Main Edition
US
FR
The social contract has been ripped up (Lynsey Addario/Getty Images)
Every day, we’re told that the NHS is collapsing. It’s failing the sick and wounded at their hour of greatest need, leaving frail old people lying for hours without an ambulance, farming out patients to care homes, and forcing the chronically sick to wait years for treatment that would enable them to get on with their lives. But is this true?
Yes, I am afraid it is. I wish I could give you a more optimistic take, and embrace the prospect that swift action can turn around the dire state of the UK’s National Health Service, but the data doesn’t lie.
“This is obviously a crisis, but we have been in crisis for a very long time,” a doctor friend told me yesterday, when it was announced that strikes by NHS staff will go ahead this month. As became clear during the pandemic, the NHS has not been able to cope with normal levels of demand for years. Even before Covid struck, one in five A&E patients were not seen within four hours, while the waiting list for non-urgent treatment had grown by 50% in the previous five years.
Today’s stories of patients waiting in ambulances for hours to be admitted should sound familiar. We heard them in 2018, with the same warnings of inevitable harm to patients, both those in the ambulances, and those waiting in vain for an ambulance to come to them. Patients were already dying in ambulances, waiting for transfer into hospital, in 2021.
The British Medical Association, attacking the Prime Minister’s “baffling lack of urgency” in addressing the crisis, says that “retaining and regrowing the workforce… is our way out of this mess”. Nurses’ leaders have also pointed to understaffing as one of the reasons for their industrial action, with pay levels falling behind inflation for the past decade as one cause of that understaffing. But while it’s true that NHS spending has increased year on year since 1997, it has done so more slowly than in comparable countries.
As early as 2013, the UK was already spending less than any other G7 country except Italy on healthcare. In 2017, when France spent £3,737 per head, and Germany £4,432, we spent £2,989. In the same year the BMJ compared the NHS to healthcare in nine other high-income countries, and found the lowest per capita spending, lowest ratio of doctors and nurses to population, and below average patient outcomes in cancer survival, life expectancy, and some types of stroke and heart attack. But throwing government money at the problem now will not turn around a collapsing system overnight. Long-term refusal to deal with problems cannot be wiped out with short-term, high-profile initiatives.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeThe irreproachable St Polly of Toynbee launched into the same topic the other day with her customary impartiality and rigour – setting up the premise of her article with the sort of neutral, searching question one has come to expect of this paragon of journalistic objectivity:
“Who do you believe: the brilliant NHS staff who treated my cancer, or ministers who spin and lie?”
Catnip to the Guardian faithful. But none stopped to consider that the answer to Polly’s question was that they might both be right.
The “brilliant NHS Staff” are saying they need more money – They’re right.
Politicians are pointing out that the NHS cannot go on requiring ever more money to be poured into it, that we cannot afford it. They too are right.
Even Wes Streeting admits the system is broken. If a Tory says such a thing they will be dismissed by the media and accused of hating nurses and wanting to sell off the NHS or some such nonsense, but when a Labour Health Sec says it then maybe even the Guardian should sit up and take notice.
Why is it that, when looking at a Govt’s record on Health, journalists reporting on the NHS only ever focus on inputs, rather than outcomes? A Govt’s health policy is only measured by what monies they make available rather than the outcomes the NHS delivers.
We want a Health service to achieve better outcomes, surely? If we can do that by more efficient means, then we should.
The UK media, of both left and right, routinely praise the German model – and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy – it steers a path (in broad terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation – and that is that if the Govt tried to copy, say, the German Healthcare model in this country then Ms Toynbee, the Guardian and the BBC would go into meltdown as all their fevered dreams of “selling off the NHS” would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories want to destroy the NHS. They may have different ideas about how to improve it, and some of their ideas have certainly been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform – AND IT DOES – then we’ll get no closer to a solution. We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
The BBC & Guardian have railed against private healthcare contracts as the “tide of privatisation.” But the NHS has for many years outsourced a variety of services – in fact spending on private outsourced services rose faster under the last Labour Govt than under the coalition or Tories, but why let facts get in the way of the narrative?
Under the coalition Govt, which is when this argument really hotted up, we are actually talking about a growth from 4.5% to less than 6%. Hardly an earth-shattering increase. Yet (from both sides – and most particularly the media) the issue is weaponised to the point that no Govt dares touch it, dares even to suggest that a major reform of the whole funding model is the only thing that will save it.
