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politicalbetting.com » Blog Archive » Three Score and Ten? Has the NHS reached the end of its natural life?

On July 5th the NHS marks its 70th birthday, and the occasion will be marked by a significant financial injection as a means of life support by the Conservative government. This should keep it breathing for a while yet, but like any ageing process we should consider whether the condition is terminal, and what the objective of continued treatment is. Is the NHS a model of health care fit for the 2020’s or are there better ways of organising it in the modern world?

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surby

NHS forever. Always first !

Big_G_NorthWales

Thank you for a real anaylsis of the NHS.

It has to be taken out of party politics and given a cross party mandate for it to survive. TM offering 20 billion extra a year and Corbyn saying he will pay more as he did today is just not the answer

surby

surby said:

Nigelb said:

California passed its own, slightly more sensible version of GDPR last week:
http://money.cnn.com/2018/06/28/technology/california-consumer-privacy-act/index.html

I have implemented the GDPR and appointed a Data Protection Officer to create and write the paperwork, questionnaires. Apart from that, nothing has changed !

Its ISO 9001 all over again.

williamglenn

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

Alistair

surby said:

surby said:

Nigelb said:

California passed its own, slightly more sensible version of GDPR last week:
http://money.cnn.com/2018/06/28/technology/california-consumer-privacy-act/index.html

I have implemented the GDPR and appointed a Data Protection Officer to create and write the paperwork, questionnaires. Apart from that, nothing has changed !

Its ISO 9001 all over again.

My rule of thumb is: If your personal data handling such that you can't easily answer GDPR queries then your data handling is bad and you should feel bad.

Alistair

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

We don't want the Irish system.

Richard_Tyndall

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

OblitusSumMe

The NHS is also a victim of increasing inequality, as that means its funding is increasingly reliant on a smaller number of people.

Somehow the great mass of the population need to become richer, so that everyone can contribute more to the NHS.

Nigelb

F1 ... Mercedes demonstrating yet again their inability to strategise on the fly.

Richard_Tyndall

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

I was under the impression the Irish system was almost as bad as the NHS. Better to take the opportunity to reform both systems along the lines of France or Germany.

ReggieCide

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

are you proposing a trial separation?

Big_G_NorthWales

Richard_Tyndall said:

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

Jeremy wouldn't like that but he is a dinosaur

williamglenn

Richard_Tyndall said:

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

I was under the impression the Irish system was almost as bad as the NHS. Better to take the opportunity to reform both systems along the lines of France or Germany.

Disclaimer: I know nothing about the Irish system.

Richard_Tyndall

Big_G_NorthWales said:

Richard_Tyndall said:

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

Jeremy wouldn't like that but he is a dinosaur

Hunt or Corbyn

ReggieCide

Big_G_NorthWales said:

Thank you for a real anaylsis of the NHS.

It has to be taken out of party politics and given a cross party mandate for it to survive. TM offering 20 billion extra a year and Corbyn saying he will pay more as he did today is just not the answer

I agree but you'd be hard pressed to find many politicians of influence (of any hue but the redder, the less likely) to publicly promote the concept. Who would hold the buggers to account when the only measures most voters are allowed to consider are cost and "how does it affect me"? Corbyn will doubtless be disappointed to have to discontinue reading out his Doubting Thomas letters, real or otherwise.

brendan16

Richard_Tyndall said:

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

I was under the impression the Irish system was almost as bad as the NHS. Better to take the opportunity to reform both systems along the lines of France or Germany.

It is similar to the NHS with a nationally directed system operated by the HSE (health service executive) - with hospitals run mostly by the HSE and some by charities often linked to the Catholic Church. The one big difference is that unless your household family income is below 15k euro (and thus aren't eligible for the famed medical card) you have to pay 75 euro per night stay in hospital, 50 euro to see a GP and 100 euro to go to casualty even for kids aged over 7 and the elderly.

Like the NHS it's good and bad in parts - overcrowded A&Es but some facilities top notch. A lot of people do go private though.

But it's not really a model we would want to reform into - it's the NHS with extra charges and some private provision.

JosiasJessop

Thanks, Dr Fox.

The truth is that the NHS was formed in a past age. We have changed massively from the late 1940s: rationing has gone, the death penalty was itself dealt a deathly blow, homosexuality is legal, and TV and communications are everywhere. The world has moved on, but the NHS remains an iceberg drifting towards the Equator.

The 'ageing' problem can be solved by evolution, not revolution. Work out the core principles, the current and future (< twenty years) demand, and how best to fulfil that demand within those principles.

Unfortunately, there are too many on the left who treat the NHS as something that cannot be altered (except when they are doing the altering). Worse, there are many when the NHS and its staff matter more than outcomes and patients - witness the current Manchester Mayor's views on the Stafford scandal. This is an evil.

Likewise, those who look to America and want to reform the NHS in that manner - ignoring the core principles - are equally wrongheaded, although less numerous.

I agree with Mr G below: it needs to be taken out of party politics. However that won't happen as long as Labour believe that the NHS is an electoral winner for them. And in the meantime the NHS will drift on until it finally melts into nothingness. And that would be a tragedy.

In addition: we have to be cleverer in the use of technology: and the NHS is terrible when it comes to trying new medical technology, with hundreds of little fiefdoms. There are also non-technological enhancements that can be made, e.g. to reduce A&E visits.

TheScreamingEagles

Nigelb said:

F1 ... Mercedes demonstrating yet again their inability to strategise on the fly.

Mercedes couldn’t organise a pregnancy on a council estate.

TheScreamingEagles

Many thanks for this Doctor Foxy.

A real joy to publish this.

FrancisUrquhart

TheScreamingEagles said:

Nigelb said:

F1 ... Mercedes demonstrating yet again their inability to strategise on the fly.

Mercedes couldn’t organise a pregnancy on a council estate.

Do they moonlight as Brexit negotiators?

williamglenn

FPT

Richard_Tyndall said:

williamglenn said:

http://www.legislation.gov.uk/ukpga/2018/16/section/10/enacted

The EU Withdrawal Act does not authorise the UK to:

...create or facilitate border arrangements between Northern Ireland and the Republic of Ireland after exit day which feature physical infrastructure, including border posts, or checks and controls, that did not exist before exit day and are not in accordance with an agreement between the United Kingdom and the EU.

So no technology on the Irish border or new checks or controls of any kind.

And again misreading. 'Does not authorise' is not the same as 'prevents'. Either side can impose border restrictions if they chose to do so. They simply can't use the December agreement as a reason to do so.

