What would help the NHS?

[Tony Williams]

Sorry I thought the comment about social engineering was in reference to the OP, I had taken it to be your aside re the previous suggestion for what you felt would help the NHS. If you were referring to social engineering in any aspect at all obviously my retort wouldn't make much sense.

No need to apologise, it was my fault for not being clear.

[barefoot]

The last WHO healthcare ranking was produced in 2000. Indeed after years of underinvestment at that time the UK ranked 18th.

I'm not convinced its all due to under-investment i.e. in the 2000 WHO report health care, as a percent of GDP was 3.4% in Singapore and 7.2% United Kingdom. If there are countries that offer better health care that spend less on it, it leads me to think there is only so much money you can throw at a problem - I think the structure of the system is just as if not more important.

Think tanks do not produce white papers unless they are biased.

May be so, it was a think tank dedicated to social reform. I have a friend that works at a think tank and he is 'Mr Labour' as far as I'm concerned, he always votes Labour regardless whereas I change who I vote for depending on what they say...and yet he still considers arguments from the right and the left when he puts his proposals together, unless he addresses arguments from both sides, he wouldn't be doing his job properly. Admittedly, the paper I read could have been from a right wing think tank for social reform that doesn't operate like his and I wouldn't have known, but if it was I think they would be arguing for an entirely private system, not recognising the good things and bad things about the private sectors role in health care as it did.

Think of what you are complaining about - lost files! Where has the govt directed the expenditure in information management in the NHS - yes a failed computer systems. Who says things are perfect?

I wasn't complaining, I'm sure there are much bigger problems, I was explaining that that was what piqued my interest in the topic and what lead me to try and do a little research.

So a part private system can work, never said it can't

Well you said "The private sector will not solve the problem", and I'm not saying it will. All I'm saying is we should try and copy other countries a bit more, and some of the better ones have a part private system.

- it simply has perverse incentives and therefore costs that do not serve the primary aim. Where people need motivation this helps alot, but remember you get what is sold not what you ask for.

I disagree, its not simply anything, its a mixed bag. The incentives are to make money, if you want to label that as perverse then that is your prerogative. But the private sector will make money by driving the cost of producing drug X down to zero, a good thing for society, and at the same time sell as much of drug X to the public as they can, a bad thing for society. I don't think the argument is as simple as you state.

[barefoot]

That doesn't sound like counter-capitalism to me, quite the reverse, and in a socialist-rooted welfare state, quite counter to the original principles.

I think that is probably a good thing then, while people using the Scottish NHS are advantaged over the English NHS and that can be seen as unfair, it also means that there is some initial investment that will help make the treatment cheaper for everyone in the long run.

[Pebble]

I'm not convinced its all due to under-investment i.e. in the 2000 WHO report health care, as a percent of GDP was 3.4% in Singapore and 7.2% United Kingdom. If there are countries that offer better health care that spend less on it, it leads me to think there is only so much money you can throw at a problem - I think the structure of the system is just as if not more important.




Well you said "The private sector will not solve the problem", and I'm not saying it will. All I'm saying is we should try and copy other countries a bit more, and some of the better ones have a part private system.



I disagree, its not simply anything, its a mixed bag. The incentives are to make money, if you want to label that as perverse then that is your prerogative. But the private sector will make money by driving the cost of producing drug X down to zero, a good thing for society, and at the same time sell as much of drug X to the public as they can, a bad thing for society. I don't think the argument is as simple as you state.

http://www.kaiseredu.org/topics_im_ihs.asp?imID=5&parentID=61


Always important not to compare apples and oranges!


Despite health care accounting for a low share of GDP, the Singaporean health care system is arriving at a crossroad as they face rapid growth and the challenges of cost containment as their currently young population ages and medical technology advances. The current financing of health care currently does not include long-term nursing care for the elderly since Medisave and Medishield are mainly used for acute hospital care.


Distribution of the population by age bracket in %
Under 5: 5.4 %
5 to 14: 13.5 %
15 to 24: 13.3 %
25 to 59: 55.5 %
60 to 79: 10.7 %
Over 80: 1.6 %
Source: Statistics Singapore,



As for drug development - this is already in private domain with exponentially escallating costs per drug developed.


The only real saving available in the NHS is to move to much less generous pension provision and to reduce staff wages. However, as Ryan Air have shown BA, once that has been achieved, service quality inevitably follows, since continued profit growth is the objective of all private institutions. As has also been shown by BA just because there is competition, does not mean that the old monoliths will become compeditive, since they remain shackled with historical costs.

Real savings could be achieved by a ruthless govt. A 20% wage cut across all public services with an enforced move away from final salary schemes - now that would bring real benefits - who has the stomach for real reform?

[Floppit]

Real savings could be achieved by a ruthless govt. A 20% wage cut across all public services with an enforced move away from final salary schemes - now that would bring real benefits - who has the stomach for real reform?

