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

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  • ToneControlToneControl Frets: 11790
    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.
    so do we feed the NHS more cash,
    change the way it works, 
    both, or do nothing?
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  • chillidoggychillidoggy Frets: 17136
    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.

    We not only have an ageing populous, but a fast increasing one, too. If we want the service, we have to tax to pay for it, however that is achieved.


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  • strtdvstrtdv Frets: 2356
    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.
    so do we feed the NHS more cash,
    change the way it works, 
    both, or do nothing?
    Any of those might be reasonable options depending on what your viewpoint is.

    More cash = higher taxes which is a difficult sell politically.

    Change the way it works: many options for this including continuing to provide emergency treatment for free but introduce a compulsory insurance scheme for other things, or indeed make primary care a paid-for service (which is the case in New Zealand).

    Do nothing: the current system will slip into steady decline with increasing demand, eventually collapsing under the strain, and a new system (probably fully private) will be brought in to replace it. Works fine for higher earners in good health but particularly those on benefits and those with chronic conditions will be hit very hard.


    Personally I'm in favour of a combination of the first two. I think introducing charges in certain areas (primary care and for non-emergencies in a&e for instance) as well as possibly introducing a universal prescription charge, and (this will be controversial) removing waiting list targets for non-essential operations and encouraging people to get them done privately would take a large burden off the NHS and allow it to allocate resources to where they are needed (currently that is cancer treatment and elderly care in the community).

    I also think that if people want expensive care well into their old age then the better off will probably have to continue to pay some sort of tax beyond retirement age

    All just my personal view of course
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  • darthed1981darthed1981 Frets: 11673
    edited July 2017
    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.
    so do we feed the NHS more cash,
    change the way it works, 
    both, or do nothing?
    Likely a combination of both. If there were easy answers I suspect it would have been done already.

    My main point is that you can't take the NHS in isolation.  Its cost is rising as a percentage of GDP as the overall costs of caring for our ageing population are currently increasing faster than GDP is.  The economic effects of Brexit in the short term will likely make this worse.

    Optimistically though, it's sort of a problem that fixes itself, as once the growth in ages levels off, the costs will as well. The real choice currently is the level of deficit to tolerate in order to maintain all public services, and how to fill the gap.  There is not much more to cut so BOTH parties will end up raising taxes.  

    The real irony is that Theresa Mays tax rises (tax accumulated oldie wealth to find care) were probably fairer than labours (fuck the rich, basically) and she ran her campaign so badly she never put that message out.

    Disclaimer: I'm a life long Labour supporter.
    We have to be so very careful, what we believe in...
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  • exocetexocet Frets: 1948
    Realistically, what are the options?

    Should we privatise the provisioning of all health services leaving funding in public hands?

    Or is the only solution to privatise the financing and delivery?

    What would impact be on cost of healthcare in UK? As we don't pay that much for it now compared to similar economies, I guess we'll end up paying more but with better outcomes for most people? I guess that in UK we don't know what the true cost of private health is because as far as I know, the NHS is the provider of last resort / only provider of emergency care and the state bears the majority of training costs?
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  • EvilmagsEvilmags Frets: 5158
    NHS costs about 120-140 per month per person. BUPA costs about 65 for full coverage. If BUPA was tax deductible at 40 a month most professionals would have it. If the other 20 was deductible from national insurance mist employers would cover the shortfall, result immediate relief of healthcare stress without de funding the NHS for those who need it. 

    Next step is adopt preventative strategies (Japan does this rigorously) with a yearly MOT that finds anything before it becomes expensive. 
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  • ChalkyChalky Frets: 6807
    edited July 2017
    exocet said:
    Realistically, what are the options?

    Should we privatise the provisioning of all health services leaving funding in public hands?

    Or is the only solution to privatise the financing and delivery?

    What would impact be on cost of healthcare in UK? As we don't pay that much for it now compared to similar economies, I guess we'll end up paying more but with better outcomes for most people? I guess that in UK we don't know what the true cost of private health is because as far as I know, the NHS is the provider of last resort / only provider of emergency care and the state bears the majority of training costs?
    Remember that no other first world country has an NHS, all these decades later. We think that is because we are better than them. They just point to our position in all the charts of mortality rates...

