18 3 mins 10 yrs

This article caught my eye. As readers will know, I have been regularly castigated in the media (BBC in particular) for daring to suggest that the NHS is far from perfect and needs major reform if it is to deliver. If you mention filthy hospital wards, uncaring nurses, bloated bureaucracy, vast waste, gross incompetency..you are damned. The NHS is beyond criticism and this absurdity characterises debate in the UK. And yet…

“No system of universal healthcare is perfect. All have their pros and cons. But by common agreement, the best and most effective tend to be those that combine public provision with some form of co-payment or compulsory health insurance. Many of the best healthcare systems also allow for extensive private sector involvement.

Yet in the UK, anything that could be construed as partial “privatisation” remains strictly off limits. Similarly, any discussion of co-payment that goes beyond simple prescription charges, dental care and so on, is taboo. Debate about the future of the NHS remains largely frozen in a miasma of post-war nostalgia. On healthcare reform, as on much else, Britain is firmly stuck in the past.

Even Sweden, spiritual home of the high-tax, social market economy, enthusiastically embraces both co-payment and private sector participation. You won’t pay less than 15 euros to see a doctor in Sweden”

And then this;

“It is often said that providing for the old and sick is the mark of a civilised society, and so it is. But if maintaining spending on healthcare and pensioners is at the expense of investment in future competitiveness – infrastructure, training and education – then it condemns the country to long-term decline.

The idea of co-payment is thought perfectly acceptable for education – higher tuition fees are just that. But when it comes to healthcare, it’s not to be discussed. The policy choices seem ever more dictated by the demographics of an ageing society. Britain prefers to spend wastefully on its past than invest in its future.

Upholding the “free at the point of use” principle for healthcare will eventually bankrupt the country if nothing is done…”

The fact is that the NHS does need major surgery but no one will countenance this. Our craven political class, bowing to media approval, keep backing off. And yet there is one certainty and it is this; the NHS is guaranteed to fail in the long term unless there is change.

 

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18 thoughts on “DON’T MESS WITH THE NHS?

  1. The NHS is far far from perfect but it is typical of the right to seek to inject the private sector into the equation of anything they percieve to be amiss. The reality of privatisation in the railway system should serve as a cautionary tale. Anyone remember Potters Bar? Through ticketing? The NHS needs to divest itself of its labyryntian beauracracy and that came about due to marketisation and all that crap. The seeds of the bloated nature of the NHS were sown when in the forties the doctors blocked its birth and had to be bought off. Theyt have milked it ever since. If you to look at a comparable system look at france. Brilliant health care, doctors paid half of what the NHS gives them. QED

  2. sgb,

    I agree with your sentence re the doctors inducement to approving their participation in the formation of the NHS. However, I would remind you that it was Aneurin Bevan, a real ‘lefty’ if ever there was one, who offered the bribe in the first instance. Surely offering a bribe is as corrpt as accepting one, and so very typical of the left, it being a lot easier ‘buy off’ opposition than to negotiate.

    That you see the injection of a degree of any ‘alternative, or supplemental private sector’ competition to the market as being a bad thing is quite amusing, especially as it is a universally known fact that where government, any government, has a monopoly in any enterprise, the product or output of that enterprise will be substantially more expensive than any sourced from a multi-supplier environment.

    The problem with any monopoly, whether private or governmental, is the lack of competition in pricing, quality and innovation.

    Competition is good, but requires good management. Monopoly is bad, but suits the political set of mind, which prefers control by diktat rather than any entrpreneurial or intellectual skill. Innovation is essential for sustainable viability.

    All in all, other than a fantasy philosophy, the government has no qualification whatsoever, to run any such enterprise as the NHS…

  3. Competition OK I get that when selling CD players or fridges, but health care? Let me ask you this. When you or your family need surgery do you want the cheapest quote, so your GP can make more money?? I don’t want an nhs driven by profit. That the NHS needs change I will admit, but a market based solution isn’t what I want. I don’t accept that competition neccesarily provides Innovation which you say essential for sustainable viability, in the same way that I don’t believe that a Stalinist monopoly is the best way either.

  4. Believe me, you may see a difference between selling CD players or fridges and the provision of a health servce, but the practicalities are exactly the same for both. Both require infrastructure and personnel, which have to be bought and paid for, that such expense is properly managed is a requirement of any enterprise, even when paid by taxes.

    The problem with a government monopoly is that expense requires very little justification, – who is there to argue with when when money is virtually on tap, it is so much easier to rhetorically, ‘just write a cheque’. Who needs all that hassle of providing a justification for any expense.

