse or a private company - as long as healthcare is free.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners.
It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
F1: FRIC suspension systems (apparently a strength of the Mercedes) could be banned for the German Grand Prix (not this weekend, but the one after).
Not sure, but I think that might be the bike system. Basically, a chap who works for Mercedes and has a bike modified the suspension to improve it, and suggested the idea to the F1 team, who adopted it either last year or the year before.
I think it's Front Rear Interconnected (FRIC). Believe it helps keep the car flat rather than having the front or rear lower and rise more significantly, improving handling.
It's important to consider who else uses it. It's been known about for at least a year, so other teams may well have something similar (possibly even more advanced but I'd guess not). I was already toying with the idea of backing Williams to top score or suchlike and this might be another reason to do so.
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
The problem with that report (and there have been other similar ones) is that it places rather more emphasis on equality of access and rather less on whether the care is actually any good. This has the effect of improving the placing of the NHS, where everyone can access care equally - it just might take a while and then kill you. It also down ranks the American system, where some people can't get medical care, but if you can it's generally pretty good.
Having said that, the US health system (as far as I know) is not one anywhere should seek to copy.
One of the major problems with the US system is professional indemnity insurance costs. Partly as a result, US doctors order far too many diagnostic tests (basically everything out there - eat your heart out Dr. House). It's a long-time since I saw the statistics, but IIRC, its something like 17 tests per issue identified in the US vs 4 tests in Germany*. That are two areas of massive deadweight cost that should be eliminated.
Tort reform would be one of the key solutions for US medical costs. But there are too many lawyers in Congress ;-)
Thanks to those wonderful people at Sky bet and Victor Chandler, offering free bets, I've been able to back Netherlands and Argentina to win in 90 mins.
But I've backed the match to go to penalties 5/1, with Bet365
Have also backed Messi, Sneijder and RVP to score first.
I've also backed both Netherlands and Argentina to win the tournament outright, as I think the odds are out of kilter because of Germany's performance last night, so this should make for a decent trading bet.
PBTories response to this thread just sums up why their Party is so toxic on the NHS.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
Yuck.
If you actually read the thread you'd realise that is absolutely not what the Tories on here are saying.
They are saying that the patients are the most important thing, much more important than any structure. That's a complex message to sell politically, but I don't think you can claim it deserves a "yuck"
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners.
It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
A lot of Doctors in this country are Muslims, them ordering nuclear materials is going to set off some alarm bells and probably a visit to Gitmo.
One of the major problems with the US system is professional indemnity insurance costs. Partly as a result, US doctors order far too many diagnostic tests (basically everything out there - eat your heart out Dr. House). It's a long-time since I saw the statistics, but IIRC, its something like 17 tests per issue identified in the US vs 4 tests in Germany*. That are two areas of massive deadweight cost that should be eliminated.
Tort reform would be one of the key solutions for US medical costs. But there are too many lawyers in Congress ;-)
(* Germany, btw, is a terrible system).
I agree entirely regarding the US. I don't know much about the German system as a whole - what's wrong with it?
Don't know the quantities - it's medical use, so will be small volume, but probably a large number of doses. I think it's something like 10-15% of hospitals, which then supply the others.
@Charles The half life of radioactive dyes for humans is remarkably short. It might be more efficient to have a local centre make them to order, and given the licensing requirements, "in house" might also make more sense? WTF, could possibly have been a slight over reaction? (if you will pardon the pun)
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
That might be the received wisdom in a struggling Trust, can you show me any evidence?
Let's have a look at CCG accounts. Here's a yorkshire CCG.
67.8% budget spent on Secondary Care. 14.9% on Primary Care. 10.9% on Health Services from Non NHS Providers 6.4% on goods and services from other NHS bodies (not Foundation Trusts)
Bottom line -fizzy pop stuff is Public Health, which is held by councils not CCGs. CCGs have to apply Tariff which diminishes by 4% every year. It's not the commissioners that are breaking the system, there's just not enough money.