I’m a huge supporter of the NHS – which means I want it to reform so it can survive.
People who pretend the NHS can limp on needing vastly more money year on year just to try and stand still do not really support the NHS. What they say they wish for, will surely bring about its demise.
Polly in her mosr recent screed glibly suggests – The government ignores the one quick fix for the NHS: good funding and decent pay for social care. For someone who has been writing about the NHS for so long that seems a childishly simple view, and one that cannot withstand the mereset scrutiny.
Would the NHS be better if more money was spent on it? In the short term, and if it was targeted, then of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term – not simply look good for whoever is currently in No 10, who’ll get the plaudits whilst saddling future generations with the cost.
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally – unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of those “brilliant NHS” workers and worthy of a C21st developed nation.
Excellent analysis, and the key point which i think emerges is that the NHS is failing because it’s politicised.
If, as seems likely, the next government is led by Keir Starmer, it’ll be interesting to see if anything changes whatsoever. It’d probably take a Labour administration to make the necessary structural changes, as the only party with the political capital to do so. We’re at the point in history when that change has become an imperative. I wonder what Toynbee would make of it, except i can’t imagine for one moment that Starmer would have the courage to initiate that change, to something closer to the more successful models. He’ll most likely just spend his time in office blaming the mess on his predecessors, and so on ad infinitum.
Exactly right.
But I’d go further than saying “the NHS is failing because it’s politicised.”
It has become almost an impossibility for any politician to criticise “Our NHS”, particularly to their core audience, whose devotion to the NHS borders on the religious.
The NHS model worked very well for quite some years. At its inception the boast that it was “The Envy of the World” might even have had a grain of truth to it. It was certainly the envy of those people around the world that couldn’t afford the level of care that British citizens were able to call on.
But we are now 74 years down that road. The system that was introduced in 1948 was workable in 1948 and for quite some time after – but that time is long past. In its current guise – and with the entirely changed demographic it seeks to serve – the NHS is no longer delivering on its promise and no amount of extra funding will address that fundamental shortcoming.
Tackling the criminal waste and inefficiency of this organisation is key – and introducing elements of privatisation, or charging monies for certain aspects NEED to be part of the equation if the NHS is to survive, yet that self-evident truth is lost in the political blame game. At every election I’ve ever witnessed, voters are exhorted to “SAVE THE NHS” by voting Labour because those hated Tory Scum are planning to sell it off or otherwise destroy it. Given that the Tories have been in power for probably twice as long as Labour in the post war period and the NHS is still with us, either the Tories are really bad at this whole ‘selling off the NHS’ policy or it is simply not true and is just a rather crude, dog-whistle message that Labour knows will play well to those who don’t stop to think about it for more than a second.
But the NHS is such a sacred cow that Govts run shy of actually fundamentally shifting the model. The supposed “root and branch” reforms of the last 30 years have only really tinkered in the margins because any Govt knows that a genuine reform would engender so much negative publicity and criticism that they’d hand their opponents the keys to No 10.
Of the friends I have in the NHS (several GPs and one Hospital Trust Administrator among them) not one – NOT ONE – thinks the current model has a hope of lasting in the long term.
Why is it that the bien pensants of the liberal left are always praising the “social democratic” model of “our EU partners” and yet when it comes to the NHS we should not even try to emulate any of the EU models of healthcare – which have a significant private sector input?
Why, if the NHS is such a shining beacon to the world, is it a model that is copied by absolutely no one else?
In 1948 the Labour Government – bless – thought that after a few years the cost of the NHS would decrease because the country would be so much healthier.
Very true. Bevan was aghast when he realised that that was wrong, and that people were using more and more medicine, doctors, nurses, treatments etc
Very true. Bevan was aghast when he realised that that was wrong, and that people were using more and more medicine, doctors, nurses, treatments etc
No one has mentioned that, if you are any sort of professional, the NHS is just a terrible place to work. Nothing about the proliferation of managers and other hangers on. It is a corrupt self-serving system.
Well said!
Well said!
