There are those who say 'it's an entity admired the world over', what nonsense. Which other country has adopted the British system of healthcare? None. If it was so admired surely there would be at least one or two. The problem with the likes of Jamie Sport is that he involves emotion instead of realism into his fondness of the NHS and that is a bad starting point on which to evaluate our healthcare system. In its infancy the NHS was greatly welcomed as healthcare would be available to all. Let's get one fact straight; it is not free, but free at the point of delivery. It is paid for by NHI contributions from those who work and further subsidised by the treasury (taxpayers).
Over the years it has not evolved but rather revolved, stuck in the circle of 'our NHS' rather than a developing 'our healthcare system'. An example is the money that has been poured in to give GPs big salaries, which resulted in GPs working far less hours and a significant number of vacancies for GPs occurred. Many posts, particularly in large cities, are still unfilled even though we are providing a par exellence education in the training of doctors. In recent years doctors, once qualified, did not see any future for themselves within the NHS and have moved abroad where they have many more opportunities and far less interference from government. What are other countries offering our doctors that we don't? The cost of training a doctor is around £500,000 so as well as losing the benefits of their skills, we are paying for the privilege. We have an NHS which has more managers than staff at the customer end of the service.
I doubt if many who 'love the NHS' have ever had the (mis)fortune to use the healthcare system of any other European country because if they had, they would realise the NHS is failing in many ways and it is by no means perfect. We have some of the worst results for the treatment of cancer and heart disease in Europe and we (parts of Scotland in particular), have the worst results for longevity. Other countries have similar social problems yet they provide better healthcare.
In Germany for example, blood test results are usually available within 24 hours. My GP here tells me to telephone in a week. There is no extensive waiting time for specialist appointments in Germany where 90% of the population contribute towards around 1,000 semi-private, fiscally independent, sickness funds (only 10% use private commercial insurance). The premiums are calculated on an 'ability to pay' basis and joining a fund is compulsory.
Recently I calculated that I have paid more here in the UK for my healthcare throughout my lifetime that I would have done if I had lived in Germany. The UK has a two-tier system and the lovers of the NHS do not want to acknowledge that, but it is very evident. On several occasions I have opted for private consultations with specialists for various reasons but the main one is the length of time it takes to have basic scans etc here. In my local hospital the scanning machine is only used 9 - 5 Monday to Friday and if the radiologist is on holiday it is only used for total emergencies, if a radiologist can be found. What a waste when there is a long list of patients requiring the service.
The NHS is Britain is now nearly 10% of GDP, a similar figure to Germany. So often we hear that the present problems within the NHS are caused by the increasing elderly in our population: 15.5% of Germany's population are over 65 with the UK's just slightly higher.
I have used the example of Germany because I have experience of their healthcare system and its quality. It still surpasses the best Britain can offer by way of results and it is not as expensive as the figures bandied around by politicians. It is not my intention to suggest we adopt the same system as Germany or any other European country, but we need a debate about healthcare. It is now time we, as individuals, took responsibility for our own health instead of leaving politicians to make the decisions for us. We've had the smoking tsar, the drinking tsar, the drugs tsar and now the dancing tsar - all people, paid by us, to tell us how to live our lives.
Billions of pounds have been poured into a healthcare system in past years and we see little improvement by way of results. Of course we have some shiny new hospitals but it is the treatment which matters. If we want the treatments that produce the best results, we have to look and listen to those who work in our system, medics and nursing staff - they know what is needed, not politicians. It is the job of politicians to decide the best way to fund a system without interfering in the running of it.
Just published, a post which may be of interest, from the Adam Smith Institute.
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27 comments:
Thanks for posting this SR - I've pinched it. I was disappointed by Cameron's response on the NHS - as Fox News said the whole response from Britain has been very defensive. Our govt and Opposition make no attempt to even acknowledge that there might be room for improvement - and that's what worries me (that and the fact that Cameron's ring-fenced the NHS budget). At this rate, I won't be voting for the Cons at the next GE - which leaves me floundering because I've known no other way since I was eighteen. Thanks again for the video.