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
Good to see Labour still has one core skill left: Messenger-Shooting.
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
Don't be ridiculous. What peer-review has this 'report' been through? What scholarly journal has published it? How has it's statistical validity been established? It isn't a piece of research, it's an eye-catching press release put together by the Commonwealth fund's head of colouring in. Its purpose is nakedly obvious and it's utterly meaningless as an endorsement of the NHS. I can't think why you brought it up, let alone attempt to defend it. Embarrassing really.
PBTories response to this thread just sums up why their Party is so toxic on the NHS.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
Yuck.
Please identify at least one of the posts which say this.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners. It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
That's a bit like saying Carphone Warehouse and Vodafone should pool their call centre staff. It makes sense at a system level, but the fact that Trusts are pitted against each other places barriers in the way of that kind of cooperation. Trusts who make agreements to rationalise services between themselves face the wrath of the Competition Commission.
The NHS has been set up with a market structure, but in a market when demand rises so do prices. The government is the only funder and they've decided they're going to spend less on hospital care every year. Even within the health ringfence, because the people who can actually spend the money are given such strict rules, it ends up with the Department of Health handing back underspend. It's crackers.
There needs to be a funding formula for the NHS as a whole based on demographics, linked to National Insurance.
What peer-review has this 'report' been through? What scholarly journal has published it? How has it's statistical validity been established? It isn't a piece of research, it's an eye-catching press release put together by the Commonwealth fund's head of colouring in. Its purpose is nakedly obvious and it's utterly meaningless as an endorsement of the NHS.
You just set the bar very high for Labour's policy pronouncements on the economy....
You too, it was extremely surreal for the first 15 minutes or so, after which I randomly laughed to myself every so often, who would think a political betting blog would have good banter.
However, like Pokémon, I feel that with PBers you've got to catch them all - hopefully there'll be another one next year with Avery, Compouter and stuarttruth in attendance!!
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
Good to see Labour still has one core skill left: Messenger-Shooting.
PBTories response to this thread just sums up why their Party is so toxic on the NHS.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
Yuck.
Please identify at least one of the posts which say this.
God we need a decent leftie on here who is acute, incisive and competent.
PBTories response to this thread just sums up why their Party is so toxic on the NHS.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
Yuck.
Please identify at least one of the posts which say this.
God we need a decent leftie on here who is acute, incisive and competent.
One of the major problems with the US system is professional indemnity insurance costs. Partly as a result, US doctors order far too many diagnostic tests (basically everything out there - eat your heart out Dr. House). It's a long-time since I saw the statistics, but IIRC, its something like 17 tests per issue identified in the US vs 4 tests in Germany*. That are two areas of massive deadweight cost that should be eliminated.
Tort reform would be one of the key solutions for US medical costs. But there are too many lawyers in Congress ;-)
(* Germany, btw, is a terrible system).
I agree entirely regarding the US. I don't know much about the German system as a whole - what's wrong with it?
Basically they messed up the public insurance system with the result that differentiated drugs aren't getting launched. Tradjenta for instance, was priced in the same category as generic metforim, while there is an infant spasm treatment that was actually pulled from the market despite being the only product for the disease.
Additionally if you look at the Dx sector, the public insurance is actually paying more than private companies for many of the basic tests and not covering the esoterics.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners.
It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process)
I do wonder why the NHS does not seem to try to maximise the use of assets nationally. I once had to have an MRI scan on an injured knee. It took about six months to get an appointment at my "local" unit in West London, as I recall. Once I got there the service was brilliant.* But I was able to travel and keen to sort my knee out, if they'd found me a spare slot in Birmingham in two weeks' time I'd have been off like a shot. Why not have a National MRI Unit somewhere like the Midlands? People who for some reason want or need to be fixed locally can be prioritised at their local hospital, the rest of us can help to make best use of resources.