The NHS may not have been sold off but the ongoing reform to every aspect of management, introduction of the internal market and procurement have complexified things so we now experience an ongoing battle between professionals and management, with associated bean counters as an inherent part of our system. There is no easy solution funding or otherwise but I am sure that improving social care and public health initiatives will greatly ease demand in the wider context and reduce burden on NHS provision. Debate about the causes of the increasingly severe numbers of acute and chronic mental health crises, especially affecting young people, supporting people for 20 years after they have been shot or broken their spines in a skiing accident, and just knowing how many millions is being spend on round the clock care for these individuals, not to mention the drain on workforce is worth highlighting. Then of course those middle class people who are really good at challenging eligibility for free healthcare for their relative who has dementia v those who haven’t got a clue. Lack of suitable housing which has stymied the brilliant initiatives 20 years ago which enabled people to receive complex care at home rather than in hospitals or being bunged off to sad care homes, all these pressures add up. What we need is a debate about the NHS as it has become embedded in our society as a solution for all ills, as the Police are also now being used and are similarly now dysfunctional. We now need to invest in the community in terms of decent housing, not all owner occupied, social care and civic infrastructure which all act as preventers of poor health- there is plenty of research to show this. The NHS can then concentrate on what it is brilliant at which is healthcare and clinical research.
In 1948 the Labour Government – bless – thought that after a few years the cost of the NHS would decrease because the country would be so much healthier.
No one has mentioned that, if you are any sort of professional, the NHS is just a terrible place to work. Nothing about the proliferation of managers and other hangers on. It is a corrupt self-serving system.
The NHS may not have been sold off but the ongoing reform to every aspect of management, introduction of the internal market and procurement have complexified things so we now experience an ongoing battle between professionals and management, with associated bean counters as an inherent part of our system. There is no easy solution funding or otherwise but I am sure that improving social care and public health initiatives will greatly ease demand in the wider context and reduce burden on NHS provision. Debate about the causes of the increasingly severe numbers of acute and chronic mental health crises, especially affecting young people, supporting people for 20 years after they have been shot or broken their spines in a skiing accident, and just knowing how many millions is being spend on round the clock care for these individuals, not to mention the drain on workforce is worth highlighting. Then of course those middle class people who are really good at challenging eligibility for free healthcare for their relative who has dementia v those who haven’t got a clue. Lack of suitable housing which has stymied the brilliant initiatives 20 years ago which enabled people to receive complex care at home rather than in hospitals or being bunged off to sad care homes, all these pressures add up. What we need is a debate about the NHS as it has become embedded in our society as a solution for all ills, as the Police are also now being used and are similarly now dysfunctional. We now need to invest in the community in terms of decent housing, not all owner occupied, social care and civic infrastructure which all act as preventers of poor health- there is plenty of research to show this. The NHS can then concentrate on what it is brilliant at which is healthcare and clinical research.
It’s true there could be quite a bit of advantage to moving to a western European equivalent of Social Insurance and better alignment of public hospitals with local govt as they have too. In many regards it would still be a direct tax though we’d all see on payslips etc, but better hypothecated and less chance politicians interfere. But that tax, short term at least, would look like a rise as you’d move it from more indirect taxation.
The problem is much like that Tories have grappled with on Social Care for 13yrs. Most know what needs to be done, the Dilnot report was extremely thorough etc. But our politics is too myopic and politicians worry more about short term electoral prospects. Everyone though has some responsibility for this – the yah-boo commentators, the media and ourselves as voters I guess.
Maybe it’s only when real crisis occurs we face up collectively to what must be done differently. Hopefully so.
Is it not also true that the NHS achieved remarkable things during the pandemic (e.g. faster vaccination than any of the EU countries?). If so, does that not mean that a centralised system does have significant advantages on occasion over a decentralised one?
Can’t say that Stephan – it’s not permitted by the Unherd bubble lol
Vaccinating the population is. not remarkable and as I understand it this was a success because it was organised outside Government.
If the response of the NHS should be remembered for anything it should be Tik-Tok videos of dancing NHS staff and the outrage that greeted the posting of videos showing hospitals ad deserted as our schools
I have a friend who was ward sister on a respiratory ward – she got Covid twice and had to be signed off with PTSD. I doubt that she would be impressed by your facile bullshit.
Vaccines were developed by publicly-funded academic research, and administered under the auspices of the NHS. It was indeed a remarkable achievement.
