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politicalbetting.com » Blog Archive » Situation critical. How the NHS could affect the path of Brexi
politicalbetting.com » Blog Archive » Situation critical. How the NHS could affect the path of Brexit
The debate in Britain about health spending is fundamentally dishonest. The left constantly press for large increases in spending. The government constantly boasts about ever-increasing spending at or above inflation levels. Voices on the right frequently argue for scaling back the health services that the public sector provides. None of them address what Britain needs.
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Final degeneration into a laughing stock.
I wonder if we'll get an added helping of 'I've never liked you, anyway'?
Out of boredom with this thread, I've been checking how and from whom the LibDems are going to have to attract sufficient votes to have any real prospect of emerging as the winners in Richmond Park. Given Zac's enormous majority and his undoubted popularity it appears at first glance to be a daunting prospect. In order to win, the Yellow team must firstly hope for a huge wave of apathy against the Tories resulting in a halving or thereabouts of the turnout of 76.5% in 2015.
One very surprising fact is the astonishing success of the Labour candidate in last year's General Election when their vote increased by a barely credible 145% from 2,979 in 2010 to 7,296. Surely there cannot be another constituency anywhere in the UK in which Labour scored such a stunning success, made all the more remarkable when one considers their dismal showing nationwide.
It must surely be taken as read that the majority of these votes for the Red Team last year will be loaned to the LibDems in order to see off Mr Goldsmith.
Come to think of it after a performance like that, perhaps the LibDems should consider selecting the clearly remarkable Sachin Patel as one of their own.
This one aspect alone makes me feel very comfortable about having lumped onto the LibDems at odds of 6/4 as soon as Ladbrokes opened their market on this by-election.
You lost get over it ......you are not a toddler.
http://stephentall.org/2016/10/25/heathrow-brexit-and-the-richmond-by-election-why-im-grateful-for-zac/
The point Alastair is trying to raise, I suggest, concerns the expectations of the average rather-less-informed typical voter in the street. The person who won't have studied the detail and followed every twist and turn, but will certainly remember (and be reminded, by those it suits) for years to come, that after Brexit there was supposed to be a lot more money for the NHS. And who, therefore, might well react particularly badly to a future NHS financial crisis.
This is I suggest a subset of the wider issue that hasn't yet hit British politics of whether Brexit has gone badly or well. We, of course, are sick of this already, as we have been practising since June 24th by analysing the colour of very cat that has crossed our path. The British public, being more sensible, realises the time for the debate is after Brexit not before, and when there is a good reason such as an actual election.
Nevertheless, just as 2010 focused endlessly upon the financial crisis and who was to blame, the 'outcome of Brexit' will loom large over the election of 2020 (and probably 2025). The NHS will be a big part of that,
- we do well - 'See! We were right to vote to leave'
- we do badly - 'See! The EU shafted us! We were right to vote to leave!
One thing that is not going to happen is the Great British Public are going to go turn around and say
'If only we had listened to our betters, such as Mr Meeks, who has ceaselessly been pointing out our mean-minded nationalistic xenophobic stupidity for the last many years...'
Although since 2010 there has been a drive to reduce admin costs and spend the money on the front line, there is still as much bureaucracy as expected in an organisation with a £100bn budget.
Significant cost savings will only be realised when the scope of NHS provision is reduced, either by restricting what treatment is available, more integration with social care, or by encouraging outside provision such as private insurance.
https://www.theguardian.com/world/2016/oct/26/spain-russian-warships-refuel-aleppo-bombing-ceuta-syria
Is it any wonder that productivity is dreadful?
The only thing to look forward to in the calamitous decision to leave te EU is witnessing the slow lingering political death of the leading Tories-particularly Johnson-who were rsponsible for it.
Right to the end
Just like a friend
I tried to warn you somehow
You had your way
Now you must pay
I'm glad that you're sorry now
"The Resolution Foundation thinktank warned the chancellor that lower tax receipts and higher spending following the Brexit vote would leave the Treasury with a shortfall in every year until 2020-21. It said a widening gap would open up between income and expenditure to leave a £23bn deficit at the end of the parliament, forcing the government to find savings or allow extra borrowing amounting to a cumulative £84bn to balance the books over the next five years."
An internal briefing document for ministers, marked “sensitive”, revealed that the government was “unlikely to bring deficit reduction entirely back on track” and that the “continuing run of disappointing data” meant there was a “severe worsening in the public finances”
https://twitter.com/KatyTurNBC/status/791090355248762880
Clinton 48 .. Trump 45
http://www.baynews9.com/content/news/baynews9/news/article.html/content/news/articles/cfn/2016/10/25/florida_decides_polls_presidential_race.html#pdfs
Florida - AIF - Sample 1,000 - 19 Oct
Clinton 44 .. Trump 41
http://static.politico.com/8a/b1/6632d7e147899c4489dd14a84e17/161024-states-statewidetrack.pdf
But don't despair on neurodegeneration. I was on the phone last night with the CEO of what I think is one of the most exciting companies in the space. Trend is towards focusing on mild and prodromal patients: i.e. delaying the development of the disease. That has real potential as if you can delay the onset of degeneration (I've heard speculation that up to 20 years may be achievable) with a monthly injection you're basically solving the problem.