* it was a private unit at an NHS hospital, and didn't discriminate between NHS and private customers, in fact the staff probably weren't told who was who. I got a cup of tea on arrival, an apology when I went in 20 minutes late (despite the fact I still finished earlier than the time given in the appointment letter) and when I'd finished, they asked me how I was getting home and then offered me another cup of tea while I waited for a train. Service like that costs nothing, IMO.
@Charles The half life of radioactive dyes for humans is remarkably short. It might be more efficient to have a local centre make them to order, and given the licensing requirements, "in house" might also make more sense? WTF, could possibly have been a slight over reaction? (if you will pardon the pun)
It makes sense to have it manufactured in house - more than about 2 hours away just doesn't work. But the NHS shouldn't be allocating facilities, paying for trained staff and manging complex logistics: they just need to focus on patient care.
Far more sensible to outsource something like that - it's not core to the mission, it doesn't need medical training and it is complex and resource intensive for the NHS to manage
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
Don't be ridiculous. What peer-review has this 'report' been through? What scholarly journal has published it? How has it's statistical validity been established? It isn't a piece of research, it's an eye-catching press release put together by the Commonwealth fund's head of colouring in. Its purpose is nakedly obvious and it's utterly meaningless as an endorsement of the NHS. I can't think why you brought it up, let alone attempt to defend it. Embarrassing really.
Reports like that don't go through peer review.
Here's an interesting report - there is little evidence differences in policy between England, Scotland and Wales have made much difference.
Previous generations would take a pragmatic view of State functions like the NHS, BBC, Royal Mail, Education.
This lot just want to flog everything and everything. Whether it works or not, whether it benefits society or not, whether it's good for the taxpayer or not.
Perhaps the current lot of big-business Tory ideologues who grew up worshipping Thatcher think it's "what she would have done". Perhaps the friends they keep and donations make all the difference.
Either way, it's one of the many reasons they will easily hit 1/3rd of a Century without winning an election.
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
Don't be ridiculous. What peer-review has this 'report' been through? What scholarly journal has published it? How has it's statistical validity been established? It isn't a piece of research, it's an eye-catching press release put together by the Commonwealth fund's head of colouring in. Its purpose is nakedly obvious and it's utterly meaningless as an endorsement of the NHS. I can't think why you brought it up, let alone attempt to defend it. Embarrassing really.
The healthy Lives section largely deals with problems of public health, so obesity may well account for why the UK and USA figures are so bad
International comparisons are fraught with difficulty, due to patterns of diagnosis and record keeping.
This interesting article for example explains the paradox of why the death rate from prostate cancer in the UK and USA is near identical, while the five year survival is 81% in the UK and 99% in theUSA for the same disease: http://www.bbc.co.uk/news/magazine-28166019
This report is not independent. The Commonwealth Fund is an organisation that campaigns for state healthcare in the US (presumably they are discreetly funded by the medical industry, which stands to gain a huge windfall from such legislation). The NHS is their idea of a wet dream, so obviously it comes out top. They also have on their Board of Directors one Simon Stevens, listed as CEO of the NHS. So couldn't really be less independent. http://www.commonwealthfund.org/about-us/board-of-directors
So your rebuttal is that the Commonwealth Fund prefers varieties of state funding to the medical mess in the US and one of its directors is an NHS big wig.
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
Don't be ridiculous. What peer-review has this 'report' been through? What scholarly journal has published it? How has it's statistical validity been established? It isn't a piece of research, it's an eye-catching press release put together by the Commonwealth fund's head of colouring in. Its purpose is nakedly obvious and it's utterly meaningless as an endorsement of the NHS. I can't think why you brought it up, let alone attempt to defend it. Embarrassing really.