So AZ, Pfizer, Moderna et al had no skin in the game and took no commercial risks?
Obviously they did – I don’t know about taking much of a risk though.
Not much risk in knocking up a product that government mandates every citizen must have.
Plus thousands of volunteers
Obviously they did – I don’t know about taking much of a risk though.
Not much risk in knocking up a product that government mandates every citizen must have.
Plus thousands of volunteers
Not vaccines, and didn’t do much for most of the population. Largely a huge scam to transfer public money into corporate hands.
In what way are these vaccines not vaccines, and what can you show me that says that they didn’t and don’t work?
Of course he can’t. He’s seen the light and the likes of you and me are ignorant sheeple, not worth bothering with.
Bivalent boosted yet?
Bivalent boosted yet?
At least these vaccines stopped people dying from covid and did reduce infection rates somewhat. I suppose that the sudden decrease in mortality from covid after the introduction of vaccines was a coincidence?
Of course he can’t. He’s seen the light and the likes of you and me are ignorant sheeple, not worth bothering with.
At least these vaccines stopped people dying from covid and did reduce infection rates somewhat. I suppose that the sudden decrease in mortality from covid after the introduction of vaccines was a coincidence?
In what way are these vaccines not vaccines, and what can you show me that says that they didn’t and don’t work?
So AZ, Pfizer, Moderna et al had no skin in the game and took no commercial risks?
Not vaccines, and didn’t do much for most of the population. Largely a huge scam to transfer public money into corporate hands.
Actually the administration of delivering the vaccine into folks arms was an NHS task done well.
The task of generating the UK vaccine in first place was a joint scientific/NHS/Industry achievement with Kate Bigham the maestro who pulled it together.
And the thousands of volunteers day and night?
And the thousands of volunteers day and night?
I have a friend who was ward sister on a respiratory ward – she got Covid twice and had to be signed off with PTSD. I doubt that she would be impressed by your facile bullshit.
Vaccines were developed by publicly-funded academic research, and administered under the auspices of the NHS. It was indeed a remarkable achievement.
Actually the administration of delivering the vaccine into folks arms was an NHS task done well.
The task of generating the UK vaccine in first place was a joint scientific/NHS/Industry achievement with Kate Bigham the maestro who pulled it together.
The NHS is now reaping the costs of that very fast jab campaign that lacked the very basics of safety scrutiny, such that there were more reported adverse events in the first year of the Covid jabs re the Yellow Card system than in the previous 40 combined. Also, as what’s done in the first 72 hours following first symptoms of a virus is key to subsequent well being, such as the administration of antivirals, what the hell was the NHS doing with it’s lame ‘go away and see if things get worse’ response?
It’s reaping the benefit of a combined flu and RSV epidemic together with the long waiting lists caused by covid. The vaccines have nothing to do with it. Stop believing everything you see on GB News and YouTube.
I don’t believe that GB News or YouTube has any control over the data to be found on VAERS or the Yellow Card adverse event reporting systems. Covid didn’t cause long waiting lists – poor decision making by people, many with ties to the pharmaceutical industry, were the root cause here. As for RSV, before the 1950s, people weren’t subject to this virus – it was imported from about 200,000 chimpanzees shipped in from Africa to take part in the early polio vaccine trials, many conducted by Jonas Salk himself. He alone caused the death of about 17,000 chimpanzees, and was ultimately responsible for introducing the human race to this respiratory virus.
I have read the reports of potential adverse events and would remind you that the publishers point out that association is not causation and that when millions of people are involved, uncommon events are bound to happen by chance. There has not been a massive increase of deaths because of the vaccines full stop.
With regard to chimpanzees, the virus was first detected in them but was actually common long before that time in Humans. Please read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154630/
I have read the reports of potential adverse events and would remind you that the publishers point out that association is not causation and that when millions of people are involved, uncommon events are bound to happen by chance. There has not been a massive increase of deaths because of the vaccines full stop.
With regard to chimpanzees, the virus was first detected in them but was actually common long before that time in Humans. Please read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154630/
I don’t believe that GB News or YouTube has any control over the data to be found on VAERS or the Yellow Card adverse event reporting systems. Covid didn’t cause long waiting lists – poor decision making by people, many with ties to the pharmaceutical industry, were the root cause here. As for RSV, before the 1950s, people weren’t subject to this virus – it was imported from about 200,000 chimpanzees shipped in from Africa to take part in the early polio vaccine trials, many conducted by Jonas Salk himself. He alone caused the death of about 17,000 chimpanzees, and was ultimately responsible for introducing the human race to this respiratory virus.