If the withdrawal agreement cannot be the reason to create the conditions needed for border checks, how do you expect to agree a withdrawal agreement which creates a border?

Nigelb

FrancisUrquhart said:

TheScreamingEagles said:

Nigelb said:

F1 ... Mercedes demonstrating yet again their inability to strategise on the fly.

Mercedes couldn’t organise a pregnancy on a council estate.

Do they moonlight as Brexit negotiators?

No - one thing they can do is plan in advance. If they’d been doing Brexit we’d already have a deal.
They are simply incapable of reacting to the unexpected.

FrancisUrquhart

Girls are banned from wearing skirts at 40 secondaries across England as schools opt for gender-neutral uniforms to cater for transgender pupils

http://www.dailymail.co.uk/news/article-5906031/Girls-banned-wearing-skirts-40-schools-insist-gender-neutral-uniforms.html

I don't understand this approach. Why not simply say trousers, skirts and shorts are all acceptable uniform options (for either sex).

I am sure there are girls who would choose to wear trousers, especially during winter, but might prefer skirts in the summer.

Andy_JS

Good afternoon. Thanks for the article Dr Foxy.

That was the worst bit of defending I've seen for a long time in the Spain / Russia match.

RoyalBlue

Just got back from a family lunch with some fellow Brexiteers. The general mood when discussing Europe was one of resignation; the government has no leverage without ‘no deal’ preparation, but they are manifestly not doing it, and it is probably now too late. The only real solution to the Irish border that will let us have our own trade policy is reunification.

While we are all hard Brexiteers in principle, we agreed that a no deal Brexit with no preparation would be utterly irresponsible. If all May can get is CU and SM with no U.K. input on rule-making, we need a second referendum.

TheWhiteRabbit

FrancisUrquhart said:

Girls are banned from wearing skirts at 40 secondaries across England as schools opt for gender-neutral uniforms to cater for transgender pupils

http://www.dailymail.co.uk/news/article-5906031/Girls-banned-wearing-skirts-40-schools-insist-gender-neutral-uniforms.html

I don't understand this approach. Why not simply say trousers, skirts and shorts are all acceptable uniform options (for either sex).

I am sure there are girls who would choose to wear trousers, especially during winter, but might prefer skirts in the summer.

I think it's about avoiding a debate about skirt length

Charles

Excellent. Thanks @Foxy

The issue is that there are several questions which get muddled up. Some are rightly intensely political, others really shouldn’t be. It’s not helpful by some on the left who see the the NHS as a massive political weapon so oppose any reform with screams of “45 mins to save the NHS” or some such crap.

In an ideal world you could have a series of Royal Conmissions (too big for one) which should operate sequentially

Starting from the basic principal that adequate healthcare should be universally available

(1) what is the remit (ie treatment vs prevention, how much elective stuff). Are we preserving life at all cost or how should we integrate into hospice movement?

(2) for a given budget of X what is the best way to deliver? (Eg DGH vs A&E retail vs convalescence vs centres of excellence etc)

(3) should it be one size fits all?

The question of money is one for politics but hopefully we can all agree we want the best health outcomes for the money available

(The other question is whether it’s just too big to manage. I’ve beem wondering recently whether we should switch the government structure from function to client based. So - for instance - you’d combine pensions/social care; education/child benefit etc. Ultimately people in different stages of life have different needs but should have a holistic service provided by the state)

DecrepitJohnL

Richard_Tyndall said:

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

France does spend more on health than we do, and not just because of insurance. The French government spends more as well. Most advocates of moving to European models do not tell us how much more money they'd spend; this is surprising because if you did want to convince voters to change then promising extra funding would be a powerful carrot -- ask Boris! The American system might be awful but one strength is innovation. I don't know if it can be measured but I'd expect most new treatments to come from the US.

ETA: what surprises many is the American government spends more on health than ours, even in what you'd think is the most market-oriented system in the world.

williamglenn

RoyalBlue said:

While we are all hard Brexiteers in principle, we agreed that a no deal Brexit with no preparation would be utterly irresponsible. If all May can get is CU and SM with no U.K. input on rule-making, we need a second referendum.

In which you would vote Remain?

JonnyJimmy

I had some mates round yesterday for drinks and made some canapés with the Labneh that I'd made the night before (sourdough crispbread smeared with garlic and herb Labneh topped with spring onion and half a yellow cherry tomato).

These were extremely popular and everyone wanted know how I made the cream cheese. Being a bit drunk I did a demonstration, and made almost a litre of it. All were shocked at how easy it is to make.

This morning I woke up to find a litre of Lebanese garlic cream cheese in my fridge and thought I ought to use it up. I went to tesco (in a new record 113mpg!) and got the ingredients to make mini moroccan spice lamb burgers, flatbreads and a chilli, radish and red onion salad to garnish.

Luckily these are delicious, as I've made enough to feed a football team so I'll be eating them for lunch all next week!

I like the header, but I think the nhs is here to stay. And grow. If we're going to have it, it ought to be coordinated and incorporated with social care.

Gardenwalker

RoyalBlue said:

Just got back from a family lunch with some fellow Brexiteers. The general mood when discussing Europe was one of resignation; the government has no leverage without ‘no deal’ preparation, but they are manifestly not doing it, and it is probably now too late. The only real solution to the Irish border that will let us have our own trade policy is reunification.

While we are all hard Brexiteers in principle, we agreed that a no deal Brexit with no preparation would be utterly irresponsible. If all May can get is CU and SM with no U.K. input on rule-making, we need a second referendum.

Pretty much my view, albeit coming from squarely the opposite direction. The Brexit promised will not be on the table. The government will hopefully, post-Chequers, decided on which of the irreconcilables to junk - likely this will be a certain notion of sovereignty as we are are unwilling to leave the customs union and may also need to concede certain elements around FOM.

If, with these compromises known, we still wish to Leave, then at least we will do so with eyes wide open - but we need a Vote on the Deal to ratify the government’s policy.

Charles

FrancisUrquhart said:

Girls are banned from wearing skirts at 40 secondaries across England as schools opt for gender-neutral uniforms to cater for transgender pupils

http://www.dailymail.co.uk/news/article-5906031/Girls-banned-wearing-skirts-40-schools-insist-gender-neutral-uniforms.html

I don't understand this approach. Why not simply say trousers, skirts and shorts are all acceptable uniform options (for either sex).

I am sure there are girls who would choose to wear trousers, especially during winter, but might prefer skirts in the summer.