Best post ever Subrosa - you're very erudite when you're pissed off. Well done.
Anything but anything Labour do is ruined by their grotesque ideology of control and power. The NHS is no different. Politcal before caring, Labour before patients.
It's a shame GV, because Cameron could have used Hannan's comments in a positive way by saying the tories would provide a better system of healthcare which would provide better results, but he chose the negative angle. I sympathise with you.
Thank you scunnert, I appreciate the compliment. x
But OR what is Cameron playing at? Hannan is right really, the labour party use the NHS as their example of perfection socialism and it's not.
You will also get a private room in Germany as opposed to finding yourself in a crowded mixed-sex ward.
If Cameron was keeping what Dan Hannan said under his hat until after the election then his cover has been blown. Although he has said that NHS funding will be ringfenced, he has not said how the money would be spent. Sacking all of the unnecessary, interfering bureaucrats and spending the money that is saved on front line services would be a good start, but he can't say that for now and all the work he has done in getting the public to trust the NHS to the Conservatives may well have been blown out of the water by one careless interview.
On the other hand, of course, he may not have intended that at all and I'm giving him too much credit for being a REAL Conservative underneath the electioneering PR.
Completely agreed on the German health system.
The provision side is more or less perfect (for a given restriction on overall cost).
I'd have a minor quibble on the funding side. The insurance is basically a high tax on employment income (about 20%) with a cap of about £30,000, so it's semi-regressive rather than progressive but hey, that's a different topic.
I think it is safe to say the snp Government will completely and totally reject everything you have said about the NHS.
I do agree Mark but there was talk, before the Wall came down, that a progressive heathcare system would be installed.
As you're aware, West Germany had to take on another country the same size as themselves and the improved system fell to the wayside because of the problems it caused.
I think Germany will, in the near future, commence debate about a more progressive heathcare programme now that the reasonably successful integration of the East has occurred.
BS, Cameron missed a superb chance to explain to the UK public how a 'new' heathcare system could benefit them. Then again perhaps he doesn't have a policy on it and that's shown by his attitude to Dan Hannan's comments.
If Cameron came out with a strong idea of how to radically change the NHS for the better, he would win many thousands of votes. It's only the people who accept second best in everything who would vote for any other party.
Of course there are quite a few who are used to second best with labour governments.
Of course they will Niko, that doesn't surprise me. But then again I'm not a party member and I think for myself.
Aye OK, things can be better done, and perhaps if the NHS were able to shake off the auditor general (a bit like the witch finder general if you delve into it) and focus on delivery of the results that REALLY mater, then without wholesale reconstruction things could be massively improved.
Have a look at this site that could point to massive improvements without much more input: http://www.systemsthinking.co.uk/home.asp . Look up his newsletter to see how people can release vast improvements but measuring the wrong thing leads to stifled promises and increased costs
Lets not prevaricate……..I’ve paid a NI stamp all my life, and for that, me and mine have been looked after from my own beginnings to that of my impending grandchild. Private Health care…..no danger. This is a clear instance where the public pot does a good job, Return to the days of having to pay to visit the doctor…..aye right!
I'm not advocating a return to paying for the doctor Dram, I'm suggesting perhaps it's time healthcare funding was taken out of government control and money put in the control of expert financiers. Yes I know such people aren't popular at present but none has caused harm or is in any way in difficulties in Europe.
I don't disagree the public pot does a good job but it could be SO much better. Speak to healthcare workers ad listen to their frustrations. Think about the amount of healthcare than is provided by charities with donations from the public.
Pop over to the likes of Belgium, France and Germany and see the standards there. People don't have to sit and wait for weeks to see if they really have cancer, they're seen within days.
Labour governments have lulled us into believing we get the NHS cheap and that's nonsense. It possibly works out as expensive as any European system but of course we'll never see the real figures because labour think the NHS is 'their' baby. It was, it's now a grumbling, aching pensioner.
I think this is your best post ever SR.