It’s reaping the benefit of a combined flu and RSV epidemic together with the long waiting lists caused by covid. The vaccines have nothing to do with it. Stop believing everything you see on GB News and YouTube.
Vaccines that no-one needed and may be related to the sudden increase in strokes and heart attacks?
Has there been a sudden increase in these two? Mortality has certainly increased, but I should think that hospitals closing and subsequent issues with ambulance delays may be more important in the increase in mortality. Do you have any evidence that more people are suffering from these two events, or are you relying on the mortality figures to guide you?
Has there been a sudden increase in these two? Mortality has certainly increased, but I should think that hospitals closing and subsequent issues with ambulance delays may be more important in the increase in mortality. Do you have any evidence that more people are suffering from these two events, or are you relying on the mortality figures to guide you?
Can’t say that Stephan – it’s not permitted by the Unherd bubble lol
Vaccinating the population is. not remarkable and as I understand it this was a success because it was organised outside Government.
If the response of the NHS should be remembered for anything it should be Tik-Tok videos of dancing NHS staff and the outrage that greeted the posting of videos showing hospitals ad deserted as our schools
The NHS is now reaping the costs of that very fast jab campaign that lacked the very basics of safety scrutiny, such that there were more reported adverse events in the first year of the Covid jabs re the Yellow Card system than in the previous 40 combined. Also, as what’s done in the first 72 hours following first symptoms of a virus is key to subsequent well being, such as the administration of antivirals, what the hell was the NHS doing with it’s lame ‘go away and see if things get worse’ response?
Vaccines that no-one needed and may be related to the sudden increase in strokes and heart attacks?
Is it not also true that the NHS achieved remarkable things during the pandemic (e.g. faster vaccination than any of the EU countries?). If so, does that not mean that a centralised system does have significant advantages on occasion over a decentralised one?
The NHS if failing because of the fundamental flaw that it was set up to serve the interests of the people who work in it and not the patients
I doubt that the GPs of 1947 would agree with you.
They would undoubtedly agree with him. As Nye Bevan famously said, in order to get the GPs to agree to join the NHS he had to “stuff their mouths with gold”.
I think the ‘stuff their mouths with gold’ remark refers to consultant distinction awards that GPs have never received.
I think the ‘stuff their mouths with gold’ remark refers to consultant distinction awards that GPs have never received.
To my eternal shame i once worked in the NHS so I know whereof what I speak
They would undoubtedly agree with him. As Nye Bevan famously said, in order to get the GPs to agree to join the NHS he had to “stuff their mouths with gold”.
To my eternal shame i once worked in the NHS so I know whereof what I speak
Yes, I keep applying for the post of Head of Wellbeing on a salary of £120,000 and tell them I’m well and being of sound mind and vote Tory but get no replies
I doubt that the GPs of 1947 would agree with you.
Yes, I keep applying for the post of Head of Wellbeing on a salary of £120,000 and tell them I’m well and being of sound mind and vote Tory but get no replies
True – UK politics is great stand up material for EU countries. Who runs the hospitals? Surgeons? Nurses? (rich white kid from Oxbridge, studied politics) Prisons? (er, same) Schools (er….) and so on. Also riffs on “Dog Licence” and “TV Licence” get great laughs in southern and eastern Europe. The amazing thing is the politicos and their civil servants actually believe they can run hospitals, prisons etc. Normal people realise how long it took them to mast er their profession they understand there’s no simple answer to complex problems. At least we have parts of the NHS suitable for our political class- Broadmoor and Rampton for instance.
Exactly right.
But I’d go further than saying “the NHS is failing because it’s politicised.”
It has become almost an impossibility for any politician to criticise “Our NHS”, particularly to their core audience, whose devotion to the NHS borders on the religious.
The NHS model worked very well for quite some years. At its inception the boast that it was “The Envy of the World” might even have had a grain of truth to it. It was certainly the envy of those people around the world that couldn’t afford the level of care that British citizens were able to call on.