Because banning is easier for teachers than allowing choice

JosiasJessop

JonnyJimmy said:

I had some mates round yesterday for drinks and made some canapés with the Labneh that I'd made the night before (sourdough crispbread smeared with garlic and herb Labneh topped with spring onion and half a yellow cherry tomato).

These were extremely popular and everyone wanted know how I made the cream cheese. Being a bit drunk I did a demonstration, and made almost a litre of it. All were shocked at how easy it is to make.

This morning I woke up to find a litre of Lebanese garlic cream cheese in my fridge and thought I ought to use it up. I went to tesco (in a new record 113mpg!) and got the ingredients to make mini moroccan spice lamb burgers, flatbreads and a chilli, radish and red onion salad to garnish.

Luckily these are delicious, as I've made enough to feed a football team so I'll be eating them for lunch all next week!

I like the header, but I think the nhs is here to stay. And grow. If we're going to have it, it ought to be coordinated and incorporated with social care.

But how was your parking?

Sean_F

williamglenn said:

FPT

Richard_Tyndall said:

williamglenn said:

http://www.legislation.gov.uk/ukpga/2018/16/section/10/enacted

The EU Withdrawal Act does not authorise the UK to:

...create or facilitate border arrangements between Northern Ireland and the Republic of Ireland after exit day which feature physical infrastructure, including border posts, or checks and controls, that did not exist before exit day and are not in accordance with an agreement between the United Kingdom and the EU.

So no technology on the Irish border or new checks or controls of any kind.

And again misreading. 'Does not authorise' is not the same as 'prevents'. Either side can impose border restrictions if they chose to do so. They simply can't use the December agreement as a reason to do so.

If the withdrawal agreement cannot be the reason to create the conditions needed for border checks, how do you expect to agree a withdrawal agreement which creates a border?

If the government needs statutory authorisation for customs checks on our Borders, then it would be incorporated into a Finance Act.

RoyalBlue

Gardenwalker said:

RoyalBlue said:

Just got back from a family lunch with some fellow Brexiteers. The general mood when discussing Europe was one of resignation; the government has no leverage without ‘no deal’ preparation, but they are manifestly not doing it, and it is probably now too late. The only real solution to the Irish border that will let us have our own trade policy is reunification.

While we are all hard Brexiteers in principle, we agreed that a no deal Brexit with no preparation would be utterly irresponsible. If all May can get is CU and SM with no U.K. input on rule-making, we need a second referendum.

Pretty much my view, albeit coming from squarely the opposite direction. The Brexit promised will not be on the table. The government will hopefully, post-Chequers, decided on which of the irreconcilables to junk - likely this will be a certain notion of sovereignty as we are are unwilling to leave the customs union and may also need to concede certain elements around FOM.

If, with these compromises known, we still wish to Leave, then at least we will do so with eyes wide open - but we need a Vote on the Deal to ratify the government’s policy.

I agree. It is vital that the final settlement is explicitly supported by the electorate, rather than be categorised as a ‘Tory Brexit’.

williamglenn

Sean_F said:

williamglenn said:

FPT

Richard_Tyndall said:

williamglenn said:

http://www.legislation.gov.uk/ukpga/2018/16/section/10/enacted

The EU Withdrawal Act does not authorise the UK to:

...create or facilitate border arrangements between Northern Ireland and the Republic of Ireland after exit day which feature physical infrastructure, including border posts, or checks and controls, that did not exist before exit day and are not in accordance with an agreement between the United Kingdom and the EU.

So no technology on the Irish border or new checks or controls of any kind.

And again misreading. 'Does not authorise' is not the same as 'prevents'. Either side can impose border restrictions if they chose to do so. They simply can't use the December agreement as a reason to do so.

If the withdrawal agreement cannot be the reason to create the conditions needed for border checks, how do you expect to agree a withdrawal agreement which creates a border?

If the government needs statutory authorisation for customs checks on our Borders, then it would be incorporated into a Finance Act.

You agree that this can only happen in the case of No Deal? A deal which includes any form of MaxFac on the Irish border cannot happen unless the legislation is amended?

Nigelb

What a surprise - Selmayr being an arse again:
https://www.theguardian.com/politics/2018/jul/01/brexit-eu-accused-of-making-false-aid-funding-claims

JonnyJimmy

JosiasJessop said:

JonnyJimmy said:

I had some mates round yesterday for drinks and made some canapés with the Labneh that I'd made the night before (sourdough crispbread smeared with garlic and herb Labneh topped with spring onion and half a yellow cherry tomato).

These were extremely popular and everyone wanted know how I made the cream cheese. Being a bit drunk I did a demonstration, and made almost a litre of it. All were shocked at how easy it is to make.

This morning I woke up to find a litre of Lebanese garlic cream cheese in my fridge and thought I ought to use it up. I went to tesco (in a new record 113mpg!) and got the ingredients to make mini moroccan spice lamb burgers, flatbreads and a chilli, radish and red onion salad to garnish.

Luckily these are delicious, as I've made enough to feed a football team so I'll be eating them for lunch all next week!

I like the header, but I think the nhs is here to stay. And grow. If we're going to have it, it ought to be coordinated and incorporated with social care.

But how was your parking?

I didn't use the accelerator at all in the car park, and only used my brake once to stop precisely between the lines in a carefully chosen spot right next to the trolley park which I was able to drive both into and out of without reversing.

So pretty good

DecrepitJohnL

One thing that strikes me from both fly-on-the wall documentaries and attending outpatients is that there are some fairly simple improvements that could be made, such as labelling cupboards so staff can find equipment more easily, and better signposting so patients (especially this one) don't get lost in a maze of corridors.

Nigelb

JonnyJimmy said:

JosiasJessop said:

JonnyJimmy said:

I had some mates round yesterday for drinks and made some canapés with the Labneh that I'd made the night before (sourdough crispbread smeared with garlic and herb Labneh topped with spring onion and half a yellow cherry tomato).

These were extremely popular and everyone wanted know how I made the cream cheese. Being a bit drunk I did a demonstration, and made almost a litre of it. All were shocked at how easy it is to make.

This morning I woke up to find a litre of Lebanese garlic cream cheese in my fridge and thought I ought to use it up. I went to tesco (in a new record 113mpg!) and got the ingredients to make mini moroccan spice lamb burgers, flatbreads and a chilli, radish and red onion salad to garnish.

Luckily these are delicious, as I've made enough to feed a football team so I'll be eating them for lunch all next week!

I like the header, but I think the nhs is here to stay. And grow. If we're going to have it, it ought to be coordinated and incorporated with social care.

But how was your parking?