Prevention is so much better than cute.
As @Charles makes clear below, there comes a point where just throwing more money at the existing NHS structure is counter productive, but another reorganisation isn't going to win any votes.
[edit didn't someone talk about integrating health and social care around the time of the GE? can't remember who. maybe memory is impaired after all]
I'm with you on the Royal commission, perhaps something that Blair could have pulled off at the height of his popularity. Maybe the chance has been missed now.
Sounds promising on the drugs. Hope in will be in time for me! (I'm not demented yet, as far as I know)
Of course there are a number of problems with this but we should unpick them rather than being rude about Alistair. Firstly Leave no longer exists and will never fight another election so they won't suffer the Lib Dems fate. Though the current government has completely own Brexit and prominent Leavers serve in it. Secondly while the extra £350m will never happen the Lib Dems not only failed to abolish Tuition Fees - they trebled them. No one is suggesting the NHS budget will be cut by £350m pw by Brexit. Thirdly the interplay between the NHS budget and service outcomes is long term and gradual. On it's current course the NHS will never collapse. It will just keep getting mildly worse week on week. It's like the proverbial lobster being slowly boiled alive. There will be no Tuition Fee betrayal ' moment ' to focus things.
Broadly the two overlapping but distinct populist, Xenophobic, sophisticated but vile big fat lies the Leave Campaign told - that the state of the NHS was foreigners fault - was British politics going momentarily off balance. When people are very drunk they think they can fly. Over the next few years we'll sober up. The policy choices on the NHS and the NHS' problems will still be there and it unsolved.
None of this means Brexit will become less popular ( though it might ), we could just keep on drinking and blame Foreigners some more ( as Edmund suggests - worth debating ) but whether post Truth campaigns like Leave are subsequently debunked or become normative is a seminal point for British politics. Worthy of a thread on PB. Of course a vocal minority of ( it seems increasingly insecure and jittery ) Leavers on here will try and shout the issue down. But this is just a microcosm of the thread's macrocosm.
British politics didn't stop on the 23rd of June. Brexit is a process not an event. It's a highly dynamic situation. We need to debate and disagree about the values in Alistair's equation or daft a different equation. Not argue there is no equation or that it's 2 + 2 = 4 and anyone who says otherwise doesn't believe in Maths.
I've no problem with demands for safety and security with the tech; that wasn't the problem. The problem was that each hospital was a series of personal fiefdoms, each of whom demanded their own conditions.
In contrast, in the US it took a few meetings to agree everything per hospital.
(She 's actually a friend of mine but "CEO of neurodegeneration company" sounded better in this context!)
Further long term servings are on their way when CCGs delegate most of their responsibilities to STP regional organisations which will probably happen gradually over two years.
Ultimately healthcare needs to move to a more educational model, but that requires people to take responsibility for their health, which is not helped by a system where A&E will bail you out for free whatever your behaviours.
For my part, I think it'd be easier to just fund it properly
Next!
On topic, the problem with Alastair's article is the headline - this is not a 'risk for Brexit' (except to how it is viewed in retrospect) but for the Tories, who are now tied securely to the Brexit raft. CV's assertion that the EU can be blamed for a bad outcome isn't going to wash.
Given the campaign, whichever side won the referendum was going to face trouble, and we can all surely imagine the leavers making the most of every negative story and indicator about the EU for years to come, had the outcome been the opposite. Taking the flak for the outcome, and the promises not kept, is however the victor's privilege, and as far as UK politics is concerned Leave now equals Tory for the foreseeable.
These days the requirements for chronic (long term care close to home, much closer to nursing than doctoring) acute (centres of excellence with highly skilled KOLs) and A&E (rapid intervention and effective triage) are all very different. They need different facilities in different places. But as the Irishman once said: "Going to Dublin? Well, I wouldn't start from here if I was you"
*reduced in this context means not increased at the rate expected or necessary to cope with increased demand
Of course, as the Leave advert showed us, when we return all the foreigners the NHS waiting rooms will be empty and the service will be much improved...
The UK has socialised healthcare paid for almost entirely from Government spending. The NHS budget will clearly be effected by the Brexit Devaluation and Brexit Inflation and any potential Brexit Cuts to come. Or the NHS budget can be protected by Brexit Taxes or more Brexit Debt.
The thing is the Leave Campaign was absolutely, totally and completely *right*.