Read it, and you will find out. (See note on Methodology, p. 28). It seems to be transparent about its relatively straightforward statistical methods which it applies to data from the OECD, WHO, and surveys commissioned by it but carried out by an independent and on the face of it respectable market research company. It is also transparent about the fact that it is the output of a politically-aligned think tank. Such documents are not usually rubbished solely on those grounds, nor expected to be peer-reviewed and published in journals.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners. It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
That's a bit like saying Carphone Warehouse and Vodafone should pool their call centre staff. It makes sense at a system level, but the fact that Trusts are pitted against each other places barriers in the way of that kind of cooperation. Trusts who make agreements to rationalise services between themselves face the wrath of the Competition Commission.
The NHS has been set up with a market structure, but in a market when demand rises so do prices. The government is the only funder and they've decided they're going to spend less on hospital care every year. Even within the health ringfence, because the people who can actually spend the money are given such strict rules, it ends up with the Department of Health handing back underspend. It's crackers.
There needs to be a funding formula for the NHS as a whole based on demographics, linked to National Insurance.
Which is why, in some cases, outsourcing is better.
Inhealth and Alliance Medical do a pretty good job of optimising utilisation of MRIs
@Charles Usually, the process is overseen by a head radiologist, and it allows for training and research. Bringing in an outside contractor might make a small saving (or not), but they lose control of that department to the terms of the contract.
Don't know the quantities - it's medical use, so will be small volume, but probably a large number of doses. I think it's something like 10-15% of hospitals, which then supply the others.
Very true - I worked on a Nuclear Medicine dept many years ago and we did this.
" we don't really have a National Health Service - we have a National Sickness Service. Concepts of promoting good public health and health education were the first casualties of economic cutbacks"
Hey, Mr. Stodge, see what you are getting at but when I am lying on the trolley at death's door I need some people who are going to fix me up not give me a lecture on good public health. A thousand words on the disadvantages of consuming too much sugar maybe worthwhile but if I am about to conk out through renal failure it may not be the best treatment.
When dosh is tight are you, you Mr. Stoge, going to tell Mrs. Smith she is about to become Widow Smith because the money that could have saved her husband has been spent on telling teenagers not to drink coca-cola and the like?
Spot on and this govt has introduced a system where ccgs spend money on don't drink fizzy pop rather than funding it's acute provider that is ffalling over. My FT hasnot even had a flat cash settlement in last couple of years and has had a 25,% increase in throughput.over the same timescale. It has gone from making a £,7m surplus used to fund cap ex to making no surplus this means it can't fund sufficient equipment mri scanners cost over £1m by the way
Not every hospital should be buying MRI scanners. It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
Which is why, in some cases, outsourcing is better.
Inhealth and Alliance Medical do a pretty good job of optimising utilisation of MRIs
Alliance have a local contract so I am familiar with their service. They are reasonably quick (though reject more referrals) but do not have joint meetings with clinicians to interpret findings, discuss likely diagnoses or plan further investigations. They cannot clarify with clinicians what the issue is and target the scan protocol appropriately. Not all MRIs are equal, and the fragmentation of services makes communication difficult. If I am really worried about a patient I use our in house scanner.
The so called unnecessary reforms of Lansley seem to have been accompanied by a remarkable increase in productivity (per the Kings fund) and an increase in front line medical staff numbers on what in real terms is no real money. This productivity increase has resulted in record numbers of patients being treated and a general perception that the NHS is doing a good job.
In a rational world those claiming that this is all some sort of spurious correlation would face a heavy burden of proof but since the allegations are being made by Labour and those pointing out what has been achieved are largely tories the public seem to have the opposite view.
I think this is just one of the odd political realities of our time. The tories need to make the best of it by providing the relevant information on every occasion and praying that we do not have a really bad winter.
BTW my good wife was asking why we had not had 5 goals yet until she spotted that the game included "those orange people who never score no matter how many shots they have".