I didn't use the accelerator at all in the car park, and only used my brake once to stop precisely between the lines in a carefully chosen spot right next to the trolley park which I was able to drive both into and out of without reversing.

So pretty good

What herbs do you recommend ?

TheScreamingEagles

Chris Grayling is determined to ensure the Tories don’t win any Northern marginals.

https://twitter.com/helenpidd/status/1013350207545839622?s=21

I bet Grayling does strategy for Mercedes F1 on the side too.

Nigelb

Raikkonen about to give up a place, I think.

JonnyJimmy

Just catching up on the last thread to read of references having been made to WW1. This reminds me that I wrote a pretty nice cryptic clue yesterday.

World War One is chaos whatever the result (3,4,2,4)

And after a few beers came up with this

A bit tutti-frutti, psychoactively (5)

TheScreamingEagles

Nigelb said:

Raikkonen about to give up a place, I think.

This is a disgrace.

JonnyJimmy

Nigelb said:

JonnyJimmy said:

JosiasJessop said:

JonnyJimmy said:

I had some mates round yesterday for drinks and made some canapés with the Labneh that I'd made the night before (sourdough crispbread smeared with garlic and herb Labneh topped with spring onion and half a yellow cherry tomato).

These were extremely popular and everyone wanted know how I made the cream cheese. Being a bit drunk I did a demonstration, and made almost a litre of it. All were shocked at how easy it is to make.

This morning I woke up to find a litre of Lebanese garlic cream cheese in my fridge and thought I ought to use it up. I went to tesco (in a new record 113mpg!) and got the ingredients to make mini moroccan spice lamb burgers, flatbreads and a chilli, radish and red onion salad to garnish.

Luckily these are delicious, as I've made enough to feed a football team so I'll be eating them for lunch all next week!

I like the header, but I think the nhs is here to stay. And grow. If we're going to have it, it ought to be coordinated and incorporated with social care.

But how was your parking?

I didn't use the accelerator at all in the car park, and only used my brake once to stop precisely between the lines in a carefully chosen spot right next to the trolley park which I was able to drive both into and out of without reversing.

So pretty good

What herbs do you recommend ?

I'm still experimenting! For this batch I used fresh mint and chives. It's really very nice with the lamb.

Sean_F

williamglenn said:

Sean_F said:

williamglenn said:

FPT

Richard_Tyndall said:

williamglenn said:

http://www.legislation.gov.uk/ukpga/2018/16/section/10/enacted

The EU Withdrawal Act does not authorise the UK to:

...create or facilitate border arrangements between Northern Ireland and the Republic of Ireland after exit day which feature physical infrastructure, including border posts, or checks and controls, that did not exist before exit day and are not in accordance with an agreement between the United Kingdom and the EU.

So no technology on the Irish border or new checks or controls of any kind.

And again misreading. 'Does not authorise' is not the same as 'prevents'. Either side can impose border restrictions if they chose to do so. They simply can't use the December agreement as a reason to do so.

If the withdrawal agreement cannot be the reason to create the conditions needed for border checks, how do you expect to agree a withdrawal agreement which creates a border?

If the government needs statutory authorisation for customs checks on our Borders, then it would be incorporated into a Finance Act.

You agree that this can only happen in the case of No Deal? A deal which includes any form of MaxFac on the Irish border cannot happen unless the legislation is amended?

I thought we were discussing a No Deal situation.

If a deal is agreed, then customs checks will be dealt with in the deal, and in the legislation that puts into place..

Nigelb

Nigelb said:

Raikkonen about to give up a place, I think.

No... uncommonly sporting of Ferrari...

rottenborough

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

williamglenn

"Trump's mother being Scottish will help us get a good trade deal."

Oh...
https://twitter.com/ddale8/status/1013426804462415872

Richard_Tyndall

DecrepitJohnL said:

Richard_Tyndall said:

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

France does spend more on health than we do, and not just because of insurance. The French government spends more as well. Most advocates of moving to European models do not tell us how much more money they'd spend; this is surprising because if you did want to convince voters to change then promising extra funding would be a powerful carrot -- ask Boris! The American system might be awful but one strength is innovation. I don't know if it can be measured but I'd expect most new treatments to come from the US.

ETA: what surprises many is the American government spends more on health than ours, even in what you'd think is the most market-oriented system in the world.

Oh I am quite happy to say how much we need to spend as it is, to me at least, an unpolitical position.

According to the World Health Organisation total UK expenditure on health care in 2015 was $4,356 per person. That includes both public and private provision.

By comparison French expenditure per person was only $4,026.

However Canadian ($4,508), German ($4,592) and Dutch ($4,746) spending per person were all higher than the British. The US is ludicrously high ($9,818) when you consider the state of their health care.

Obviously I would expect these have al increased since 2015.

The French have better health care provision than the NHS for lower per capita spending but I would suggest we should be looking to have German or Dutch levels of spending combined with French (or German or Dutch) systems.

Richard_Tyndall

brendan16 said:

Richard_Tyndall said:

williamglenn said:

If Ireland were reunified, how would they go about integrating the Northern Irish NHS into the health system of Ireland, and would this provide any useful lessons for NHS reform to create a more European style system?

I was under the impression the Irish system was almost as bad as the NHS. Better to take the opportunity to reform both systems along the lines of France or Germany.

It is similar to the NHS with a nationally directed system operated by the HSE (health service executive) - with hospitals run mostly by the HSE and some by charities often linked to the Catholic Church. The one big difference is that unless your household family income is below 15k euro (and thus aren't eligible for the famed medical card) you have to pay 75 euro per night stay in hospital, 50 euro to see a GP and 100 euro to go to casualty even for kids aged over 7 and the elderly.

Like the NHS it's good and bad in parts - overcrowded A&Es but some facilities top notch. A lot of people do go private though.

But it's not really a model we would want to reform into - it's the NHS with extra charges and some private provision.

Thanks Brendan. Sounds like both countries should be looking to continental European systems.

williamglenn

Sean_F said:

I thought we were discussing a No Deal situation.

If a deal is agreed, then customs checks will be dealt with in the deal, and in the legislation that puts into place..

The withdrawal agreement comes first, and will be an international treaty. Based on the current state of play, if there is a withdrawal agreement it will have to include the backstop.

Incidentally this ties in with @RoyalBlue's argument that it is in the Tory party's interests for a second referendum. May said "no British PM could agree to a customs border between NI and GB". If the withdrawal agreement implies that this could be a future consequence of Brexit, then she will have to seek some kind of mandate from the people and the best way to do it is a referendum on the deal.

