And the countries with the best survival rates in Europe are Sweden and Finland, both countries that follow a Beveridge model of healthcare. Same principle as the NHS, albeit organised differently. A big difference, of course, is their funding of healthcare. Relatively speaking, they spend more than we do.
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Politics, politics, politics
- Thread starter markysimmo
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And the countries with the best survival rates in Europe are Sweden and Finland, both countries that follow a Beveridge model of healthcare. Same principle as the NHS, albeit organised differently. A big difference, of course, is their funding of healthcare. Relatively speaking, they spend more than we do.
Gutter Boy
Tim Sherwood
I think they can get to that level. Germany, Scandinavia, Canada manage it.
Compulsory annual health checks to massively slash the need for acute services, ditch EU procurement and competition rules (also ending PPPs), drug treatment reduction targets, and social insurance funding (to shift the burden from general taxation to corporations) would all help move it out of the 1950s. These are the sort of structural changes needed.
Things like the management layers are consequences of the perverse incentives, rather than a design flaw in themselves.
Grays_1890
Chris Jones
Teresa May really does not give a brick about the people of the UK.
The whole talk from her on the NHS is that the issues were planned? Like having a brick NHS was all part of some grand scheme is a joke. The NHS is in a huge crisis and no doubt, its one thing it being in trouble its another to insult people by saying its not.
The whole talk from her on the NHS is that the issues were planned? Like having a brick NHS was all part of some grand scheme is a joke. The NHS is in a huge crisis and no doubt, its one thing it being in trouble its another to insult people by saying its not.
Gutter Boy
Tim Sherwood
Fair. But we can't operate it here because Reaganomics are so ingrained. We just end up with the worst of both works - fairly expensive crap (either expensive good or cheap crap would be preferable).
That why I think social insurance funding (like Germany) would be a better solution here - people won't pay more general taxation, because they know the rich and corporations avoid it, so get the corporations to pay for it directly.
nayimfromthehalfwayline
Andy Thompson
I think they are what happens in civil service, its cliche but often true. There has been no incentive to streamline things, its easy to just add a manager for everything - its what happens.
And while its not the only flaw, by far, it is illustrative of the sort of thing that is fundamentally wrong with how the NHS operates.
Strip out half the managers and you can probably double the nurses. Net spend of 0 and a significant improvement already.
If I put my tinfoil hat on, I would say that maybe the Tories prefer to inadequately fund nationalised organisations (such as the NHS), see them struggle and then present the solution as privatisation. It's been done before (Rail for example) so why not this too? It's their ideology.
nayimfromthehalfwayline
Andy Thompson
It does fit. And it conveniently moves the problems away from them as well. Though, of course, it would produce a different set of problems down the line.
The issue with that is Labour. They have run a very popular campaign on re-nationalising services and investing in them, as well as existing ones. People like that - and the Tories will not want to go the opposite way simply for popularity reasons...
Grays_1890
Chris Jones
Yeh I get that but they are playing down the crisis, the interview yesterday with Marr was dreadful. People who are in queues, laying in ambulances in a car park or waiting two weeks for an appointment know there is a crisis. you can't insult them by saying there isnt.
Gutter Boy
Tim Sherwood
I mean perverse incentives like tendering.
Hospitals can't just buy things - drugs, artificial limbs, IT systems, beds, cleaning products, whatever. They all have to go out to tender. Here a cartel of private companies all double or triple their prices (bidding for the public sector is the procurement equivalent of selling/renting something for a wedding). And the hospital have to use one these cartel frameworks, they can't just pop down to Wilkinsons to get their anti-bac at a fraction of the price.
But they are also time bound. So every 4 years say, you have to tender for a new IT system, even though they've spent 3.5 years setting up and getting people to use to the current one. A different company wins because they only upped their price by 30%, when all the others went 40%, and there's years of chaos again as everything gets thrown out the window.
Running all that kind of thing is what creates and sustains the management layers. It's not things you want clinicians doing instead (which can happen as a misguided reform). It's not things that should be happening at all; but does because of neo-liberal interests. The worst of both worlds
That's a reasonable argument. However, I think Reaganomics/Thatcherism is losing steam here and a mixed economy will come back, so it's not impossible for us to be a bit more Scandinavian in our approach to public services.
Where I disagree with most in this thread is that I don't think the NHS is just a terrible organisation or a terrible provider of healthcare. I think it does have problems and it can improve how it's organised for sure. But I do believe funding to be the main issue, which is compounded by government cuts to social care and other social programs.
From wikipedia: https://en.wikipedia.org/wiki/Healthcare_in_Sweden#Financing
By 2015 the cost had risen to 11.9% of GDP -the highest in Europe.
If we treated the NHS with the same mentality as the Swedish state, things like cancer survival rate would vastly improve and I'm sure we could avert a crisis each Winter. That, for me, is the crux of it. I still appreciate the problems not related to funding, but funding, imo, is the major issue.