The NHS is a national religion, under huge budget pressure and it's funding is clearly linked to our EU membership. The Leave Campaign were right in their framing of the issue and they won. The question now is whether it's a pyrric victory.
The NHS was on a course for eventual meltdown no matter how much money was/is being thrown at it. It's model, circa 1948, is decades out of date, but the political class has over the years built it into the conscience of the nation as a magic healing tree and now dare not touch it, being the cowards they are.
Perhaps Mr Meeks and his fellow Remainers will come up with a plan to save the NHS while still being tied to the the EU pudding. You never know!
I want to be treated by the health service in that leave video. It looked really good, and everyone was so friendly and helpful.
http://www.bbc.co.uk/iplayer/episode/b07d6f8y/eu-referendum-campaign-broadcasts-vote-leave-23052016
This matters in party political terms, of course, because both sides were headed by leading Conservative politicians. It`s the Tories who will get the blame. They can`t just wriggle out of it.
It was in short deliberate and in a curious way skilful creation of a Prism through which the Lib Dems would seen. All else refracted through it afterwards. It was a Ratnering of the Lib Dem brand that Gerald could only dream off.
Your blathering on with facts and arguments that the policy introduced had considerable merit is laughable. Thanks is politics. What have facts got to do with it ? It was about Trust, Branding, Prisms and High Politics. Clegg and the Lib Dems got what they deserved.
Apparently he's unsure whether the Sphinx does in fact have a secret, even though he's a close acquaintance from before she was married. A prominent Leaver, he's not at all reassured by her performance to date.
http://www.moneysavingexpert.com/students/student-loans-tuition-fees-changes
http://www.realclearpolitics.com/epolls/2016/president/us/general_election_trump_vs_clinton-5491.html
I am less pessimistic about NHS spending in the medium term. As Alastair points out a disproportionate share of healthcare spending is currently spent on people over 75. A large number of these suffer from dementia which requires them to have 24 hour nursing care. Good quality care means they can live a long time.
As Charles and others point out there are considerable signs of hope in at least the stopping of the onset of dementia if not (yet) its cure. Similarly, there are remarkable advances, not least in Dundee, in the use of photobiology to treat cancers. Some of the treatments involve painting the relevant areas and exposing to sunlight. Whilst it has historically been true that spending on health has risen faster than spending overall this is not immutable and breakthroughs in a few key areas could have a big and positive impact.
In the short run I fear some sort of crisis is inevitable. Whether it has any connection in the public mind with Brexit or not only time will tell. An announced increase in spending to deal with current deficits in the Autumn Statement is inevitable but may well prove to be insufficient.
I felt genuinely sorry for the Sphinx and was enormously grateful to her for carrying the can for the good of the nation. I wished her well.
Until that conference speech.
"I'm sorry to tell you Mrs Cohen but your son has an oedipus complex"
"Oedipus shmoedipus...... just as long as hes a good boy who loves his mother"
Hasn't done her too much harm so far. And when was the last PM who left office as a hero? Departure after failure is pretty much guaranteed, plan or no. So it is only a matter of time.
Using a hospital as social elective care could work although I syspect it's the wrong design. I'd rather go back to smaller local convalesence homes. But it's an interesting idea
Pharmacies should also used much more than they are and more aggressively co- located with GPs and other outpatient facilities.
But the problem is if you suggest "closing a&e" people start screaming before they even think about whether it's the right thing to do to improve patient care
The voters of Leaverstan were typically older, poorer, and less able to access private resources to fund their health and social care than the voters of Remania. They want an old style welfare state as part of their socially conservative Britain. May and Hammond are going to have to find the money.
Alaistair is not exagerrating the stress on the system, indeed he understates it. Last Tuesday there were 20 ambulances in the forecourt at Leicester Royal Infirmary with patients in the back, unable to offload as there was no space or beds in our main hospital. This is a weekly event happenning up and down the land.
I suspect this 'worst candidate' thing is based on nothing more than a repeated rumour. I can't think of a British PM except for Blair who coud have given such a good account of themseves during the three debates.
At least Obama had healthcare.
1. No party has a solution to the demand push of an ageing populace and expensive new treatments
2. No party wants to front up to the reality that bigger regional specialist hospItaly has to be the way forward and that means that you can't have an A&E and specialist cancer/heart/children's hospital in every town
3. The Tories are pumping more money into the system and front line services are starved of cash. The elephant in the room being the creeping privatisation and marketisation of services ducking cash away from doctors to lawyers and contract managers
4. Given Jeremy Hunts direct family links to private medicine and the various papers written by Tories about how to privatise the NHS starting with "create a crisis" then "offer privatisation as a solution" it shouldn't be a surprise that so many trusts are being allowed to go under. That's the whole idea
Unfortunately for Hunt and his friends, Boris has knackered their scheme. There isn't growing openness to more privatisation. There is growing clamour for more public funding.