Jeremy Hunt and the demonisation of the NHS

[buctootim]

Statistics are a notoriously tricky subject of course. However, if France does indeed boast a superior healthcare system compared to the UK, then that may well be because the French opt to spend rather more than we do in this area:

 

http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spending-compared

 

The French system is good, and they spend about 25% more than us. There are also a large number of charges which the patient has to pay, only some of which can be reclaimed.

 

As Jonnyboy said, most of the critics of the NHS literally have no ****ing clue what they are talking about -- including many of the ministers who have 'reformed' it. It, along with education is one of the most messed about with, overloaded by government imposed bureaucracy organisations going. Despite that it is incredibly efficient. It is better than most health services which spend the same as us and not too far off many which spend far more. It does that by cutting back on hotel services and customer focussed access times - highly desirable but non core spend - building maintenance, catering, laundry, cleaning and out of hours working.

 

Lets be clear about what efficiency means - it means delivering the maximum volume of healthcare to a good standard on a limited budget. In order to do that then managers deliberately over book clinics in order to save wasted slots because they know 20% of people wont bother to turn up or even cancel in advance. If you have to wait for an hour past your appointment, its not poor planning, its maximising effective use of resources. It also means minimising weekend or evening working, it means poor quality meals and relatively low standards of cleaning. Non of that is because the NHS is crap - its because its performing to the targets set for it on a budget 20-30% less than comparable nations.

 

The idea is that more private business involvement is going to lower costs and improve efficiency is risible, beyond a joke. Its been tried so many times and proved to be a failure that its amazing some still believe it. At core you are taking NHS staff on minimum wage who are mostly motivated by a sense of working for the public good - and replacing them with a contractor who needs to make a 10% profit from the bid and operate with higher overheads - two sets of contract managers the NHS never had before. The contractor still employs the same staff because of TUPE and they are still on the same minimum wage. Guess where the efficiencies come from to make the profit and extra overheads? Service quality, its the only variable.

 

It you want a health service like France, Germany and Switzerland the NHS can deliver it for you no problem, but you need to stump up 25% more funding. If you want to pay the same rates as Slovenia then be satisfied with healthcare only marginally better. It only seems to be in Britain that we are obsessed by the idea we can get something for nothing - that the reason for the shortfalls in the NHS is because everyone in it is **** and incompetent and the answer is to contract out to G4S and Sodexho. Utter utter bellends. If the Tories really ever got free reign to reform the NHS you'd end up the US business dominated model - as Wade Garrett said - a poor service at more than double what the NHS is costing now. That is what real business efficiency in healthcare looks like - phsyicians on $1m pa but neo-natal death rates and life expectancies poorer than Cuba or Costa Rica

Edited 14 February, 2016 by buctootim

[Hockey_saint]

The French system is good, and they spend about 25% more than us. There are also a large number of charges which the patient has to pay, only some of which can be reclaimed.

 

As Jonnyboy said, most of the critics of the NHS literally have no ****ing clue what they are talking about -- including many of the ministers who have 'reformed' it. It, along with education is one of the most messed about with, overloaded by government imposed bureaucracy organisations going. Despite that it is incredibly efficient. It is better than most health services which spend the same as us and not too far off many which spend far more. It does that by cutting back on hotel services and customer focussed access times - non core - highly desirable but non core spend - building maintenance, catering, laundry, cleaning and out of hours working.

 

Lets be clear about what efficiency means - it means delivering the maximum volume of healthcare to a good standard on a limited budget. In order to do that then managers deliberately over book clinics in order to save wasted slots because they know 20% of people wont bother to turn up or even cancel in advance. If you have to wait for an hour past your appointment, its not poor planning, its maximising effective use of resources. It also means minimising weekend or evening working, it means poor quality meals and relatively low standards of cleaning. Non of that is because the NHS is crap - its because its performing to the targets set for it on a budget 20-30% less than comparable nations.

