Politics, politics, politics

[Gutter Boy]

Perhaps we should try paying a similar amount and see if we could afford similar ...crazy idea.

I don't disagree. But to do so health needs to be localised/broken into much smaller units and funded much more by corporations. The 1940s one-size fits all/lowest common denominator/mass bureaucracy/all general taxation model doesn't work

 

[nayimfromthehalfwayline]

Yeah, IIRC America spends more per capita on healthcare than any other country, yet their system fails tens of millions of their own citizens (the insurance companies like it though).

For all the talk of inefficiency, the NHS provides excellent healthcare coverage for the population as a whole at a relatively low cost (when you look at the per capita spend compared to other developed nations). Even with these inefficiencies in place, if the spending was brought into line with other OECD nations, the service would improve and the pressures on it would ease.

I dont understand the logic of "Its not working great, it could work a lot better, but lets just stuff (waste) loads of money in because other countries spend more".

I think the NHS is amazing, and does an incredible job while being virtually hamstrung by - well all the cliches of the public sector.

I still think it should be run better, offer more value for every pound put in - because thats what it SHOULD be doing.

Chances are, that being the case, we could offer better healthcare than anywhere in the world, and for less cost. Really, that is entirely possible and should be the aim.

 

[the dza]

I dont understand the logic of "Its not working great, it could work a lot better, but lets just stuff (waste) loads of money in because other countries spend more".

I think the NHS is amazing, and does an incredible job while being virtually hamstrung by - well all the cliches of the public sector.

I still think it should be run better, offer more value for every pound put in - because thats what it SHOULD be doing.

Chances are, that being the case, we could offer better healthcare than anywhere in the world, and for less cost. Really, that is entirely possible and should be the aim.

It's not being as badly run as you think imo, otherwise how could they provide such good healthcare coverage at a low level of spending (relative to other developed nations)? So I don't agree with the argument of "it's not working great and putting more money in is just a waste." IMO, it's working pretty well and funding it to a more reasonable level (which is why I compare it to other nations) will make it work better. I think it's a strawman to suggest that any increase in spending is simply a waste of money, I just don't agree with that argument at all.

Why continue to starve it of the funds it needs to keep going? If the service slides backwards due to inadequate funding, then people die when they don't need to. There can be improvements along with money invested, it can be both. People can walk and chew gum at the same time.

 

[nayimfromthehalfwayline]

See if you know anyone that works there, speak to them, it will become very evident very fast.

It is doing a great job despite itself, it could be doing a much greater job without a single extra pound, if it was run efficiently and not so shockingly wasteful of funds.

Im not against a "both" approach, providing the institution is properly and thoroughly reworked and run in a more competitive fashion, simply pouring money in now doesnt actually fix anything - it just patches it up. Until a little way down the line when even more money is required to keep the show on the road.

 

[the dza]

Im not against a "both" approach, providing the institution is properly and thoroughly reworked and run in a more competitive fashion

What does this entail exactly?

 

[nayimfromthehalfwayline]

Thats beyond me, to be quite honest.

As Im aware, there is far too much management, not enough front line. Trusts trying to rip each other off. Money spent on systems that are never properly implemented. Just general wastage, that really isnt acceptable.

How to fix that, IMO, is to streamline the management as much as possible to put more people and use on the front lines.

I always liked the idea of looking to the military. They seem to run much more efficiently, yet manage sites across the country (world), know logistics, gets as much on the front line as possible with a command chain that makes and effects decisions quickly.

Whoever knows how all that works - get them on it.

 

[the dza]

Thats beyond me, to be quite honest.

As Im aware, there is far too much management, not enough front line. Trusts trying to rip each other off. Money spent on systems that are never properly implemented. Just general wastage, that really isnt acceptable.

How to fix that, IMO, is to streamline the management as much as possible to put more people and use on the front lines.

I always liked the idea of looking to the military. They seem to run much more efficiently, yet manage sites across the country (world), know logistics, gets as much on the front line as possible with a command chain that makes and effects decisions quickly.

Whoever knows how all that works - get them on it.

I think the NHS is more efficient than the military, personally. Almost every major spending project undertaken by the armed forces is delivered over budget and late. What do you mean by "run in a more competitive fashion"? Who is competing with who?

 

[nayimfromthehalfwayline]

I think the NHS is more efficient than the military, personally. Almost every major spending project undertaken by the armed forces is delivered over budget and late. What do you mean by "run in a more competitive fashion"? Who is competing with who?

I just think the military structure, efficient command/decision making, management of disparate resources and general ability to get the money to the front lines is exactly the sort of thing the NHS needs.

More competitive? Not competing with anyone per se - but being run more as if private enterprise. Were the NHS not public sector they wouldnt waste money so freely, they would drive expenses down, spend more wisely etc. Thats all I mean.

Fact is, they are bloated and wasteful, with no real desire to change that. To be run more competitively would be to challenge that ethos.

And no, Im not talking about running as a private company so be profitable/feed boardroom fat cats/rip off staff etc. Just be more demanding of what they get for their £.