Grays_1890
Chris Jones
Ultimately the government as part of their election manifesto argued that they could run a good NHS, they are failing that promise. Its not for me or you or anyone on here to reinvent the NHS its down to those that were voted in to deliver an NHS that works for the public. There is no hiding from the fact that the NHS is in a bad bad way.
I don't feel bad doe demanding improvements from the government
I don't feel bad doe demanding improvements from the government
I'm very biased against this Tory government (I know, I hide it so well!) but I also thought that interview was particularly poor. It was as if she said "listen, nevermind about the NHS, we're not gonna have a vote on fox-hunting. So that's something, right?!"
Isn't most of the healthcare funding in Sweden at a local level? I'm sure I remember reading that.
I believe that their national taxation is fairly low, with some large local add on taxes. The local principle is one that I've spoken about in the past - most people would pay anything to look after their family, give their fortune to look after their friends, give heavily to look after their neighbour, all the way down to the point where thousands of kids die daily in Africa and even conscientious people do little about it.
It's far easier to get people to contribute heavily to something they can see working with their own eyes. It's also easier to get people to pay more if they know they can move the other side of a border and pay less/receive less. I'd be very happy with an NHS system that funded heavily with a scaled contribution - I only rely on the NHS for emergency services so I'll just pay for the emergency part of the care. My payments for private health care for my family and me are savings to the NHS which could be passed on to my disgusting tax bill.
Gutter Boy
Tim Sherwood
But no one can solve it anyway because too many of the populous are emotionally wedding the idea of a Heron Food Health Service.
Grays_1890
Chris Jones
yeh it was terrible. I mean I could not believe what I was hearing to be honest.
nayimfromthehalfwayline
Andy Thompson
It really is a terribly organised organisation. And, IMO, that is the real root of most of its problems.
Anyone Ive ever spoken to within it points to the same issues every single time.
Of course, thats not the ONLY issue - but it is a major one. And, to my mind, until that is "fixed" any other actions like pouring more money into it are just wasteful.
As I said, streamline the management structure and you can significantly increase frontline staff without an extra penny spent - and how significant an improvement would that one action be?
Anyone Ive ever spoken to within it points to the same issues every single time.
Of course, thats not the ONLY issue - but it is a major one. And, to my mind, until that is "fixed" any other actions like pouring more money into it are just wasteful.
As I said, streamline the management structure and you can significantly increase frontline staff without an extra penny spent - and how significant an improvement would that one action be?
That's truer than most people realise.
A friend who used to work for me is a good (not great) salesman. He now sells into the NHS - selling products they already buy. The money for that company is so good he's had £Ks of bonuses in his first couple of years - drives an E Class with a full spec (drives is the wrong term, the car drives itself), has been given at least one reasonably high end watch, etc. He tells me it's like printing money - his company makes so much it almost doesn't know what to do with it. The wife of someone I work with does a similar thing, selling consumables to hospitals. Again, she describes it as ridiculous the amount that is paid for what they provide.
My company was looking to provide a part of the service that is involved in making a hospital bed. When we followed the supply chain, it turns out a completed bed passes through 4 different companies before the end re-seller sells to the NHS. This is after 6 different companies have all made small parts of that in the process. There's no vertical integration in the supply chain whatsoever - the reason being that there's so much money being made that nobody is interested in rocking the boat. There's enough profit for everyone and it's you and I that end up paying for it.
Without the pressure of compete or fail, bloating is the obvious result.
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Gutter Boy
Tim Sherwood
I think there's something in whole the British approach to health that won't allow that though, at least not at the moment. The whole prevention rather than cure thing has no place in the current system. More money with the current mindset would just buy bigger sticking plasters (or more managers funnelling it out through the tender windfall). It really needs a visionary to redesign (and rebrand) it. But right and left are so suspicious of each other on this topic that the very suggestion would spark a riot.
A lot of the organisation is culturally very rotten too. The Blood Service is the worst. It's probably got the worst culture of any organisation in the country, alongside Sports Direct and Ryan Air.
Gutter Boy
Tim Sherwood
I don't work for the public sector, but we do receive funding from it, so are bound by its tendering rules.
A little example that gets me every time is train tickets. I book a train ticket to London for me, it costs £12 from megatrain. I book the exact same ticket through our work's authorised (only permitted) seller and it costs £200. Every train journey I book, I tinkle £188 of taxpayer money into Richard Bransons and the travel agents' tax havens.
According to the link I posted earlier, their county councils have the right to collect income tax, so their local government tax and spending seems to operate the way ours does nationally. So they collect much more tax at a local level and spend it accordingly. They still operate to the Beveridge principle in that it's taxation and spending that provides healthcare to citizens.
https://en.wikipedia.org/wiki/Healthcare_in_Sweden#Financing
Costs for health and medical care amounted to approximately 9 percent of Sweden’s gross domestic product in 2005, a figure that remained fairly stable since the early 1980s. By 2015 the cost had risen to 11.9% of GDP -the highest in Europe.[4] Seventy-one percent of health care is funded through local taxation, and county councils have the right to collect income tax. The state finances the bulk of health care costs, with the patient paying a small nominal fee for examination. The state pays for approximately 97% of medical costs