But we are now 74 years down that road. The system that was introduced in 1948 was workable in 1948 and for quite some time after – but that time is long past. In its current guise – and with the entirely changed demographic it seeks to serve – the NHS is no longer delivering on its promise and no amount of extra funding will address that fundamental shortcoming.
Tackling the criminal waste and inefficiency of this organisation is key – and introducing elements of privatisation, or charging monies for certain aspects NEED to be part of the equation if the NHS is to survive, yet that self-evident truth is lost in the political blame game. At every election I’ve ever witnessed, voters are exhorted to “SAVE THE NHS” by voting Labour because those hated Tory Scum are planning to sell it off or otherwise destroy it. Given that the Tories have been in power for probably twice as long as Labour in the post war period and the NHS is still with us, either the Tories are really bad at this whole ‘selling off the NHS’ policy or it is simply not true and is just a rather crude, dog-whistle message that Labour knows will play well to those who don’t stop to think about it for more than a second.
But the NHS is such a sacred cow that Govts run shy of actually fundamentally shifting the model. The supposed “root and branch” reforms of the last 30 years have only really tinkered in the margins because any Govt knows that a genuine reform would engender so much negative publicity and criticism that they’d hand their opponents the keys to No 10.
Of the friends I have in the NHS (several GPs and one Hospital Trust Administrator among them) not one – NOT ONE – thinks the current model has a hope of lasting in the long term.
Why is it that the bien pensants of the liberal left are always praising the “social democratic” model of “our EU partners” and yet when it comes to the NHS we should not even try to emulate any of the EU models of healthcare – which have a significant private sector input?
Why, if the NHS is such a shining beacon to the world, is it a model that is copied by absolutely no one else?
It’s true there could be quite a bit of advantage to moving to a western European equivalent of Social Insurance and better alignment of public hospitals with local govt as they have too. In many regards it would still be a direct tax though we’d all see on payslips etc, but better hypothecated and less chance politicians interfere. But that tax, short term at least, would look like a rise as you’d move it from more indirect taxation.
The problem is much like that Tories have grappled with on Social Care for 13yrs. Most know what needs to be done, the Dilnot report was extremely thorough etc. But our politics is too myopic and politicians worry more about short term electoral prospects. Everyone though has some responsibility for this – the yah-boo commentators, the media and ourselves as voters I guess.
Maybe it’s only when real crisis occurs we face up collectively to what must be done differently. Hopefully so.
The NHS if failing because of the fundamental flaw that it was set up to serve the interests of the people who work in it and not the patients
True – UK politics is great stand up material for EU countries. Who runs the hospitals? Surgeons? Nurses? (rich white kid from Oxbridge, studied politics) Prisons? (er, same) Schools (er….) and so on. Also riffs on “Dog Licence” and “TV Licence” get great laughs in southern and eastern Europe. The amazing thing is the politicos and their civil servants actually believe they can run hospitals, prisons etc. Normal people realise how long it took them to mast er their profession they understand there’s no simple answer to complex problems. At least we have parts of the NHS suitable for our political class- Broadmoor and Rampton for instance.
Excellent comment. The endless reheated, partisan, simplistic rubbish from the likes of Toynbee are part of the problem. A health system that works best for everyone, from the poorest upwards, should be the sole consideration. A specific funding model dating from the 1940s should not be sacrosanct if it’s no longer fit for purpose. One thing everyone can agree on: this is now really urgent. But what government will have the courage and foresight to deal with it?
Excellent, Paddy.
Question is what do you ignore? Lots.
First its a Beveridge system where insurance, supply and regulation are combined. The recipe for a disaster. Solution is a Bismark system where those three legs are split
Second, you ignore the treat now pay later costs. Pensions
On social care again the cause of the mess is that socialist pension ponzi. People have been asset stripped so cannot pay for social care. The debts are too large for the tax payers to fund, so social care is screwed.
The next problem is the NHS as a religion. ie. If you lose the NHS, you will get the US system. Actually on the avoidable deaths count, that is an improvement. Instead go Swiss or Dutch, 1 or 2 in the world. The NHS doesn’t make divison one. Second you would be back in Victorian times. Yeah right, as if the rest of the wold is stuck there.
The NHS is dead as are significant numbers of its patients as a result of its treatment. But the victim pays.
You have hit the nail on the head and most sensible people would agree if only we could take the “politics”out of it!