The NHS in Scotland is miles behind that which is provided in France, German, Belgium and the Scandanavian countries. I understand it is even worse in England.
I've just had my first ever experience of hospital with Ninewells in Dundee and the Royal Infirmary in Edinburgh. In most cases the staff were superb, but the little mistakes that were made because of failures in communication and overworked staff were scary. (Additionally Ninewells is filthy!)
Despite the money that has been thrown at it over the past 12 years the NHS leaves a great deal to be desired.
All that said, I wouldn't like to be American, and on the receiving end of their healthcare... well, not unless I had Dick Cheney's money.
The NHS needs reforming. Lessons could be learned from better practice in Europe, and this could have been Cameron's opportunity to shine, and at the same time to reassure us that under the Tories we will be able to access health care free at the point of delivery.
He failed badly.
Awe Tris, that's so kind of you to say.
Many of the staff are superb but the best ones are leaving to work in the US, Australia, New Zealand and some, with language skills, to Europe. Staff morale is so low and has been for years.
Ninewells is filthy but so are most hospitals if look beyond the never-endingly shined floors and the fancy bed curtains. They're all dirty because basic cleaning skills aren't used - by that I mean elbow grease. It's thought that chemicals will do the work instead.
First time i've seen this mutual backslapping session. The first 5 minutes was about the G20 summit and has to my mind completely mis-read the whole situation in that I think Obama is the driver for continental Europe style regulations in the finacial markets, Brown is the roadblock for this.
Regards health, what Hannan has said is true, but as i have pointed out in my own post, it is the Thatcherite believers who have caused a lot of the problems with the NHS. I note as well Hannan used the word "Market" when referring to doctors, our health service should be a service not a commodity like furniture or food or anything else bought and sold.
As for your post, it is a very good post. I have no recent experience of the NHS (having had a lot of experience of it during my childhood, see my post on this), and i will defend it, but it is not without serious flaws, which you have done a sterling job of outlining here. I think a lot of the flaws can be attributable to Conservitive and New Labour attempts to privatise the system through the back door, for example sub contracting cleaning services, the internal market system and New Labours initial obsession with targets. My partner does have a lot of experience of the NHS though and she has said many of the same things that you have said here, especially the point about there being more mangers than necessary. On your point about scans, she has to ask for an MRI scan from her specialist after relapses. Sufferers of MS in the US i have been lead th believe get scans annually, and seem to be much more advanced with certain treatments for this and other diseases.
In a lot of respects the US system is more advanced than our cut price NHS (the money probably is going into those management paypackets and the black hole called PFI), however it is not a universially available system. This is at the moment the only criteria where the NHS is ahead of the American system, and it is this which Obama is trying to sort out.
I don't mind the use of 'market' regarding healthcare Allan, after all it is a supply and demand service.
You make a great point mentioning the 'tinkering' of labour and the tories - feeble attempts to copy other European countries which provide far higher standards but not enough courage to change for the better.
Isn't it sad your partner doesn't get the same care as say the US and very possibly many other countries? Why are we prepared to accept sub-standard heathcare? (That isn't a criticism about staff btw).
Any money that goes into the NHS is creamed off by the top 10% and it never even reaches the middle, far less the patient base.
Thanks for the comment Subrosa.
I would actually venture to suggest that we are encouraged/bullied into accepting second best. From call centre's who ask you to stop shouting down the phone (even if you are not shouting), lawyers who do not do their job, police who do not know the law to to doctors who label patients as problem people if they question diagnosis (and boy can my partner give examples of this, as I think quite a lot of people can, but are too afraid). There is a culture in public life where the quest for a better service is actively discouraged.
Indeed we are Allan. We have been 'social engineered' so accept what's give/told to us and nothing more. This would never have happened in my grandparents time or we would never have improved from Victorian times, although since then we have been controlled.
The problem with public life is that there are no parameters for inadequacy or just pure incompetence. I've know unions to protect those and to ignore the professional employees who need help. Too often I'm afraid, hence my distrust of unions.
