LSE analysis of NHS says patient outcomes are very poor, "holy cow" status stops improvement

Drew_TNBD

mellowsun said:

This is why I like working for startups - dead wood isn't tolerated and if you don't perform, you are out the door.

Ha!! If only!!

chrispy108

guitarfishbay said:

The NHS is absolutely not perfect, but looking at the brutal cost in the States I'd rather keep it and try to find better ways to improve it. 

I wondered how long it would take for someone to reply as if the only two types of healthcare systems are ours and the States, when most of the rest of the Western world exist happily somewhere between the two.

guitarfishbay

chrispy108 said:

guitarfishbay said:

The NHS is absolutely not perfect, but looking at the brutal cost in the States I'd rather keep it and try to find better ways to improve it. 

I wondered how long it would take for someone to reply as if the only two types of healthcare systems are ours and the States, when most of the rest of the Western world exist happily somewhere between the two.

And if you read the rest of my posts I'm not against criticising or changing aspects of the NHS or even suggesting charging for things.

It seems you were reading the thread hoping to make this specific comment though.

guitarfishbay

Fretwired said:

WezV said:

Im fine with the idea of a DNA charge as long as it works both ways.  I spent 3 hours sitting in a waiting room last year for a consultation.  The first thing he said was "do you know why your here?", apparently they had spent 3 hours trying to figure it out and decided just to ask.

i had some issues a few months before so just assumed it was a follow up.  Apparently not.

DNA charges would cost more than was collected. A waste of time and effort.

The problem is simple. Not enough GPs. And the reason for that is not enough people are allowed to train to become doctors. The government deliberately restricts numbers to keep costs down.

I'm not sure I agree with it being a waste of time and effort.  To me it's not something that would purely be weighed as cost recouped by fines... my hope would be a change of culture over time towards the service.  Right now people can just not turn up and there's essentially no consequence to them.  In theory they can be struck off a list after 3 instances (providing written warnings are given) but they're still entitled to be registered at an NHS GP Surgery so the problem just moves elsewhere.  And it isn't just GP Surgeries - the same stuff happens with Secondary Care too.  Dental Practices can charge for missed appointments.

Regarding GPs - there are a huge number of factors affecting this.  In terms of cost effectiveness the ideal thing are partnerships, who have an interest in running a profitable practice, who are also employers of admin staff and have a vested interest in their performance etc.  The reality is it's less stressful to make more money and have more flexibility by not being a partner in a major city.  My mate qualified as a GP recently, he's a part timer in London and makes up the rest of his wage doing Locum work.  If he wants to he can out earn his full time partners, and if he doesn't want to he can have a 4 day weekend.  It makes no sense for him to be a partner at all.

Then there's the international marketplace... Doctors can potentially have a better quality of life leaving the UK.  I have no idea of the legal position regarding any investment in training here, but it certainly does prove to be an issue for the NHS.

Then there's just pure culture.

My understanding of Australian healthcare (told to me anecdotally) is there's more of an emphasis on the patient's responsibility.  The UK psyche generally sees responsibility on lying with the Doctor to fix their issue.  Hence we see targets based on number of patients who have stats within a certain range on a chronic disease - in reality some patients are outside of the range by their own actions (or lack of), but that's never something that can be discussed in the UK.  Same thing with education too, it seems accepted to blame teachers for a child's failings when actually the parents could very well have more of an impact in the child's educational development by taking a bigger role themselves.

chillidoggy

GP's are the biggest log-jam in the healthcare system. That an the medical profession's dogged, and absolute adherence to the code that says no-one, whoever they are, can ever hope to by-pass their GP. I have a company healthcare scheme which gives access to consultants, but they will never do a fucking thing without that GP referral. Fucking crazy when you can't get a GP appointment in the first place.

Drew_TNBD

Sexy nurses love a bit of DNA.

TimmyO

Evilmags said:

The Mises institute is one of two US based think tanks that promote Austrian school economics. (Cato being the other). The student concerned will be a postgraduate economist so certainly more qualified than the majority of journalists to analyse and comment. 

Surely someone from MI can only interpret in accordance with their existing beliefs, rather than analyse? 