I am afraid you are being illogical. The evidence clearly shows that the UK spends less on health care than other countries. A further problem is that the spending has fluctuated with above inflation increases over certain periods following by below inflation increases. On top of that there have been many attempts to reorganise the system in an attempt to increase efficiency.
The core problem remains insufficient, erratic funding and it seems perverse to focus on changing the system yet again before addressing the the funding issue.
One often missed area is primary care, where funding has been severely constrained. This chronic underfunding of GP services has had a particularly damaging effect by sabotaging preventative care and increasing the load on hospitals.
My wife and I are medical doctors and after austerity was introduced in 2010 we could see that the NHS was doomed. We took out private insurance for our family and will continue to rely on this. A two tier system is inevitable as long as we keep electing Tories.
The evidence shows the opposite. But I nowadays cant bothered to point out again and again the facts. See my earlier post.
Ah yes, Anton, those years of vicious Tory Austerity – by which you presumably mean those merciless and savage cuts that saw public spending wantonly slashed from £610 billion in 2015 to only £870 billion a year pre-Covid?
(I suppose it would be pointless to remind you that Alistair Darling was promising “harder and deeper” cuts in the run-up to the 2015 election?)
Rather than pretend it is only a question of underfunding, maybe you might consider the waste you (presumably) see around you in the NHS.
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem – and might lead Politicians and Health professionals towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all. Surely you would agree?
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis.
Spot on the nail Paddy. I really pity those who are so blinded by their love-fest with the NHS that they cannot see that fundamental reform is the only way to save it for future generations.
Agreed
Agreed
Spot on the nail Paddy. I really pity those who are so blinded by their love-fest with the NHS that they cannot see that fundamental reform is the only way to save it for future generations.
Two points:
We do not spend less on health care than major comparators, we spend more, for less effect; and
It is entirely logical to change the system because it delivers such poor results for such high expenditure
Don’t forget that the Private Funding Initiative well used by Tony Blair is still costing Health Trusts in England over £2 Billion in Interest payments a year and will continue to do so for many years to come.
Try reading this. We are in the same ballpark as most other countries: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=OE
The evidence shows the opposite. But I nowadays cant bothered to point out again and again the facts. See my earlier post.
Ah yes, Anton, those years of vicious Tory Austerity – by which you presumably mean those merciless and savage cuts that saw public spending wantonly slashed from £610 billion in 2015 to only £870 billion a year pre-Covid?
(I suppose it would be pointless to remind you that Alistair Darling was promising “harder and deeper” cuts in the run-up to the 2015 election?)
Rather than pretend it is only a question of underfunding, maybe you might consider the waste you (presumably) see around you in the NHS.
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem – and might lead Politicians and Health professionals towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all. Surely you would agree?
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis.
Two points:
We do not spend less on health care than major comparators, we spend more, for less effect; and
It is entirely logical to change the system because it delivers such poor results for such high expenditure
Don’t forget that the Private Funding Initiative well used by Tony Blair is still costing Health Trusts in England over £2 Billion in Interest payments a year and will continue to do so for many years to come.
Try reading this. We are in the same ballpark as most other countries: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=OE
John Pilger made an excellent documentary called “The Dirty War on the NHS”. Just google or YouTube for it.
Did the NHD pay for private treatment for its staff in those days?
Did the NHD pay for private treatment for its staff in those days?
Cracking post Paddy.
By the way, you wouldn’t happen to comment BTL at the guardian woud you? If you don’t already maybe give it a go – it would be a very wecome voice of sanity amongst all the drivel. (I would though estimate a very short spell until the censors shut your account down 🙂 )
I spent several years commenting on the Guardian site – (under the name LastOfThePelicans.) Sheer intellectual masochism on my part, I know.
In my mind (on my more optimistic days) I was on a mission to civilise – to persuade people that neither side is ‘evil’ – that the “other side” merely have a different approach to finding solutions. But on my more lucid days I probably realised it was a lost cause and I was merely shouting into the wind.
There are plenty of excellent, reasonable posters on the G, trying to introduce a reasoned counter-narrative, but they are ganged-up on and shouted down by the Guardian faithful, annoyed at the interruption to their daily 2-minute hate.