The so called unnecessary reforms of Lansley seem to have been accompanied by a remarkable increase in productivity (per the Kings fund) and an increase in front line medical staff numbers on what in real terms is no real money. This productivity increase has resulted in record numbers of patients being treated and a general perception that the NHS is doing a good job.
In a rational world those claiming that this is all some sort of spurious correlation would face a heavy burden of proof but since the allegations are being made by Labour and those pointing out what has been achieved are largely tories the public seem to have the opposite view.
I think this is just one of the odd political realities of our time. The tories need to make the best of it by providing the relevant information on every occasion and praying that we do not have a really bad winter.
BTW my good wife was asking why we had not had 5 goals yet until she spotted that the game included "those orange people who never score no matter how many shots they have".
Ha! Sounds like the sort of thing my wife would say (clearly neither of our wives watched the Holland Spain game!)
Comments
Returning to topic, I don't think we're disagreeing. I'm sure most people feel they've had a broadly positive experience; whether or not their experience could and should have been a world better for the tax they pay is another matter. Also, no-one polls the dead, do they?
The worst example recently of this is Stafford - it's fairly clear that the hospital was failing large numbers of patients and at least some were dying unnecessarily. There were big protests - not complaining about the poor care but about plans to rationalise the services. The original whistle- blower was hounded from the town! NHS worshippers everywhere remember: the patients matter more!
In come Labour with 24 hours to save the NHS (again, what about the patients?) and abolish fundholding. It then takes them about 10 years to realise that actually that was a bad idea and bring in Choose and Book, an overly bureaucratic, restricted version of fundholding, which then needs fixing by the coalition. If they hadn't messed things up in 97 a whole lot of time and money could have been saved.
In other words the approach and achievements of Osborne in managing the economy effectively are the most feasible means of supporting the NHS's future funding needs.'
You are correct AveryLP.
As the economy grows spending on the NHS can grow in proportion and the QIPP economies can continue.
https://www.evidence.nhs.uk/qipp
It was Labour who initiated and promised these 20 billion economies.
Healthcare in 2010 was £117 billion, in 2015 its due to be £133 billion.
All health care systems are struggling as the cost of medicine rises. It's no use pretending that there is an unlimited pot of money. The service has to manage with what it can get.
http://www.commonwealthfund.org/about-us/board-of-directors
I agree about the polling. It's extraordinarily difficult to extrapolate from personal experience, though nearly everyone does. Personally I agree with Hurst that it's a curate's egg, but on the whole it's very good when one's got something serious and physical - not so much going from personal experience but from talking to a lot of voters under both governments. Mental health treatment is probably a bit better than 20 years ago butvery much a lottery.
European Central Bank (ECB) member Benoit Coeure has said that Britain leaving the European Union would have an "enormous shock" on the region.
At a roundtable discussion in Athens, Coeure said: "The UK leaving would constitute an enormous shock and [be] very difficult to manage."
Coeure, who is is part of the six-member Executive Board of the Governing Council, added: "We are in effort to bring capital markets together, we don't need that kind of shock."
The comments relate to the UK's in-out referendum on EU membership planned for 2017, as Prime Minister David Cameron looks to change Britain's ties to the bloc if the Conservatives win the General Election in 2015.
In essence, if people raised concerns, the answer from Government was not "how can we fix it", but "we have a Labour Government, there can't be any problems in the NHS"
Look carefully at the full report. None of the political parties has challenged the veracity of the report or those who wrote it and your thin attack on it and them is frankly risible.
When a government invests enormous amounts of actual and political capital into something, in full view of its people, it can't be allowed to go wrong.
See collectivized farms in Maoist china. Grain production soaring (apparently) - 50 million dying of starvation.
@TogetherDarling: Debate STV 5 Aug. Alex Salmond will finally have to set out the true cost & answer the big unanswered questions about independence #indyref
Having said that, the US health system (as far as I know) is not one anywhere should seek to copy.