    Our NHS is free at the point of use Monseuir!
    Oui, and twice as many of your babies die before their first birthday!
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  • exocetexocet Frets: 1948
    edited July 2017
    Evilmags said: moo
    NHS costs about 120-140 per month per person. BUPA costs about 65 for full coverage. If BUPA was tax deductible at 40 a month most professionals would have it. If the other 20 was deductible from national insurance mist employers would cover the shortfall, result immediate relief of healthcare stress without de funding the NHS for those who need it. 

    Next step is adopt preventative strategies (Japan does this rigorously) with a yearly MOT that finds anything before it becomes expensive. 
    But in UK Bupa isn't full coverage because

    1) No A&E

    2) Access to it is via your GP who will invariably filter out some cases where no attention is required.

    So what do we think "full healthcare per person / for a family" would be?

    I currently have family healthcare via a work scheme - it's a pittance really because of the risk that they don't cover.


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  • EvilmagsEvilmags Frets: 5158
    The biggest costs are age and new treatment. Growing old is insurable I've had Pru health and BUPA from work and both were pretty comprehensive. Here my Adeslas full EU wide cover is 65 a month with Gp visits covered. We got it for my 77 year old mother in law at 200 a month. She's 5,3 a female amd 10 kilos heavier than me so she is a risk.  
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  • EricTheWearyEricTheWeary Frets: 16253
    exocet said:
    Evilmags said: moo
    NHS costs about 120-140 per month per person. BUPA costs about 65 for full coverage. If BUPA was tax deductible at 40 a month most professionals would have it. If the other 20 was deductible from national insurance mist employers would cover the shortfall, result immediate relief of healthcare stress without de funding the NHS for those who need it. 

    Next step is adopt preventative strategies (Japan does this rigorously) with a yearly MOT that finds anything before it becomes expensive. 
    But in UK Bupa isn't full coverage because

    1) No A&E

    2) Access to it is via your GP who will invariably filter out some cases where no attention is required.

    So what do we think "full healthcare per person / for a family" would be?

    I currently have family healthcare via a work scheme - it's a pittance really because of the risk that they don't cover.


    And BUPA rely on NHS trained staff ( so don't bear those costs and that the medical treatment you get is exactly the same anyway) as well as the number of things they won't treat (BUPA  won't treat pre existing or chronic conditions). Those figures make the NHS look good value for money compared to BUPA ( which , just to be clear, couldn't make a profit without effectively leaching off the NHS). 
    Tipton is a small fishing village in the borough of Sandwell. 
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  • darthed1981darthed1981 Frets: 11673
    Given the demographic you would typically associate with rock music, I'm always amused by how much this part of the forum skews right sometimes.

    People never cease to surprise me :)
    We have to be so very careful, what we believe in...
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  • strtdvstrtdv Frets: 2356
    TBH if I needed A&E I'd be much happier in an NHS hospital than in a private hospital, certainly for the genuinely life/limb threatening stuff.

    Some of the private care is pretty poor for the medical emergencies end of things
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  • EvilmagsEvilmags Frets: 5158
    BUPA is non profit. Most nurses in private hospitals are foreign and as far as I know the NHS does not have ownership of physicians. 
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  • the_twinthe_twin Frets: 130
    Getting back to the article referred to by the OP, the premise of this is that the British public somehow worship the NHS. In reality they spend a great deal of time complaining about its perceived shortcomings. They vote for political parties whose policies are to restrict funds for health and social care and to make working in the service unattractive.  On the other hand any attempt to change things is met with public protest, often led by the local MP As a result many services are delivered from crumbling Victorian buildings with outdated equipment, often in the wrong place, with duplication of effort and inefficiency. Financial pressure results in short term "fixes" such as vacancy freezes or increased waiting with predictable consequences. Don't get me started on the state of NHS information technology.