AlastairMeeks

More needs to be spent. More needs to be expected of individuals. Less should be provided in some areas. None of this will be popular.

JosiasJessop

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

The DfT and Network Rail have really screwed future large-scale rail enhancements. It's clear no-one has any idea how much such upgrades to existing lines will cost.

TheScreamingEagles

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Morris_Dancer

Good afternoon, everyone.

F1: very exciting race. Also, very green. Ironically, the only bet I made that didn't end up green was the one I tipped in an article. But still very pleased.

Will try writing the post-race tosh but many things occurred so I may well omit something by accident.

Morris_Dancer

Mr. Eagles, it's just dumb. Grayling can find £2bn to bugger Stonehenge with a tunnel, but nothing to keep promises on electrifying northern rail lines.

Nigelb

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

The reality of the policy is every bit as bad as the optics.
Grayling is solid oak between the ears, but he is being allowed to perpetuate this nonsense by an aimless and powerless prime minister.

DecrepitJohnL

1-1 at half time is a surprise, especially as the Spanish 1 was surely the oddest own goal in recent history.

MaxPB

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Indeed. I said it on here previously, if we're going to spend money on trains and high speed rail then we should start from the top, two lines coming down from Newcastle (via Leeds) and Liverpool (via Manchester) down to Birmingham should be done first, then do the Birmingham to London link afterwards. Politically it makes a lot more sense than spending £40bn+ on more rail infrastructure in the south. Economically it's probably marginal either side, I don't see the economic case for HS2 in general but we should at least make some kind of political capital from it.

Gardenwalker

Nigelb said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

The reality of the policy is every bit as bad as the optics.
Grayling is solid oak between the ears, but he is being allowed to perpetuate this nonsense by an aimless and powerless prime minister.

Would be laughable if it didn’t indicate a delusional complacency about Tory prospects at the next election.

The Tories, by being so crap across so many dimensions, are enabling Corbyn-ism, and putting the country’s future at risk. Like the Bourbons, the post-Cameron Tories have learned nothing and forgotten nothing.

RoyalBlue

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

williamglenn

Gardenwalker said:

Nigelb said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

The reality of the policy is every bit as bad as the optics.
Grayling is solid oak between the ears, but he is being allowed to perpetuate this nonsense by an aimless and powerless prime minister.

Would be laughable if it didn’t indicate a delusional complacency about Tory prospects at the next election.

The Tories, by being so crap across so many dimensions, are enabling Corbyn-ism, and putting the country’s future at risk. Like the Bourbons, the post-Cameron Tories have learned nothing and forgotten nothing.

https://www.the-tls.co.uk/articles/public/brexit-politics-george-walden/

The spectacle of such a talented yet leaderless nation stumbling blindly towards an unmapped future, tapping its stick fearfully as it goes, inspires sadness, shame and pity. As penury and not so splendid isolation loom, the question becomes, who are the patriots now?

rottenborough

RoyalBlue said:

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

The optics on this as the North faces rail chaos are beyond belief. Maybe Grayling is a Jezza convert and is now a deep sleeping agent?

JosiasJessop

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Oh, stop your whining.

If you hadn't noticed, the main reason for the timetable failure on Northern Rail at the end of May was Network Rail's inability to deliver similar upgrades. So the 'desolate north' has been getting a heck of a lot of upgrades: perhaps not as much as you want, or even deserve, but they are happening.

As a good Conservative, I'd have thought you were not keen on writing blank cheques for upgrades - as we have seen happen on the GWML electrification, and we saw on the WCML upgrade a decade ago.

To give you an idea of the scale of the problem, the GWML program was costed at about £1.3 billion. A few months ago its costs were £3.2 billion. The WCML upgrade program was about a tenfold increase in costs, and was reduced in scope and delivered very late.

I'd prefer a reduced electrification scheme over a number of years, but such upgrades also rely on new stock, and the new stock is needed much sooner.

So, what would your upgrade program be?

Sandpit

Well we all lost money on that race...

rottenborough

MaxPB said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Indeed. I said it on here previously, if we're going to spend money on trains and high speed rail then we should start from the top, two lines coming down from Newcastle (via Leeds) and Liverpool (via Manchester) down to Birmingham should be done first, then do the Birmingham to London link afterwards. Politically it makes a lot more sense than spending £40bn+ on more rail infrastructure in the south. Economically it's probably marginal either side, I don't see the economic case for HS2 in general but we should at least make some kind of political capital from it.

Personally I think HS2 needs to be built, but I see no point to the Southern part of HS2 unless it links directly into St Pancras and can run international trains to the continent.

DecrepitJohnL

Richard_Tyndall said:

DecrepitJohnL said:

Richard_Tyndall said:

An excellent thread header by Dr Fox.

I would suggest though that one thing we do need to do is look at European systems - particularly the French - and how they introduce private money into their National Health service. Whilst a significant proportion of the service is provided by the private sector in France (whilst generally remaining free at the point of delivery), that private sector is far more constrained than we are used to in the UK. Drug costs, treatment costs and service quality are all very tightly regulated and private companies go into health care not because it will make them vast sums of money per se but because it will provide a steady, predictable income over a long period. This is the way we should be looking at private provision of health services in the UK rather than the awful US system.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

France does spend more on health than we do, and not just because of insurance. The French government spends more as well. Most advocates of moving to European models do not tell us how much more money they'd spend; this is surprising because if you did want to convince voters to change then promising extra funding would be a powerful carrot -- ask Boris! The American system might be awful but one strength is innovation. I don't know if it can be measured but I'd expect most new treatments to come from the US.

ETA: what surprises many is the American government spends more on health than ours, even in what you'd think is the most market-oriented system in the world.

Oh I am quite happy to say how much we need to spend as it is, to me at least, an unpolitical position.

According to the World Health Organisation total UK expenditure on health care in 2015 was $4,356 per person. That includes both public and private provision.

By comparison French expenditure per person was only $4,026.

However Canadian ($4,508), German ($4,592) and Dutch ($4,746) spending per person were all higher than the British. The US is ludicrously high ($9,818) when you consider the state of their health care.

Obviously I would expect these have al increased since 2015.

The French have better health care provision than the NHS for lower per capita spending but I would suggest we should be looking to have German or Dutch levels of spending combined with French (or German or Dutch) systems.

OECD has France on higher per-capita expenditure in France: $4,600 vs $4,200 in 2016.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

It may be that it depends on the small print as to what is classified as health spending.

JosiasJessop

RoyalBlue said:

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

Costs on such projects are so out of control that no-one knows how much it would cost.