 

The idea is that more private business involvement is going to lower costs and improve efficiency is risible, beyond a joke. Its been tried so many times and proved to be a failure that its amazing some still believe it. At core you are taking NHS staff on minimum wage who are mostly motivated by a sense of working for the public good - and replacing them with a contractor who needs to make a 10% profit from the bid and operate with higher overheads - two sets of contract managers the NHS never had before. The contractor still employs the same staff because of TUPE and they are still on the same minimum wage. Guess where the efficiencies come from to make the profit and extra overheads? Service quality, its the only variable.

 

It you want a health service like France, Germany and Switzerland the NHS can deliver it for you no problem, but you need to stump up 25% more funding. If you want to pay the same rates as Slovenia then be satisfied with healthcare only marginally better. It only seems to be in Britain that we are obsessed by the idea we can get something for nothing - that the reason for the shortfalls in the NHS is because everyone in it is **** and incompetent and the answer is to contract out to G4S and Sodexho. Utter utter bellends. If the Tories really ever got free reign to reform the NHS you'd end up the US business dominated model - as Wade Garrett said - a poor service at more than double what the NHS is costing now. That is what real business efficiency in healthcare looks like - phsyicians on $1m pa but neo-natal death rates and life expectancies poorer than Cuba or Costa Rica

 

Absolutely this.

 

Jeremy Hunt has argued that localisation of Healthcare is a much better idea. Well, this is all sounding far too familiar to the line taken when the Conservatives were opposing it's creation (they believed councils and charitable organisations were better placed to do the caring (the current incorporation of charities into previously state-run sectors ring any bells?)) There's little on the conservative alternative back then (although it would probably mostly be privately-funded.

 

I mention this article because it winds my junior doctor friends up as well as there is a Bevan quote they're not too fond of ...About stuffing their mouths with gold.

 

http://www.independent.co.uk/life-style/health-and-families/features/the-birth-of-the-nhs-856091.html

[stug76]

The French system is good, and they spend about 25% more than us. There are also a large number of charges which the patient has to pay, only some of which can be reclaimed.

 

As Jonnyboy said, most of the critics of the NHS literally have no ****ing clue what they are talking about -- including many of the ministers who have 'reformed' it. It, along with education is one of the most messed about with, overloaded by government imposed bureaucracy organisations going. Despite that it is incredibly efficient. It is better than most health services which spend the same as us and not too far off many which spend far more. It does that by cutting back on hotel services and customer focussed access times - non core - highly desirable but non core spend - building maintenance, catering, laundry, cleaning and out of hours working.

 

Lets be clear about what efficiency means - it means delivering the maximum volume of healthcare to a good standard on a limited budget. In order to do that then managers deliberately over book clinics in order to save wasted slots because they know 20% of people wont bother to turn up or even cancel in advance. If you have to wait for an hour past your appointment, its not poor planning, its maximising effective use of resources. It also means minimising weekend or evening working, it means poor quality meals and relatively low standards of cleaning. Non of that is because the NHS is crap - its because its performing to the targets set for it on a budget 20-30% less than comparable nations.

 

The idea is that more private business involvement is going to lower costs and improve efficiency is risible, beyond a joke. Its been tried so many times and proved to be a failure that its amazing some still believe it. At core you are taking NHS staff on minimum wage who are mostly motivated by a sense of working for the public good - and replacing them with a contractor who needs to make a 10% profit from the bid and operate with higher overheads - two sets of contract managers the NHS never had before. The contractor still employs the same staff because of TUPE and they are still on the same minimum wage. Guess where the efficiencies come from to make the profit and extra overheads? Service quality, its the only variable.

 

It you want a health service like France, Germany and Switzerland the NHS can deliver it for you no problem, but you need to stump up 25% more funding. If you want to pay the same rates as Slovenia then be satisfied with healthcare only marginally better. It only seems to be in Britain that we are obsessed by the idea we can get something for nothing - that the reason for the shortfalls in the NHS is because everyone in it is **** and incompetent and the answer is to contract out to G4S and Sodexho. Utter utter bellends. If the Tories really ever got free reign to reform the NHS you'd end up the US business dominated model - as Wade Garrett said - a poor service at more than double what the NHS is costing now. That is what real business efficiency in healthcare looks like - phsyicians on $1m pa but neo-natal death rates and life expectancies poorer than Cuba or Costa Rica

I'm intrigued by this dispute, largely because of the lack of information available, to someone on the outside, to make an informed opinion. I don't trust either party to be honest.