    Unfortunately all monopolies have a strong ‘Stalinist’ element, whether private or governmental, – the ‘do as I say’ syndrome is very strong when there is no competition, even in the old days of paternalisticly owned private enterprise, there was strong streak of dictatorship, which is why so many of those entities are no longer around today, and if they are, it is in name only.

  5. There is a perception that to obtain money from the provision of health care is wrong but for 1.3 million employees of the NHS this is the way that they earn a living. Alongside this false perception is the perception that Private Health Care is inferior to that provided by the NHS. This is also false as Private Medicine is probably built on the agreed principles of best practice in order to attract patients. Another false perception is that the Government is more capable of running the NHS than Health Care Professionals and that the bigger the hospital, the better it is. Absolute nonesense. It appears that our Health Care System is founded on false perception after false perception and fed bureaucratic nonesense.

    In fact I would argue that the provision of health care is so complex (and getting more complex) that the Government should stay well clear and leave that particular aspect to those who know better. In my opinion the Governments real function is to find the cash. Clinical standards should be upheld by Professional Bodies and Hospitals should be Independant Establishments which serve their communities.

  6. sgb –

    Competition OK I get that when selling CD players or fridges, but health care?

    Yes!

    Why is it that CD players and fridges and shoes and cars and bread and bricks and flowers and books and everything you can see in your home improves over time, becomes more abundant and generally becomes cheaper in real terms yet health care is somehow immune from the same processes?

    In all cases we’re talking about optimum allocations of scarce resources. In this sense there is not the slightest difference between CD players and health care.

    You want the best possible health care, improving health care, the widest available health care, cheaper health care? Great, so get the government out of it and leave the market to work its magic.

  7. Can’t happen, won’t happen, doesn’t happen in any country in the world including the most capitalist for reasons previously stated a hundred times here.

    It’s not that kind of issue.

  8. The market also leaves millions of americans without any health care at all. I don’t want the market deciding my health care particularly as i have a long term pre-existing health condition. Toxic for any market based health care provider. The private sector are not interested in preventative care, best outcomes for patients they only care about the bottom line. I repeat that the NHS needs to change but whole scale privatisation is not acceptable to the public because the private sector in this country does not have the trust. They will cherry pick and line their pockets, and the rest of us can go to hell

  9. With proper regulation, the private market works great.

    My private insurer / employer has always provided preventive care, etc – it’s the right thing to do and it ultimately reduces the amounts that they pay out in medical bills.

    But yes, without regulation, you can never solve the costs / preexisting condition problem. Which is why all countries in the real world regulate this area.

  10. sgb –

    What market leaves millions of Americans without health care? Health care in the US is wholly controlled by the government. There’s no market.

  11. “whole scale privatisation is not acceptable to the public because the private sector in this country does not have the trust.”

    I don’t think that even Cameron was suggesting wholesale privatisation. There doesn’t need to be anything of the kind, – as long as there is some alternative to the ‘take it or leave it’ attitude of the NHS.

    Regarding the trust factor, I don’t believe the government sector has the public’s confidence either! Your last sentence hints that perhaps you have some preconceived generalised conclusions of the private sector, and in particular of its involvement in the health industry. Doesn’t reaching such a conclusion indicate that you have stopped thinking about this problem, and now have a closed mind on what is a rapidly changing subject?

  12. By your standards, there’s no market anywhere – you seek something utopian that doesn’t exist.

    Yet, many here do enjoy good health care, and most in the developed world enjoy good health care as well.

  13. Posssibly I have a closed mind on this issue because I think the Tories have a doctrinaire attitude to dealing with this problem. I have a little knee jerk response when it comes this issue and I admit this may colour my judgement. But I do not the government want to start a process that cannot be reversed and will end in the usual suspects raking in the cash whilst people like me are forgotten and unhelped. I have already lost loads of money since the Tories took power. I do not want to lose my access to healthcare down the line either.

  14. In addition any private health company will two potentially conflicting priorities. To provide the best possible care, and provide a profit. my contention is that at some point they will/must conflict.

  15. sgb,

    I’m sure you have no worries re losing your healthcare ‘down the line’, – granted you may not be to get your boobs fixed quite so easily as at present, but I am sure that there will always be some organisation to deliver your ‘meal-on-wheels’.

    Just how have you lost ‘loads of money’ within the last twelve months? You wouldn’t be exagerrating now – would you?

  16. sgb,

    Surely any organisation, public or private has the obligation to shareholders or taxpayers to provide the best service and value for money possible. It is the NHS who seems to think this doesn’t apply to them!

  17. Loads of money is a relative concept I know but I have lost at least 10% on child tax credit and other I have lost other money too.

    Not great in the scheme of thing but I live on very little so even a small loss has massive implications for me.

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