If you still want to go ahead on that basis, fair enough. But be aware that others will want their pet projects that you disagree with to go ahead as well on a similar basis.

Nigelb

MaxPB said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Indeed. I said it on here previously, if we're going to spend money on trains and high speed rail then we should start from the top, two lines coming down from Newcastle (via Leeds) and Liverpool (via Manchester) down to Birmingham should be done first, then do the Birmingham to London link afterwards. Politically it makes a lot more sense than spending £40bn+ on more rail infrastructure in the south. Economically it's probably marginal either side, I don't see the economic case for HS2 in general but we should at least make some kind of political capital from it.

The investment required for a new East-West route doesn’t begin to compare with HS2, and I would guess the economic returns would be superior - let alone the social ones.

TheWhiteRabbit

COME ON RUSSIA

in a strictly football context you understand

TheScreamingEagles

JosiasJessop said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Oh, stop your whining.

If you hadn't noticed, the main reason for the timetable failure on Northern Rail at the end of May was Network Rail's inability to deliver similar upgrades. So the 'desolate north' has been getting a heck of a lot of upgrades: perhaps not as much as you want, or even deserve, but they are happening.

As a good Conservative, I'd have thought you were not keen on writing blank cheques for upgrades - as we have seen happen on the GWML electrification, and we saw on the WCML upgrade a decade ago.

To give you an idea of the scale of the problem, the GWML program was costed at about £1.3 billion. A few months ago its costs were £3.2 billion. The WCML upgrade program was about a tenfold increase in costs, and was reduced in scope and delivered very late.

I'd prefer a reduced electrification scheme over a number of years, but such upgrades also rely on new stock, and the new stock is needed much sooner.

So, what would your upgrade program be?

Nonsense

https://twitter.com/jenwilliamsmen/status/1012603163747192832?s=21

TheScreamingEagles

I can’t cheer for a side with that c**t Sergio Ramos in it nor can I cheer for Russia.

This is France v Argentina all over again

Morris_Dancer

Mr. Sandpit, *cough*

Hedged the Bottas win bet. And may've backed Haas double classified finish. And Raikkonen podium.

The only bet I had that failed was the one I tipped in the pre-race article

Foxy

DecrepitJohnL said:

Richard_Tyndall said:

An excellent thread header by Dr Fox.


Edit: Oh and I agree we need to pay more. But In would prefer that to be via private insurance than just pumping more tax payer's money in the behemoth.

France does spend more on health than we do, and not just because of insurance. The French government spends more as well. Most advocates of moving to European models do not tell us how much more money they'd spend; this is surprising because if you did want to convince voters to change then promising extra funding would be a powerful carrot -- ask Boris! The American system might be awful but one strength is innovation. I don't know if it can be measured but I'd expect most new treatments to come from the US.

ETA: what surprises many is the American government spends more on health than ours, even in what you'd think is the most market-oriented system in the world.

I think that the US system is very innovative, and successful at development of new techniques because of its diverse small business orientation. This is a very expensive system, and one that insurance companies try to contain, but successful on its own terms.

I am sceptical about compulsory insurance and the venom from Republicans in repealing Obamacare seems to be confirmation that I am not alone. Perhaps my views have been influenced by seeing too many insurance companies wriggling out of paying fro private patients. The problem of compulsory insurance is that it is still redistributive, and the low risk will nearly always pay far more than they use. At least in the short term.

To satisfy the consumerist society, and for all their Corbynism Millenials are very consumerist, there does need to be self funding as an option. My scheme of individual healthcare savings accounts is designed to circumvent the insurance companies, as spending would be consumer controlled. There is little benefit for swapping a faceless NICE committee for its insurance company equivalent. It would also be a form of saving for social care in retirement, but uunlike pensions could be drawndown for health need during working life.

Any transition from an NHS to a safety net system plus more private sector would have to be a slow one. Both Staff and patients need time to adjust and shift their expectations. Like Brexit transition it needs an agreed direction of travel and no sudden shocks.

Thanks for all the kind comments. I am not sure if my header reads more as an epitaph than the hymns of praise that we will see this week. Like the Curate's egg, the NHS is good in part, but having been involved for half its life I have tasted the rotten parts too.

MaxPB

rottenborough said:

MaxPB said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Indeed. I said it on here previously, if we're going to spend money on trains and high speed rail then we should start from the top, two lines coming down from Newcastle (via Leeds) and Liverpool (via Manchester) down to Birmingham should be done first, then do the Birmingham to London link afterwards. Politically it makes a lot more sense than spending £40bn+ on more rail infrastructure in the south. Economically it's probably marginal either side, I don't see the economic case for HS2 in general but we should at least make some kind of political capital from it.

Personally I think HS2 needs to be built, but I see no point to the Southern part of HS2 unless it links directly into St Pancras and can run international trains to the continent.

Tbh, the walk from Euston to St Pancras is short, what we might see is an underground walkway with an "airside" section for transfer passengers coming in from Paris/Brussels. Linking the two together with a piece of railway track will be impractical as two tube lines already run under that piece of space.

Foxy

TheScreamingEagles said:

I can’t cheer for a side with that c**t Sergio Ramos in it nor can I cheer for Russia.

This is France v Argentina all over again

I would rather Spain fell out of our side of the draw. Go Russia!

Richard_Tyndall

DecrepitJohnL said:

OECD has France on higher per-capita expenditure in France: $4,600 vs $4,200 in 2016.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

It may be that it depends on the small print as to what is classified as health spending.

Yep I saw the two sets of figures and went with the WHO version as I thought it was probably more accurate. Since I am arguing for more spending anyway - to German or Dutch levels - I didn't think it would be contentious. I would be interested to know why the two organisations have such different figures.

tlg86

TheScreamingEagles said:

JosiasJessop said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Oh, stop your whining.

If you hadn't noticed, the main reason for the timetable failure on Northern Rail at the end of May was Network Rail's inability to deliver similar upgrades. So the 'desolate north' has been getting a heck of a lot of upgrades: perhaps not as much as you want, or even deserve, but they are happening.

As a good Conservative, I'd have thought you were not keen on writing blank cheques for upgrades - as we have seen happen on the GWML electrification, and we saw on the WCML upgrade a decade ago.

To give you an idea of the scale of the problem, the GWML program was costed at about £1.3 billion. A few months ago its costs were £3.2 billion. The WCML upgrade program was about a tenfold increase in costs, and was reduced in scope and delivered very late.