ToneControl

TimmyO said:

Evilmags said:

The Mises institute is one of two US based think tanks that promote Austrian school economics. (Cato being the other). The student concerned will be a postgraduate economist so certainly more qualified than the majority of journalists to analyse and comment. 

Surely someone from MI can only interpret in accordance with their existing beliefs, rather than analyse? 

not like anyone else then?

Evilmags

ToneControl said:

TimmyO said:

Evilmags said:

The Mises institute is one of two US based think tanks that promote Austrian school economics. (Cato being the other). The student concerned will be a postgraduate economist so certainly more qualified than the majority of journalists to analyse and comment. 

Surely someone from MI can only interpret in accordance with their existing beliefs, rather than analyse? 

not like anyone else then?

It is generally an acceptable reference for an a admit paper in economics. A Blog is clearly a viewpoint of am economist and not a peer reviewed paper

Snap

Lewy

Funkfingers said:

A realistic solution might be to keep Accident & Emergency free at the point of delivery but make everything else chargeable. There would be a corresponding reduction in direct taxation and an increase in health insurance. This would, of course, be considered unfair but at least it has some chance of funding itself.

I struggle with that argument, mainly because I have zero faith that the reduction in taxation would in real terms outweigh the costs of private health insurance, especially as people approach retirement age and the tax break will mean less and the costs of health insurance become insane. It'll just become another exercise in rinsing the majority of the economically contributing population, whilst simultaneously fucking over people who can't afford insurance.

EricTheWeary

Lewy said:

Funkfingers said:

A realistic solution might be to keep Accident & Emergency free at the point of delivery but make everything else chargeable. There would be a corresponding reduction in direct taxation and an increase in health insurance. This would, of course, be considered unfair but at least it has some chance of funding itself.

I struggle with that argument, mainly because I have zero faith that the reduction in taxation would in real terms outweigh the costs of private health insurance, especially as people approach retirement age and the tax break will mean less and the costs of health insurance become insane. It'll just become another exercise in rinsing the majority of the economically contributing population, whilst simultaneously fucking over people who can't afford insurance.

Having spent more time than I'd like at A and E departments I think it seems fair to say they are used as informal GP surgeries as well as for emergencies and leaving them free whilst charging for everything else would see them collapse within a week. 

crunchman

I'm not sure that charging for GP appointments would be a good idea.  It's likely to discourage people from going when they need to.  If they have an infection that needs antibiotics, and they decide not to go to the GP early, and end up hospitalised and on drips, then the charging is counter productive.  Charging for DNAs might help, but as said above, the cost of collection would almost certainly be more than was raised.

One solution would be to charge a small sum, say £8 per day, towards bed and board while in hospital.  You could make it free for those who get free prescriptions (children, pregnant women, people with chronic diseases, and pensioners).

That wouldn't be an out of the way charge, but it would help balance the books.  It also wouldn't be enough to encourage hospitals to keep people in for unnecessary treatment.

In most hospitals I've visited, they could turn the heating down a degree or two as well and save on heating bills.

chillidoggy

The GP appointments debacle already discourages people enough. I include myself in that and you'll see me moaning like hell about it on here all the time.

But I already pay for the NHS as part of my NI contribution which is a lot, so I'm not sure I'd want to pay all over again for it and in any case that kind of goes against the whole NHS ethos of being free at the point of treatment.

Having my wife treated in a hospital after a nasty accident in the US two years ago, the first thing they wanted to know was how I was going to pay for her treatment. The hospital administrator dealt solely with that, and I have no doubt that she made far more than she cost that particular night. I'd like to see those not entitled to free NHS treatment being charged the same as a first step in the right direction.

strtdv

The NHS has many flaws. The problem is that fixing them is politically difficult, as it would mean:

-Increased service centralisation, which is unpopular. The truth is, if you want very good outcomes for things, particularly specialised surgery, and to a lesser extent things like radiotherapy, then you want a couple of big centres that deal with big numbers rather than lots of smaller centres that only deal with a handful of cases a year.