Major over Blair all day long, sorry I voted against you john I was wrong
Edit. He looks a bit like a cross between Margaret and Nick from the Apprentice though!
The NHS has been brought to its knees because the evil Tories have wasted £3billion on top down re-organisation and only increased funding in line with inflation. Given that Labour were (as far as we could tell) planning cuts in NHS funding, how can they say the NHS would have been better with them in charge?
The question for the future is how we effectively fund the NHS in the decades to come and which politician is brave enough to seek the inevitable truths and place the solutions before a wary electorate.
What's your view of Ed's electoral chances? I only ask because you don't actually say, preferring to post other people's drivel.
Another reason maybe,obviously depending on the maths,a Labour minority,as opposed to any formal coalition,is a bet worth considering,if only as a saver.
Public bad, state bad, never mind pragmatism or patient care, let's go for ideology and allow millions to be siphoned from the care of sick people to the profits of private companies (who donate to the Tory Party).
Yuck.
I didn't of course suggest that health education should be funded instead of proper medical care and treatment as you well know if you'd bothered to engage your brain before responding.
There is a counter-argument that valuable treatment resources are being wasted because people are making bad health choices through ignorance but I'm not sure about that. There is, I think, a role for public health education relating to areas like nutrition and exercise.
The main issue isn't really the NHS in isolation but how we care for an ageing population whose reliance on NHS-related and other State services is considerable. Do we treat our elderly population with the dignity they deserve ? Given we have a Government elected on the votes of the elderly, it's not surprising they are well looked after in policy terms.
It's also surprising to see a Spectator blog critical of and making fun of the Labour Party leader published on here by a Conservative supporter with the most damaging text thoughtfully cut and pasted - actually, it's about as surprising as the Sun rising in the east tomorrow morning.
Yuck
It leads to sub-optimal utilisation and ineffective allocation of limited resources.
Mechanisms to pool and share MRIs is the most effective - and there are a couple of good companies that do this (plus guarantee the necessary supply of FDG in the process).
BTW did you know that lots of NHS hospitals make nuclear material in their basements? I mean, WTF? Just buy the stuff.
What sort of radioactive material, and in what quantities?
Not sure, but I think that might be the bike system. Basically, a chap who works for Mercedes and has a bike modified the suspension to improve it, and suggested the idea to the F1 team, who adopted it either last year or the year before.
I think it's Front Rear Interconnected (FRIC). Believe it helps keep the car flat rather than having the front or rear lower and rise more significantly, improving handling.
It's important to consider who else uses it. It's been known about for at least a year, so other teams may well have something similar (possibly even more advanced but I'd guess not). I was already toying with the idea of backing Williams to top score or suchlike and this might be another reason to do so.
Tort reform would be one of the key solutions for US medical costs. But there are too many lawyers in Congress ;-)
(* Germany, btw, is a terrible system).
Thanks to those wonderful people at Sky bet and Victor Chandler, offering free bets, I've been able to back Netherlands and Argentina to win in 90 mins.
But I've backed the match to go to penalties 5/1, with Bet365
Have also backed Messi, Sneijder and RVP to score first.
I've also backed both Netherlands and Argentina to win the tournament outright, as I think the odds are out of kilter because of Germany's performance last night, so this should make for a decent trading bet.
They are saying that the patients are the most important thing, much more important than any structure. That's a complex message to sell politically, but I don't think you can claim it deserves a "yuck"
Don't know the quantities - it's medical use, so will be small volume, but probably a large number of doses. I think it's something like 10-15% of hospitals, which then supply the others.
The half life of radioactive dyes for humans is remarkably short.
It might be more efficient to have a local centre make them to order, and given the licensing requirements, "in house" might also make more sense?
WTF, could possibly have been a slight over reaction? (if you will pardon the pun)
Let's have a look at CCG accounts. Here's a yorkshire CCG.
http://www.hambletonrichmondshireandwhitbyccg.nhs.uk/data/uploads/hrw-ccg-annual-report-1314.pdf
67.8% budget spent on Secondary Care.