 

One point I would pick up on though, is that in my experience, the NHS is terribly inefficient. The flows of information is woeful, as an example, I took my son in to A and E and I would say apart from waiting, we spent most of our time filling out forms, with the same information on them. Everyone we spoke to would go through the same questions. It's this sort of bureaucracy, and presuambly this goes on at all levels, where the private sector is, or could be much better. To assume that sevice levels would be the only place where efficiency savings could be made is plainly wrong, almost scaremongering.

 

I guess that the NHS (3rd largest employer in the world?) is so large that its almost impossible to please everyone and changes will inevitably upset someone, and the inertia to change must be massive. Perhaps it does need to be broken up?

 

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[Gemmel]

(3rd largest employer in the world?)

 

Worlds largest employer

[buctootim]

Absolutely this.

 

Jeremy Hunt has argued that localisation of Healthcare is a much better idea. ]

 

Its just an endless merry-go-round. What the NHS really needs (and education) is to be left alone. I started work for the NHS at Brighton Health Authority in 1989 when it managed it own hospitals directly. By 1991 it had been merged into East Sussex HA still managing hospital but not GPs. By 1993 East Sussex and the other county Has were merged into South East England Commissioning Authority and the hospitals were now independently managed and there was a separate body for GPs. Soon it became clear some hospitals couldn't survive and they were merged into bigger NHs trusts and oh by the way regional commissioning is too remote so we need to do away with that and give more power to GPs and go local again. That took us up to about 1998 - five major reorganisations / changes under one single government in nine years. I left at that point but the reorganisations haven't stopped.

[buctootim]

I'm intrigued by this dispute, largely because of the lack of information available, to someone on the outside, to make an informed opinion. I don't trust either party to be honest.

 

One point I would pick up on though, is that in my experience, the NHS is terribly inefficient. The flows of information is woeful, as an example, I took my son in to A and E and I would say apart from waiting, we spent most of our time filling out forms, with the same information on them. Everyone we spoke to would go through the same questions. It's this sort of bureaucracy, and presuambly this goes on at all levels, where the private sector is, or could be much better. To assume that sevice levels would be the only place where efficiency savings could be made is plainly wrong, almost scaremongering.

 

I guess that the NHS (3rd largest employer in the world?) is so large that its almost impossible to please everyone and changes will inevitably upset someone, and the inertia to change must be massive. Perhaps it does need to be broken up?

 

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A couple of things. At lot of the form fillings is the direct result of government reforms which changed the way hospitals are funded from a block grant based on catchment population size and demographics to be being paid per procedure / activity. So now you have to capture every contact with a nurse, tablet given, referral to doctor if the hospital wants to get paid. The other part of the form filling is an audit trail for anti negligence purposes - its part of the same culture whereby your bank has to give you a long disclaimer speech every time you report a card stolen or take out insurance. Again your assumption that the hospital doesn't know this is bureaucracy and does it for fun is wrong - it is simply operating to the system imposed on it, as any successor for profit business would have to.

 

Is the NHS really one organisation? Sure the government want it to be accountable to a single CEO but in fact in England alone there are 209 clinical commissioning groups, 154 acute trusts, 56 mental health trusts, 37 community providers, 10 ambulance trusts and 7,900 GP practices - all with their own boards and CEOs. Is that a single organisation? Would it still be a single organisation if they were all for profit companies or registered charities? Does the NHS employ more staff than are employed by healthcare providers in comparable countries? (the answer is no by the way).

 

The UK had 2.8 physicians per 1,000 people in 2013, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, 3.3 in France, 2.8 in New Zealand and 2.6 in Canada.

The UK had 2.8 hospital beds per 1,000 people in 2013, compared to 8.3 in Germany, 6.3 in France, 3.1 in Denmark, 3.0 in Spain and 2.8 in New Zealand.