I'd prefer a reduced electrification scheme over a number of years, but such upgrades also rely on new stock, and the new stock is needed much sooner.

So, what would your upgrade program be?

Nonsense

https://twitter.com/jenwilliamsmen/status/1012603163747192832?s=21

I am not certain, but I suspect what shows is that as May approached, the TOC started to put more and more effort into gearing up for the TT change. So that would mean more drivers taken off service trains to do training on the electric trains.

EDIT: Though I'm not sure what was going on with short formations.

Sean_F

Morris_Dancer said:

Mr. Eagles, it's just dumb. Grayling can find £2bn to bugger Stonehenge with a tunnel, but nothing to keep promises on electrifying northern rail lines.

What purpose does Grayling serve?

Richard_Tyndall

JosiasJessop said:

RoyalBlue said:

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

Costs on such projects are so out of control that no-one knows how much it would cost.

If you still want to go ahead on that basis, fair enough. But be aware that others will want their pet projects that you disagree with to go ahead as well on a similar basis.

And yet you are in favour of the biggest of these projects (HS2) which has already shown its costs are out of control.

Big_G_NorthWales

Sean_F said:

Morris_Dancer said:

Mr. Eagles, it's just dumb. Grayling can find £2bn to bugger Stonehenge with a tunnel, but nothing to keep promises on electrifying northern rail lines.

What purpose does Grayling serve?

Non at all

Sandpit

Morris_Dancer said:

Mr. Sandpit, *cough*

Hedged the Bottas win bet. And may've backed Haas double classified finish. And Raikkonen podium.

The only bet I had that failed was the one I tipped in the pre-race article

Lucky you! Thankfully I lost less money today than I made yesterday.

Morris_Dancer

Mr. Sandpit, ha, yeah, it makes a nice change. Glad I hedged the Bottas bet. At that stage he seemed nailed on for a 1-2. But I remain slightly haunted by complacently failing to hedge my Con majority bet at the last election...

Foxy

AlastairMeeks said:

More needs to be spent. More needs to be expected of individuals. Less should be provided in some areas. None of this will be popular.

The way to square the circle is for us to lead healthier lives, via the usual suspects of eating and drinking less, exercising more, and not driving each other mad, as well as not smoking. The Marmot report linked in the header was pretty sound in its proposals.

There always needs to be a universal service covering emergencies and critical care. These are the parts of healthcare that need central planning. None of us is immune to a sudden major trauma, and it is at those times that the NHS is at its best. A lot of other healthcare is more amenable to fragmentation to generate competition and innovation.

Personally, I hear good things about the Dutch system, but as well as being a nation of thin cyclists they do have the highest social care spend in the EU, I think.

Morris_Dancer

F1: just adding the points to my records, and surprised to discover Leclerc finished ahead of Ericsson, given he was behind very late on. Wonder if there was a late pass.

tlg86

Foxy said:

AlastairMeeks said:

More needs to be spent. More needs to be expected of individuals. Less should be provided in some areas. None of this will be popular.

The way to square the circle is for us to lead healthier lives, via the usual suspects of eating and drinking less, exercising more, and not driving each other mad, as well as not smoking. The Marmot report linked in the header was pretty sound in its proposals.

There always needs to be a universal service covering emergencies and critical care. These are the parts of healthcare that need central planning. None of us is immune to a sudden major trauma, and it is at those times that the NHS is at its best. A lot of other healthcare is more amenable to fragmentation to generate competition and innovation.

Personally, I hear good things about the Dutch system, but as well as being a nation of thin cyclists they do have the highest social care spend in the EU, I think.

This is interesting. It's been suggested in the past that the problem we are having now is that the generation reaching their 80s are the healthiest group there has been and probably likely to be. You're points about the Dutch keeping fit and spending a lot on social care are probably connected.

JosiasJessop

Richard_Tyndall said:

JosiasJessop said:

RoyalBlue said:

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

Costs on such projects are so out of control that no-one knows how much it would cost.

If you still want to go ahead on that basis, fair enough. But be aware that others will want their pet projects that you disagree with to go ahead as well on a similar basis.

And yet you are in favour of the biggest of these projects (HS2) which has already shown its costs are out of control.

I am in favour of HS2 (as it currently stands), and am unsure why you think its cost are 'out of control', especially in comparison to the existing network enhancement projects I mentioned.

However, it is a very different style of project. Enhancements that do not much touch existing infrastructure are relatively easier to budget: witness HS1 or Crossrail, which kept pretty much to time and cost budget compared to WCML upgrade or GW electrification.

In fact, the problematic parts of Crossrail are turning out to be the places it integrates with Network Rail, hence why Ealing, West Acton and Southall (and others) will be opening late.

I've also said repeatedly in the past that the thing that is most likely to kill HS2 will be Euston, which is a black hole (pun intended).

Scott_P

https://twitter.com/SimonJonesNews/status/1013445145772077056

TheScreamingEagles

Scott_P said:

https://twitter.com/SimonJonesNews/status/1013445145772077056

Scotland's Andy Murray chickens out, take that Knighthood back.

Foxy

tlg86 said:

Foxy said:

AlastairMeeks said:

More needs to be spent. More needs to be expected of individuals. Less should be provided in some areas. None of this will be popular.

The way to square the circle is for us to lead healthier lives, via the usual suspects of eating and drinking less, exercising more, and not driving each other mad, as well as not smoking. The Marmot report linked in the header was pretty sound in its proposals.

There always needs to be a universal service covering emergencies and critical care. These are the parts of healthcare that need central planning. None of us is immune to a sudden major trauma, and it is at those times that the NHS is at its best. A lot of other healthcare is more amenable to fragmentation to generate competition and innovation.

Personally, I hear good things about the Dutch system, but as well as being a nation of thin cyclists they do have the highest social care spend in the EU, I think.

This is interesting. It's been suggested in the past that the problem we are having now is that the generation reaching their 80s are the healthiest group there has been and probably likely to be. You're points about the Dutch keeping fit and spending a lot on social care are probably connected.

Current Eighty year olds had (TB, smog and German bombs excepted!) a healthy child hood with food rather spartan and rationed, and plenty of exercise outdoors. This set them up with good habits for life apart from smoking. I think it quite possible that they will outlive subsequent generations.

TheScreamingEagles

JosiasJessop said:

Richard_Tyndall said:

JosiasJessop said:

RoyalBlue said:

rottenborough said:

Wow! The Tories really do want to lose the next election don't they?

https://twitter.com/Andrew_Adonis/status/1013407073726533632

This is an insane decision. We can find £20bn for the NHS, but not some hundreds of millions to improve a rail link between two major cities?