14.9% on Primary Care.
10.9% on Health Services from Non NHS Providers
6.4% on goods and services from other NHS bodies (not Foundation Trusts)
An example from the south, Herefordshire
http://www.herefordshireccg.nhs.uk/annual-reports
Bottom line -fizzy pop stuff is Public Health, which is held by councils not CCGs.
CCGs have to apply Tariff which diminishes by 4% every year. It's not the commissioners that are breaking the system, there's just not enough money.
It makes sense at a system level, but the fact that Trusts are pitted against each other places barriers in the way of that kind of cooperation. Trusts who make agreements to rationalise services between themselves face the wrath of the Competition Commission.
The NHS has been set up with a market structure, but in a market when demand rises so do prices. The government is the only funder and they've decided they're going to spend less on hospital care every year. Even within the health ringfence, because the people who can actually spend the money are given such strict rules, it ends up with the Department of Health handing back underspend. It's crackers.
There needs to be a funding formula for the NHS as a whole based on demographics, linked to National Insurance.
However, like Pokémon, I feel that with PBers you've got to catch them all - hopefully there'll be another one next year with Avery, Compouter and stuarttruth in attendance!!
http://www.dailymail.co.uk/news/article-2673461/Oklahoma-congressional-race-takes-bizarre-twist-challenger-accuses-incumbent-robot-double-real-Congressman.html
Additionally if you look at the Dx sector, the public insurance is actually paying more than private companies for many of the basic tests and not covering the esoterics.
* it was a private unit at an NHS hospital, and didn't discriminate between NHS and private customers, in fact the staff probably weren't told who was who. I got a cup of tea on arrival, an apology when I went in 20 minutes late (despite the fact I still finished earlier than the time given in the appointment letter) and when I'd finished, they asked me how I was getting home and then offered me another cup of tea while I waited for a train. Service like that costs nothing, IMO.
Far more sensible to outsource something like that - it's not core to the mission, it doesn't need medical training and it is complex and resource intensive for the NHS to manage
Here's an interesting report - there is little evidence differences in policy between England, Scotland and Wales have made much difference.
http://www.nuffieldtrust.org.uk/compare-UK-health
Previous generations would take a pragmatic view of State functions like the NHS, BBC, Royal Mail, Education.
This lot just want to flog everything and everything. Whether it works or not, whether it benefits society or not, whether it's good for the taxpayer or not.
Perhaps the current lot of big-business Tory ideologues who grew up worshipping Thatcher think it's "what she would have done". Perhaps the friends they keep and donations make all the difference.
Either way, it's one of the many reasons they will easily hit 1/3rd of a Century without winning an election.
Stats junkies can analyse it here: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf
The healthy Lives section largely deals with problems of public health, so obesity may well account for why the UK and USA figures are so bad
International comparisons are fraught with difficulty, due to patterns of diagnosis and record keeping.
This interesting article for example explains the paradox of why the death rate from prostate cancer in the UK and USA is near identical, while the five year survival is 81% in the UK and 99% in theUSA for the same disease: http://www.bbc.co.uk/news/magazine-28166019
Inhealth and Alliance Medical do a pretty good job of optimising utilisation of MRIs
Usually, the process is overseen by a head radiologist, and it allows for training and research.
Bringing in an outside contractor might make a small saving (or not), but they lose control of that department to the terms of the contract.
In a rational world those claiming that this is all some sort of spurious correlation would face a heavy burden of proof but since the allegations are being made by Labour and those pointing out what has been achieved are largely tories the public seem to have the opposite view.
I think this is just one of the odd political realities of our time. The tories need to make the best of it by providing the relevant information on every occasion and praying that we do not have a really bad winter.
BTW my good wife was asking why we had not had 5 goals yet until she spotted that the game included "those orange people who never score no matter how many shots they have".