Edited 14 February, 2016 by buctootim

[stug76]

A couple of things. At lot of the form fillings is the direct result of government reforms which changed the way hospitals are funded from a block grant based on catchment population size and demographics to be being paid per procedure / activity. So now you have to capture every contact with a nurse, tablet given, referral to doctor if the hospital wants to get paid. The other part of the form filling is an audit trail for anti negligence purposes - its part of the same culture whereby your bank has to give you a long disclaimer speech every time you report a card stolen or take out insurance. Again your assumption that the hospital doesn't know this is bureaucracy and does it for fun is wrong - it is simply operating to the system imposed on it, as any successor for profit business would have to.

 

Is the NHS really one organisation? Sure the government want it to be accountable to a single CEO but in fact in England alone there are 209 clinical commissioning groups, 154 acute trusts, 56 mental health trusts, 37 community providers, 10 ambulance trusts and 7,900 GP practices - all with their own boards and CEOs. Is that a single organisation? Would it still be a single organisation if they were all for profit companies or registered charities? Does the NHS employ more staff than are employed by healthcare providers in comparable countries? (the answer is no by the way).

 

The UK had 2.8 physicians per 1,000 people in 2013, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, 3.3 in France, 2.8 in New Zealand and 2.6 in Canada.

The UK had 2.8 hospital beds per 1,000 people in 2013, compared to 8.3 in Germany, 6.3 in France, 3.1 in Denmark, 3.0 in Spain and 2.8 in New Zealand.

You don't seem to like the government's role in the NHS and are against privatisation. You obviously have a lot more knowledge or experience on this topic (do you work in the NHS?) what's your solution given there is no money in the pot?

 

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[buctootim]

I'm not against privatisation per se - its not ideological - its simply that there are very few instances where a private company can genuinely operate healthcare more efficiently.

 

Providing healthcare is not like manufacturing where you can come up with a more efficient means of production or design, or economies of scale, or source raw materials more cheaply. Its not like retail where you can reduce product costs by playing one supplier off against another or put lesser quality products in nicer packaging, or sell higher quality ones at bigger margins. You are employing doctors and nurses on nationally agreed pay rates, they are working to nationally agreed treatment protocols that shouldn't be varied. They are using drugs bought using a national purchasing consortium - which gets amazingly low prices compared to individual hospitals in other countries, far better than any private company will get. Where will a private company make the savings to fund a profit margin and pay for the contract managers which aren't necessary when you have directly employed staff?

 

Most of the Private Finance Initiatives were a way of getting buildings and equipment now without putting up capital at the cost of very expensive maintenance agreements over 25 years or more. Yes you can contract out imaging (MRI, CAT X ray etc) to Philips, nuclear medicine to Siemens and get that nice new suite and scanner now - but it wont look so good in year 15 of the contract when the scanner is outdated and you have already paid more than you could have bought one outright for. I wasted 18 months of my work life at St Marys in London working with McDonnel Douglas to design a new computer system integrating patient records, activity capture, finance, clinics and pharmacy. They were gung ho when they came in, very bullish about how they conquered space - spent three years and £18m on it and admitted defeat.

 

I don't work in the NHS anymore - I earn more money for fewer hours and get a more respect outside. When I joined it was still seen as a publicly valuable job. The needless political interference in the service and Daily Mail attacks about how ****e everything was has largely destroyed that ethos. That's why there is a massive staff retention problem, people leave a salaried job and go back as agency and earn three times as much or go to work for a private contractor which then sells itself back to the NHS.

 

We may well destroy the NHS as it currently is. Only at that point - when the costs are 30% higher and the medical outcomes are the same will people realise what they had.

 

Re a solution. There is no solution apart from either spending more or doing less. Getting to nirvana through efficiency savings is illusory.

 

Demand for healthcare increase annually. At some point we will have to decide that there are cases where treatment wont be offered to certain groups or under certain circumstances.

Edited 15 February, 2016 by buctootim

[Hockey_saint]

You don't seem to like the government's role in the NHS and are against privatisation. You obviously have a lot more knowledge or experience on this topic (do you work in the NHS?) what's your solution given there is no money in the pot?

 

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The French model, at the very beginning at least, would cost a heck of a lot more! Also, form filling is pretty standard where ever you go. Ever been treated in a US hospital? I have.

[Goatboy]

Worlds largest employer

 

McDonalds employs more and US Dept of Defense employs most.