    There is no simple answer to the challenge of providing healthcare to an increasingly unhealthy population for any country, but wrestling the NHS from the vagaries of politics would be a great help.
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  • ToneControlToneControl Frets: 11790
    Evilmags said:
    NHS costs about 120-140 per month per person. BUPA costs about 65 for full coverage. If BUPA was tax deductible at 40 a month most professionals would have it. If the other 20 was deductible from national insurance mist employers would cover the shortfall, result immediate relief of healthcare stress without de funding the NHS for those who need it. 

    Next step is adopt preventative strategies (Japan does this rigorously) with a yearly MOT that finds anything before it becomes expensive. 
    BUPA doesn't cover any A&E or maternity costs

    It shouldn't be taxed though, that's just taking the piss

    MOTs would be good, I suggested this at one place I worked about 12 years ago, no interest
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  • the_twinthe_twin Frets: 130
    Plenty of research to show health "MOTs" are a waste of time and money. 
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  • ToneControlToneControl Frets: 11790
    Evilmags said:
    The biggest costs are age and new treatment. Growing old is insurable I've had Pru health and BUPA from work and both were pretty comprehensive. Here my Adeslas full EU wide cover is 65 a month with Gp visits covered. We got it for my 77 year old mother in law at 200 a month. She's 5,3 a female amd 10 kilos heavier than me so she is a risk.  
    my BUPA was way more than that at 50

    this couple pay £1k a month at 70 with no serious illnesses:
    http://www.thisismoney.co.uk/money/markets/article-3595418/The-couple-charged-12-000-year-Bupa-health-insurance-ve-no-illnesses-customers-30-years.html

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  • ToneControlToneControl Frets: 11790
    exocet said:
    Evilmags said: moo
    NHS costs about 120-140 per month per person. BUPA costs about 65 for full coverage. If BUPA was tax deductible at 40 a month most professionals would have it. If the other 20 was deductible from national insurance mist employers would cover the shortfall, result immediate relief of healthcare stress without de funding the NHS for those who need it. 

    Next step is adopt preventative strategies (Japan does this rigorously) with a yearly MOT that finds anything before it becomes expensive. 
    But in UK Bupa isn't full coverage because

    1) No A&E

    2) Access to it is via your GP who will invariably filter out some cases where no attention is required.

    So what do we think "full healthcare per person / for a family" would be?

    I currently have family healthcare via a work scheme - it's a pittance really because of the risk that they don't cover.


    And BUPA rely on NHS trained staff ( so don't bear those costs and that the medical treatment you get is exactly the same anyway) as well as the number of things they won't treat (BUPA  won't treat pre existing or chronic conditions). Those figures make the NHS look good value for money compared to BUPA ( which , just to be clear, couldn't make a profit without effectively leaching off the NHS). 
    that's a jaundiced view, it's easier to make the case that private health care takes the load from the NHS, and tops up the salary of consultants who might emigrate otherwise
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  • ToneControlToneControl Frets: 11790
    Evilmags said:
    BUPA is non profit. Most nurses in private hospitals are foreign and as far as I know the NHS does not have ownership of physicians. 
    NHS can insist on 42 hours a week (or something like that), then the consultant can do private work on top
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  • ToneControlToneControl Frets: 11790
    the_twin said:
    Getting back to the article referred to by the OP, the premise of this is that the British public somehow worship the NHS. In reality they spend a great deal of time complaining about its perceived shortcomings. They vote for political parties whose policies are to restrict funds for health and social care and to make working in the service unattractive.  On the other hand any attempt to change things is met with public protest, often led by the local MP As a result many services are delivered from crumbling Victorian buildings with outdated equipment, often in the wrong place, with duplication of effort and inefficiency. Financial pressure results in short term "fixes" such as vacancy freezes or increased waiting with predictable consequences. Don't get me started on the state of NHS information technology.

    There is no simple answer to the challenge of providing healthcare to an increasingly unhealthy population for any country, but wrestling the NHS from the vagaries of politics would be a great help.
    Putting aside the demographics,
    your other points are all consistent with a nationalised industry

    Try telling a few people that a nurse is just someone doing their job for a wage that is comparable to other jobs with the same hours and skill level, and then tell me that the UK public are rational when discussing the NHS



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