Pathetic.

Costs on such projects are so out of control that no-one knows how much it would cost.

If you still want to go ahead on that basis, fair enough. But be aware that others will want their pet projects that you disagree with to go ahead as well on a similar basis.

And yet you are in favour of the biggest of these projects (HS2) which has already shown its costs are out of control.

I am in favour of HS2 (as it currently stands), and am unsure why you think its cost are 'out of control', especially in comparison to the existing network enhancement projects I mentioned.

Cost of HS2 rail link jumps by £8bn

The cost of building the HS2 high-speed rail line between London and north has shot up by more than a fifth to almost £43bn.

https://www.ft.com/content/4acc946c-de84-11e2-b990-00144feab7de


The first major construction contracts for Britain’s new high-speed rail line are set to be awarded on Monday, as a new study estimated that each mile of the initial section will cost over £400m, almost twice the official figure.

https://www.ft.com/content/653c8dd2-6a37-11e7-bfeb-33fe0c5b7eaa


Initial costs for High Speed 2 (HS2) main civil works are coming in around £1bn over budget, New Civil Engineer can reveal.

https://www.newcivilengineer.com/latest/exclusive-hs2-civil-works-1bn-above-target-cost/10031999.article

Would you like me to post more links showing HS2's costs are out of control?

Morris_Dancer

F1: post-race ramble of a very eventful grand prix, and a lot of churn in the standings too:
http://enormo-haddock.blogspot.com/2018/07/austria-post-race-analysis-2018.html

JosiasJessop

TheScreamingEagles said:

JosiasJessop said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Oh, stop your whining.

If you hadn't noticed, the main reason for the timetable failure on Northern Rail at the end of May was Network Rail's inability to deliver similar upgrades. So the 'desolate north' has been getting a heck of a lot of upgrades: perhaps not as much as you want, or even deserve, but they are happening.

As a good Conservative, I'd have thought you were not keen on writing blank cheques for upgrades - as we have seen happen on the GWML electrification, and we saw on the WCML upgrade a decade ago.

To give you an idea of the scale of the problem, the GWML program was costed at about £1.3 billion. A few months ago its costs were £3.2 billion. The WCML upgrade program was about a tenfold increase in costs, and was reduced in scope and delivered very late.

I'd prefer a reduced electrification scheme over a number of years, but such upgrades also rely on new stock, and the new stock is needed much sooner.

So, what would your upgrade program be?

Nonsense

https://twitter.com/jenwilliamsmen/status/1012603163747192832?s=21

These enhancement projects are not delivered immediately, and there is much disruption whilst they are ongoing.

Also, there were significant disruptions with the stock changes / cascades: AIUI trains that were due to be coming from Scotland not coming due to Hitachi not being able to design windscreens, and the HST remodelling for Scotrail.

There is a major issue here: the failure of Hitachi and others to deliver the new trains and upgraded trains, along with Network Rail's failure to provide enhancements, means that several TOCs don't have the trains they need.

TheScreamingEagles

JosiasJessop said:

TheScreamingEagles said:

JosiasJessop said:

TheScreamingEagles said:

Spend billions on HS2 is fine but a spend a few million on the desolate North is a no no.

Oh, stop your whining.

If you hadn't noticed, the main reason for the timetable failure on Northern Rail at the end of May was Network Rail's inability to deliver similar upgrades. So the 'desolate north' has been getting a heck of a lot of upgrades: perhaps not as much as you want, or even deserve, but they are happening.

As a good Conservative, I'd have thought you were not keen on writing blank cheques for upgrades - as we have seen happen on the GWML electrification, and we saw on the WCML upgrade a decade ago.

To give you an idea of the scale of the problem, the GWML program was costed at about £1.3 billion. A few months ago its costs were £3.2 billion. The WCML upgrade program was about a tenfold increase in costs, and was reduced in scope and delivered very late.

I'd prefer a reduced electrification scheme over a number of years, but such upgrades also rely on new stock, and the new stock is needed much sooner.

So, what would your upgrade program be?

Nonsense

https://twitter.com/jenwilliamsmen/status/1012603163747192832?s=21

These enhancement projects are not delivered immediately, and there is much disruption whilst they are ongoing.

Also, there were significant disruptions with the stock changes / cascades: AIUI trains that were due to be coming from Scotland not coming due to Hitachi not being able to design windscreens, and the HST remodelling for Scotrail.

There is a major issue here: the failure of Hitachi and others to deliver the new trains and upgraded trains, along with Network Rail's failure to provide enhancements, means that several TOCs don't have the trains they need.

The problems long predate the stock changes and upgrades.

Pagan

Foxy said:

AlastairMeeks said:

More needs to be spent. More needs to be expected of individuals. Less should be provided in some areas. None of this will be popular.

The way to square the circle is for us to lead healthier lives, via the usual suspects of eating and drinking less, exercising more, and not driving each other mad, as well as not smoking. The Marmot report linked in the header was pretty sound in its proposals.

There always needs to be a universal service covering emergencies and critical care. These are the parts of healthcare that need central planning. None of us is immune to a sudden major trauma, and it is at those times that the NHS is at its best. A lot of other healthcare is more amenable to fragmentation to generate competition and innovation.

Personally, I hear good things about the Dutch system, but as well as being a nation of thin cyclists they do have the highest social care spend in the EU, I think.

You seem to neglect that studies in both the us and netherlands is that lifetime healthcare costs for those that live healthily exceed those that smoke , drink or are obese. That is even before you factor in the tax take reduction from lower sin taxes and higher payouts on pensions

FrancisUrquhart

Was that farage in the crowd at the Spain vs Russia footy?

TheScreamingEagles

FrancisUrquhart said:

Was that farage in the crowd at the Spain vs Russia footy?

No, Dmitry Medvedev.

FrancisUrquhart

TheScreamingEagles said:

FrancisUrquhart said:

Was that farage in the crowd at the Spain vs Russia footy?

No, Dmitry Medvedev.

I did wonder. Came back from getting a cold one from the fridge and they quickly flicked to the posh seats and thought that can’t be nige surely.

Sandpit

Morris_Dancer said:

Mr. Sandpit, ha, yeah, it makes a nice change. Glad I hedged the Bottas bet. At that stage he seemed nailed on for a 1-2. But I remain slightly haunted by complacently failing to hedge my Con majority bet at the last election...

Don’t go there, the last election was my first try at spread betting and I lost a pile on it. I also had a grand on the Tory majority at 1/4 a couple of days out.