I work for the Public Sector but am paid roughly a 1/4 (FTE) of a low GP wage which is still far higher than the minimum wage, many others are paid just over minimum wage where a 20% cut would be illegal by current law. We already have our wages frozen which I don't actually disagree with and our holidays cut. Some of the services we offer are currently frozen and with that in mind I have no objection to it hitting our own pockets. I would rather lose 20% of my wage than see frontline carers lose the same however I can't be quite so confident that I would remain in the public sector, given a lower wage than those offered by charities and the chance to switch to a smaller employer with a more 'charitable' remit - I'd probably be offski!

[barefoot]

http://www.kaiseredu.org/topics_im_ihs.asp?imID=5&parentID=61
Always important not to compare apples and oranges!

We have a different health care system, one is an apple, and one is an orange, I agree - they work in a fundamentally different ways. This is my point. I'm of the opinion that we might be able to learn something from other countries that do health care in a different way than us though, and that rank better than us.

In the US they spend a lot more money than us in health care, and yet have a system that ranks worse than the NHS. And Singapore spend less, yet rank better...as I said previously, I'm still not convinced that it is all about how much money you throw at the problem, I think it is more complicated than that, and probably related to the structure of the system.

The current financing of health care currently does not include long-term nursing care for the elderly since Medisave and Medishield are mainly used for acute hospital care.

So if they doubled their budget to 7% of GDP and covered long term nursing care they would still be spending less than us and would still have better health care...sounds ok to me

As for drug development - this is already in private domain with exponentially escallating costs per drug developed.

Exponential? That is quite a claim.

In general, I think technological advances allow us to make more stuff for less money. Research for new drugs has to be done and that is expensive, so new drugs will be more expensive than old drugs if that is what you are referring to.

The only real saving available in the NHS is to move to much less generous pension provision and to reduce staff wages.

If anything, cutting wages would be an incentive for people to leave healthcare. I think its a slightly more complicated issue than that.

[barefoot]

Hmm, my post seems to have got lost...here goes again...

http://www.kaiseredu.org/topics_im_ihs.asp?imID=5&parentID=61
Always important not to compare apples and oranges!

We have a different health care system, one is an apple, and one is an orange, I agree - they work in a fundamentally different ways. This is my point. I'm of the opinion that we might be able to learn something from other countries that do health care in a different way than us though, and that rank better than us.

In the US they spend a lot more money than us in health care, and yet have a system that ranks worse than the NHS. And Singapore spend less, yet rank better...as I said previously, I'm still not convinced that it is all about how much money you throw at the problem, I think it is more complicated than that, and probably related to the structure of the system.

The current financing of health care currently does not include long-term nursing care for the elderly since Medisave and Medishield are mainly used for acute hospital care.

So if they doubled their budget to 7% of GDP and covered long term nursing care they would still be spending less than us and would still have better health care...sounds ok to me

As for drug development - this is already in private domain with exponentially escallating costs per drug developed.

Exponential? That is quite a claim.

In general, I think technological advances allow us to make more stuff for less money. Research for new drugs has to be done and that is expensive, so new drugs will be more expensive than old drugs if that is what you are referring to, I still doubt it is exponential though.

The only real saving available in the NHS is to move to much less generous pension provision and to reduce staff wages.

If anything, cutting wages would be an incentive for people to leave healthcare. I think its slightly more more of a complicated issue than that.

[Pebble]

I wonder what the conservatives are thinking?


http://www.telegraph.co.uk/news/news...mpaigners.html


David Cameron has met a health care pressure group that advocates full privatisation of the National Health Service - a meeting that could infuriate doctors and nurses.


His decision to meet the radical group, which calls the NHS a "dystopian, Soviet-style calamity", will be seen as foolhardy after the painstaking efforts he has made to reassure voters that the NHS is safe in Tory hands.


Not that 'Dr' Helen Evans has any conflicts of interest here!

http://www.farsightspi.com/farsight-background.htm

[Floppit]

I wouldn't trust David Cameron not to eat lightly roasted puppies for Sunday lunch - but that's perhaps not entirely rational! However not trusting the Conservatives with NHS is slightly better grounded.

One thing that has always disturbed me is the notion that free market economics can be productively brought to bare within the health sector. Not that I'm suggesting there's no place at all for them just that it's place is surely limited by the nature of medicine, from the need to share rather than own knowledge to relative costs of such a vast array of treatments within a setting of almost infinite variability.

I remember reading many years ago of the disadvantages teaching hospitals face in regard to targets and costs - it was a very long time ago, during an economics module in the mid 90s!

[Tony Williams]

I wouldn't trust David Cameron not to eat lightly roasted puppies for Sunday lunch - but that's perhaps not entirely rational!

I dunno - as the saying goes: "A dog is not just for Christmas - properly cooked and carved, it can last into the New Year!"

One thing that has always disturbed me is the notion that free market economics can be productively brought to bare within the health sector. Not that I'm suggesting there's no place at all for them just that it's place is surely limited by the nature of medicine, from the need to share rather than own knowledge to relative costs of such a vast array of treatments within a setting of almost infinite variability.