 

[ShipOfTheseus]

In terms of the ratio of managers to front line, and the matching of provision to demand, primary & secondary education is probably the most efficient public service. But that's because it delivers a highly standardised and predictable product. The MoD is generally believed to be a basket case as far as back office goes.

 

[nayimfromthehalfwayline]

As I said, I dont claim to know the ins and outs - just the general point.

The Army has bases everywhere, manages its people and resources effectively - thats one of the primary issues with the NHS IMO.

 

[ShipOfTheseus]

The army's job is to train, to give the impression of being prepared for eventualities and occasionally - very occasionally - to do stuff. If doctors spent most of their time practising on corpses and being deployed randomly from hospital to hospital to get more practising in, and only once in a blue moon had to see actual patients (usually because they were super-skilled and deployed, deniably, in nurse outfits, to foreign hospitals), then the NHS would look pretty competent from the outside.

 

[nayimfromthehalfwayline]

If thats what you take from my point then Ive nothing else to add, its wasted.

 

[ShipOfTheseus]

I get the point that military structures are good in a crisis. Same goes for policing. I think the same may be true for A&E, though, which is where the similarity applies.

 

[nayimfromthehalfwayline]

Not at all. Its nothing to do with crisis.

Its everything to do with having a lean management chain, that actually make decisions, so that most resource can be pushed to the front line. And so that that front line can be run effectively.

Its about the logistics of managing across large geographical areas, and having the management in place to run effectively.

And the supply chains etc to service these various functions/bases/places.


From what Ive heard from people in the NHS there are far too many managers, none of which actually make decisions. And, in order to facilitate the manager-go-round, its the people in the various teams at the bottom of the chain that get sacrificed. Thats backwards, to say the least. Teams constantly losing good people, but managers never being removed. Just shuffled around periodically to mask their incompetence.

How much saving could be had if we stripped out half the managers? The ones that remain actually manage, and the cost saved going back into more nurses and administrative staff etc? A decent structure facilitates that. People actually run things, make decisions, and have the staff required to meet the need.

 

[Parklaner81]

For all the talk of inefficiency, the NHS provides excellent healthcare coverage for the population as a whole at a relatively low cost (when you look at the per capita spend compared to other developed nations). Even with these inefficiencies in place, if the spending was brought into line with other OECD nations, the service would improve and the pressures on it would ease.

Did you mean into line with higher-spending OECD nations?

I ask because I'm sure I saw some data that put us pretty much plum in the middle of this group (OECD nations), measured by spending per capita.

 

[Gilzeantoscore]

Gutter Boy falls for the classic Tory tactic of running a government department into the ground, pointing out that it is no longer fit for purpose and therefore needs to be sold off/ broken up. Lenin described people like him as "useful idiots." He runs the Tory line on just about everything.

 

[scaramanga]

Gutter Boy falls for the classic Tory tactic of running a government department into the ground, pointing out that it is no longer fit for purpose and therefore needs to be sold off/ broken up. Lenin described people like him as "useful idiots." He runs the Tory line on just about everything.

Why would Lenin describe someone who damages his cause as useful and why would he describe someone supporting a method that proved his ideologies to be destined for failure an idiot?

Sounds like a bit of a fudgewit to me.

"Useful idiot" appears to be a term that you throw about the place when you want somebody to be mildly insulted without any real understanding of the meaning or context in which it was used. Neither, it appears, do you have any wish to analyse and/or assess the relevance to the discussion at hand. It makes you sound like one of those not very bright people who quote Confucius in an attempt to sound intelligent.

 

[Gutter Boy]

Gutter Boy falls for the classic Tory tactic of running a government department into the ground, pointing out that it is no longer fit for purpose and therefore needs to be sold off/ broken up. Lenin described people like him as "useful idiots." He runs the Tory line on just about everything.

Not sold off - localised/decentralised. Nothing with more than 150 staff can operate efficiently. The army was being talked about earlier - that's exactly what they do - break them up into small functional units of that sort of size

I'd still have them state funded (though through social insurance), just highly devolved in their operation. Smaller, independent, local hospitals.

It's the attempt at authoritarian control through the state's bureaucratic machinery that kills it

 

[the dza]

Did you mean into line with higher-spending OECD nations?

I ask because I'm sure I saw some data that put us pretty much plum in the middle of this group (OECD nations), measured by spending per capita.

Yeah, sorry -- more specifically nations such as France and Germany (population/economy size similar to our own) or those countries that are often held up for there superior healthcare outcomes, such as Sweden.

This is quite a good article I think: https://www.kingsfund.org.uk/publications/spending-and-availability-health-care-resources

 

[SpurMeUp]

In terms of the ratio of managers to front line, and the matching of provision to demand, primary & secondary education is probably the most efficient public service. But that's because it delivers a highly standardised and predictable product. The MoD is generally believed to be a basket case as far as back office goes.

...and therein lies the limits of our current education system. The moment you allow people to personalise learning, their learning improve. One size fits a few people only. We have the technology now to tailor all learning and do it efficiently. But I think it will take a few decades before people shake education up - from a victorian system that hasn't really been updated.