-Increased cost. The best treatments in the world are expensive. I'm no advocate for big pharma, but ultimately we have yet to find a better alternative. People are also getting more complex surgical treatments, and treatments are being offered to frailer and more comorbid people than in the past. This all leads to increased cost.
The options are we either increase funding (and by extension taxes), or we lower or expectations of what treatments are available on the NHS (which could mean that certain expensive treatments are only available to those with insurance, or it could mean that we reduce all the services by a certain percentage).
Efficiency savings are not the answer here, as the NHS is already the most efficient health service in the world.

-there are also issues regarding public health. As a society we are very bad at looking after our own health. Every doctor who works in hospital medicine will know of a small minority of patients who take up a significant proportion out resources because they refuse to help themselves. I don't have an easy answer for this but it's definitely an issue.

On top of this you have an ageing population, nurses and doctors moving to other countries for better working conditions and pay, the public rejection of "experts", and increasingly doctors not taking up training posts due to poor working conditions.

ToneControl

strtdv said:

The NHS has many flaws. The problem is that fixing them is politically difficult, as it would mean:

Efficiency savings are not the answer here, as the NHS is already the most efficient health service in the world.

how do we know this is true?
this article says our patient outcomes are on a par with Eastern Europe

strtdv

ToneControl said:

strtdv said:

The NHS has many flaws. The problem is that fixing them is politically difficult, as it would mean:

Efficiency savings are not the answer here, as the NHS is already the most efficient health service in the world.

how do we know this is true?
this article says our patient outcomes are on a par with Eastern Europe

A variety of highly regarded sources including the Nuffield Trust and the Commonwealth Fund have come to this conclusion.
Efficiency savings are marginal gains, there's maybe a couple of percent in there but no huge gains to be made.

If you want inefficient, go to the USA.

darthed1981

There are a lot of extreme opinions here, not least in the original quoted article, which comes from a pretty right-wing perspective.  Still, at least no right-wing Austrians ever did anything bad...

Anyhow - the media blows it out of all proportion, but it is really far too big to fail or be scrapped.  Of course there are happy mediums in other countries, but there is no reason the NHS will inevitably collapse.

The last few years seem to be a constant push from the treasury that they will give the NHS more money but only the absolute minimum they need.  The NHS wants (and briefs) that it needs more, that's really all it is.

The reality is, we as a country have an ageing population, and this affects everything, not just the NHS.  It will be a continued economic challenge to look after the elderly without putting a huge extra tax burden on working people.

Lewy

.Totally posted on the wrong thread. Nothing to see here.

ToneControl

strtdv said:

ToneControl said:

strtdv said:

The NHS has many flaws. The problem is that fixing them is politically difficult, as it would mean:

Efficiency savings are not the answer here, as the NHS is already the most efficient health service in the world.

how do we know this is true?
this article says our patient outcomes are on a par with Eastern Europe

A variety of highly regarded sources including the Nuffield Trust and the Commonwealth Fund have come to this conclusion.
Efficiency savings are marginal gains, there's maybe a couple of percent in there but no huge gains to be made.

If you want inefficient, go to the USA.

how do they measure efficiency in health provision?
very strangely to my mind

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
we come top - hooray!
Except UK comes 10th out of 11 for "healthy lives" - i.e. lifespan and how ill you are, but we offer the NHS to all, it's cheap and no one gets special treatment (well that's what we pretend).
That's a pretty crap analysis I think

https://www.nuffieldtrust.org.uk/news-item/we-won-the-world-cup-of-health-care-systems
says:
 these results provide only a partial view of health care quality and how patients and physicians answer the questions may be affected by their own experiences and expectations; which are likely to differ across countries, cultures and population groups.

For example, if the British are generally positive about their health care system and have lower expectations than say the Norwegians, the UK system will score better.

So, we need to examine the raw scores more closely even if we do rank at the top. We may have scored first in co-ordinated as well as patient-centred care, but on some selected indicators we performed very poorly. In the report these were weighted equally – but some indicators may be more important than others.

this is interesting btw:
https://www.ncbi.nlm.nih.gov/pubmed/11685786

I can't see much point in comparing with the USA, no one wants to emulate that