It's certainly difficult, but the public sector is notoriously casual about costs unless it's facing free-market competition, and with a finite budget (and potentially almost infinite demand), higher costs means fewer patients treated. Some element of cost discipline does need to be applied somehow.

[Floppit]

The bit of work I do in the Public Sector (assessing 'need') doesn't have any private sector competition but we certainly aren't casual over costs, for example you can have homecare up to the cost of residential care but not beyond it, and that is regardless of what's best for the person (mind you at that stage there's probably not a great deal of conflict - residential care is very expensive!). We're careful how much we print and pens, pencils etc are kept under lock and key! However that has been achieved it's been done without competition, often just because we know services are being withheld due to lack of funds. The financial caution isn't what gets moaned about, lack of permanent contracts, workload and redeployment are by far the more 'sensitive' topics.

[Tony Williams]

That's good, and I know that public sector services can be run on a tight budget (I used to run some) but that doesn't necessarily apply to all aspects of the operation. On cleaning and catering, for example, it was only the prospect of the services being contracted out that focused the unions' minds on trying to match private sector efficiency.

[barefoot]

I tried to post this already...not sure why it didn't work...

http://www.kaiseredu.org/topics_im_ihs.asp?imID=5&parentID=61
Always important not to compare apples and oranges!

We have a different health care system, one is an apple, and one is an orange, I agree - they work in fundamentally different ways. This is my point. I'm of the opinion that we might be able to learn something from other countries that do health care in a different way than us though, and that rank better than us.

In the US they spend a lot more money than us in health care, and yet have a system that ranks worse than the NHS. And Singapore spend less, yet rank better...as I said previously, I'm still not convinced that it is all about how much money you throw at the problem, I think it is more complicated than that, and probably related to the structure of the system.

The current financing of health care currently does not include long-term nursing care for the elderly since Medisave and Medishield are mainly used for acute hospital care.

So if they doubled their budget to 7% of GDP and covered long term nursing care they would still be spending less than us and would still have better health care...sounds ok to me

As for drug development - this is already in private domain with exponentially escallating costs per drug developed.

Exponential? That is quite a claim.

In general, I think technological advances allow us to make more stuff for less money. Research for new drugs has to be done and that is expensive, so new drugs will be more expensive than old drugs if that is what you are referring to.

The only real saving available in the NHS is to move to much less generous pension provision and to reduce staff wages.

If anything, cutting wages would be an incentive for people to leave healthcare. I'm not convinced that 'the only real saving available' is pensions and wages. I think its slightly more more of a complicated issue than that.

[Floppit]

There's more to motivation than just money. I have a very good friend about to leave one NHS job as a result of being denied a training request, and it's not just her, her colleagues feel the same way. People work for more than just money, that's not to underplay the role of money, just to say that there's more to it.

If a 20% (less for those less well paid!) cut in pay was coupled with increased training the number of those in favour of it would likely increase. Organisations that rely on voluntary staff know a great deal about what factors other than money lead people to trade their time for free. Until last year I worked one evening a week as a volunteer for experience, for the future opportunities it could open and for the pleasure. For the first 8 years of my working life I did a complex and dangerous tasks for ridiculously low pay but vast learning opportunities.

There's a real return from training that doesn't exist by pay alone, the chance to increase the added value of a workforce, their productivity.

Pay is a funny thing, the more there is the more is needed, bigger houses bought, higher living costs, differing social group comparisons, raised expectations and a shift in the line between need and want. I think people who have by my standards very real wealth are no less fearful of losing any of it. Freezing pay has the advantage of reaching the same ends in the long term without expecting a level of wisdom I suspect only a few possess. That said there still needs to be reasons why people would want to do the job in a world where they have choices so it comes back to broadening the picture of motivation beyond just financial gain.

[Tony Williams]

There's more to motivation than just money. I have a very good friend about to leave one NHS job as a result of being denied a training request, and it's not just her, her colleagues feel the same way. People work for more than just money, that's not to underplay the role of money, just to say that there's more to it.

Very much so. Money is only an issue if you're not getting enough to pay the bills and other basic essentials. After that, job satisfaction becomes far more significant, and the most important element of that is for employees to have some control over their work and environment (including training) rather than simply following orders. Obviously, some jobs are more rewarding than others for some people (as a - mostly - vegetarian I would not wish to work in an abbatoir whatever the salary and conditions, for instance), but that is more down to individual personality.

Pay is a funny thing, the more there is the more is needed, bigger houses bought, higher living costs, differing social group comparisons, raised expectations and a shift in the line between need and want. I think people who have by my standards very real wealth are no less fearful of losing any of it.

It's the difference between income and expectations which is crucial to satisfaction, but the level of expectations also comes down to individual personalities, as well as history (once you've achieved a certain standard of living, it can be psychologically devastating to lose it, whatever the level may be).

I am reminded of that newspaper owner, Lord Black, who was a very wealthy man by almost any standards but not wealthy enough to support the lifestyle which his glamorous and high-maintenance new wife wanted, so he ended up misappropriating funds (=stealing) from his company.