S, "As you're aware, West Germany had to take on another country the same size as themselves"
West Germany, one of the richest countries in the world with a population of sixty million took on East Germany, with a population of sixteen million.
Also, their health system might have changed since I left in 1993 (but what I remember is much the same as what you describe above).
I've never said the NHS was perfect, but it isn't bad given that it gives universal access to treatment.
Two positive examples from recently:
my poor niece who also has glandular fever (nothing to do with me, honest)got her blood results and diagnosis within 4 hours
she came to stay with me cos she was really sick and her mum was on a course. I had to speak to my GP about her. He did the necesssaries for her and a while later phoned me to tell me that something else needed doing for my husband and could he get in touch. Pretty good service, especially as the initial issue had been my husband's mistake not the practice's.
I may be lucky but it's always come up trumps for me. Of course it has its problems and needs change but those problems are mostly down to the aftermath of Tory underinvestment and the natural Labour collectivist approach. Some fairly robust tweaking and it should deliver better as it needs to.
This is a service which has provided me with the drugs I've needed at minimal cost, has immunised my daughter from all sorts of diseases at no additional cost to me, which has provided the liberation of free contraception which is particularly important to women and which I fervently believe enabled me to know my grandparents.
My husband's father was a GP pre NHS and had to turn away people because they couldn't afford to pay. He found it very hard to deal with the fact that poor people died when there were drugs to save them.
I don't think any other model in the world can match the universal provision and the range of provision of our NHS.
Fair enough Mark about the numbers, but they also integrated (or did their best to) a different culture without their healthcare system collapsing. Yes, I know they still have problems, but none appear to be in healthcare.
I don't think it has changed too much Mark. It's a simple, effective system where the money trickles right to the bottom and without the numerous 'creamers' we have in the NHS.
Hi Caron. What European country does not give healthcare to all their people?
If you mean by universal treatment world-wide treatment I think that's wrong. I think only the population of a country should receive treatment free at the point of delivery and all others who wish treatment in the UK should pay. I know many do not though.
Caron I don't see any underinvestment in the NHS, I only hear about waste and that's from those who work within it at the sharp end.
You are obviously very happy with the NHS and I'm not. I don't think the vast sums of money thrown into it are used wisely. If we had a better system (and let's not forget we have some of the worst results in Europe and even further afield), then we could have a superb health service. We have the talent although it is leaving our shores at a rate of knots because it's so unhappy.
I remember my parents telling me they had to pay 2/6d to get a doctor out because I had chickenpox and they didn't know what was wrong. Of course I'm not saying we ought to go back to these times, but we both know that there are still poor people who don't get the drugs they need to save their lives.
If only politicians came up with a way of funding our healthcare without them insisting on boxes being ticked. If they would only keep there noses out of an organisation which has a staff with specialised knowledge and skills.
If only...
Caron, a wee statistic for you from the World Health Organisation.
'Britain is ranked 15th best in Europe and 18th in the world'.
http://en.wikipedia.org/wiki/Healthcare_in_the_United_Kingdom
Doesn't that make you wonder why 14 other European countries are providing better healthcare for their people?
Hi Rosa - I think we are furiously agreeing. John Seddon and his sytems thinking people have demonstrated time and again that by measuring the wrong thing and developing "lists" and "Tick in the box" mentality you demotivate the staff, add in hugh costs and inefficiency. I'd like to let Seddon lose on the NHS but as he says - the biggest bar to progress is the Audit commision busy measuring the wrong stuff. Seddons work in local government is an eye openner. I'm with you, out with the timewasting management mumbo jumbo and in with a more efficient and effective direction. Give the staff some simple tools and they'll transform performance. If everyone who read this blog would only repeat this mantra "measures drive behaviours" every time they hear people chuntering on about "we should measure this and that and the other" then ask the question why and make them think through why they need to do it. As soon as you invent a list, people will manipulate and cheat to get the result they want. The NHS is in the clag because most of the time it performs agaist duff targets.
Anyway - having said that I'm away for a line down - I'm feeling better now
Many thanks for that Dram. You're absolutely right of course.
I do hope others read this thread.
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