[sadoldgit]

The French model, at the very beginning at least, would cost a heck of a lot more! Also, form filling is pretty standard where ever you go. Ever been treated in a US hospital? I have.

 

I was treated for food poisoning in a hospital in Oregon. The doctor was excellent and phoned me two or three times after seeing him to make sure I was doing ok. Probably worried that I would sue if not!

[Wade Garrett]

Some really informative posts from buctootim.

 

Funny, I have just been watching some daytime television. Someone had a fire at their council flat, the council looked to be doing a great job in looking to quickly sort the flat out, and that of neighbours. Meanwhile, another house had illegally been converted to 6 flats, each of which consisted of basically a room with a few stud walls giving a tiny kitchen, bathroom and bedroom. The tenant in question was on housing benefit, and the landlord was being paid £256 per week for one flat.

 

My point is, as buctootim says, private doesn't necessarily mean better. The Tory government seem to have a pathological distrust of any public body that isn't there to make a profit. Hospitals are no exception.

[Wade Garrett]

I was treated for food poisoning in a hospital in Oregon. The doctor was excellent and phoned me two or three times after seeing him to make sure I was doing ok. Probably worried that I would sue if not!

 

You were lucky, my experience in New York was 1000 times worse.

[buctootim]

McDonalds employs more and US Dept of Defense employs most.

 

12.2m work in healthcare in the US, dwarfing the NHS even allowing for the population difference - but because thats across different healthcare providers people think there isnt bureacracy.

Edited 15 February, 2016 by buctootim

[Johnny Bognor]

It only seems to be in Britain that we are obsessed by the idea we can get something for nothing

 

.... this is not helped by politicians on both sides banging on about the NHS being free at the point of delivery. It's not free. It's been pre-paid by the tax payer. It's only free to those who don't pay taxes or don't pay into the system. I would prefer them to say that there would be no further charges for care at the point of use.

[buctootim]

I would prefer them to say that there would be no further charges for care at the point of use.

There are different arguments about the pros and cons of charging at least part of the cost. Paying something towards the cost of your own health care tends to make people value it more and not, for example make appointments and not bother to turn up. On the other hand having a charging mechanism just introduces a whole new layer to finance department of hospitals to raise and chase more invoices, making it less efficient.

 

In France you have to pay between 23 and something like 50 euros for a doctors appointment and then claim the money back from two different bodies. I imagine some wealthier people cant be bothered and dont claim, whilst other really poor people dont go for an appointment because they dont have the 50 euros. I've heard (but havent seen confirmed) that in Australia they dont make you pay but do give you an invoice showing how puch your treatment cost - so at least you appreciate the value and treat the service with respect.

[Johnny Bognor]

There are different arguments about the pros and cons of charging at least part of the cost. Paying something towards the cost of your own health care tends to make people value it more and not, for example make appointments and not bother to turn up. On the other hand having a charging mechanism just introduces a whole new layer to finance department of hospitals to raise and chase more invoices, making it less efficient.

 

In France you have to pay between 23 and something like 50 euros for a doctors appointment and then claim the money back from two different bodies. I imagine some wealthier people cant be bothered and dont claim, whilst other really poor people dont go for an appointment because they dont have the 50 euros. I've heard (but havent seen confirmed) that in Australia they dont make you pay but do give you an invoice showing how puch your treatment cost - so at least you appreciate the value and treat the service with respect.

 

I would welcome the Australian way, to get away from the notion that the NHS is free.

Edited 15 February, 2016 by Johnny Bognor

[Hockey_saint]

I would welcome the Australian way, to get away from the notion that the NHS is free.

 

Totally this. The right-winger in me get's quite annoyed (come on, I live in Shirley) when I hear newly arrived A8 members say how they feel great about using a free healthcare system...When it's never ever been free, we pay for this throughout our lifetime.

 

Also, on the US subject. I once stayed with a couple who work for US Healthcare company; I was always a bit worried when they suggested that you could probably walk in a busy road...even a non-pedestrian one and just sue if anyone hits you.

 

Scary stuff! I also know their daughter waited 8 hours in an ER department there.