Eventually I was banned – not for anything I’d written per se, but for copying and pasting extracts from earlier Guardian articles where the author had taken a position 180 degrees out from the one they were currently espousing. The moderators didn’t like me exposing the elasticity of their writers’ principles and that their outrage might be put on, just a little bit. Polly Toynbee, Simon Jenkins and the ludicrous Marxist 3rd former, Owen Jones were, unsurprisingly, the worst culprits.
Not reading CIF every day has, for the last six months, been good for the soul.
I do recognise the moniker. Too bad for everyone else over at the G that they are now unable to enjoy your perspectives. Account shutdown seems very much an inevitability if the ‘journalists’ over there are contradicted too much.
I don’t doubt that last bit for a second!
Paddy, great stuff. You might want to give the comments section at The Spectator a whirl.You’d need to subscribe but the are some very cheap introductory offers so you could check it out.
Your well informed command of detail would be most welcome there. As with all commenting sections we have a small minority of fruitcakes for amusement, but it’s a fast moving and lively group.
Thank you. I’m already a regular poster at the Speccie – and have been for years – under the name “Finknottle” – (all my older posting accounts are PG Wodehouse references).
The Spectator posters are probably closer to my own way of thinking, so i get far less push-back. I don’t mind trying to make the case for a minority viewpoint – but i did find the Guardian exhausting simply due to the level of hate one receives if one dares to counter the prevailing G orthodoxy.
For all that you might encounter trenchant postions at the Spectator, it is as nothing when compared to the vitriol over at the Guardian.
Now that Quillette has died the ‘death of a thousand cuts’ (though that might be a typo) – the Spectator and Unherd are – in my humble opinion – the best, most reasonable commenting sites available, for those few of us that give a damn.
Thank you. I’m already a regular poster at the Speccie – and have been for years – under the name “Finknottle” – (all my older posting accounts are PG Wodehouse references).
The Spectator posters are probably closer to my own way of thinking, so i get far less push-back. I don’t mind trying to make the case for a minority viewpoint – but i did find the Guardian exhausting simply due to the level of hate one receives if one dares to counter the prevailing G orthodoxy.
For all that you might encounter trenchant postions at the Spectator, it is as nothing when compared to the vitriol over at the Guardian.
Now that Quillette has died the ‘death of a thousand cuts’ (though that might be a typo) – the Spectator and Unherd are – in my humble opinion – the best, most reasonable commenting sites available, for those few of us that give a damn.
This has also been my exact experience posting in the Guardian comments section.
When I read the Guardian there were plenty of intelligent comment highlighting the absurdity of many of the views expressed in the articles but increasingly anything that was directly critical of the stupidities advanced in the articles became deleted and eventually any articles that the Guardian knew would attract critical attention from previous experience disallowed comment altogether. I keep a wary eye on Unherd’s policies regarding comment.
I can imagine that quoting extracts from Guardian articles to expose the inconsistencies of the author’s views would be particularly provoking to the censors.
I keep reading Unherd not simply for the articles, and there are some excellent writers among some dross, but for the sort of intelligent detailed commentary you supply so regularly as well as many other commentors both intelligent and humorous.
I do recognise the moniker. Too bad for everyone else over at the G that they are now unable to enjoy your perspectives. Account shutdown seems very much an inevitability if the ‘journalists’ over there are contradicted too much.
I don’t doubt that last bit for a second!
Paddy, great stuff. You might want to give the comments section at The Spectator a whirl.You’d need to subscribe but the are some very cheap introductory offers so you could check it out.
Your well informed command of detail would be most welcome there. As with all commenting sections we have a small minority of fruitcakes for amusement, but it’s a fast moving and lively group.
This has also been my exact experience posting in the Guardian comments section.
When I read the Guardian there were plenty of intelligent comment highlighting the absurdity of many of the views expressed in the articles but increasingly anything that was directly critical of the stupidities advanced in the articles became deleted and eventually any articles that the Guardian knew would attract critical attention from previous experience disallowed comment altogether. I keep a wary eye on Unherd’s policies regarding comment.
I can imagine that quoting extracts from Guardian articles to expose the inconsistencies of the author’s views would be particularly provoking to the censors.
I keep reading Unherd not simply for the articles, and there are some excellent writers among some dross, but for the sort of intelligent detailed commentary you supply so regularly as well as many other commentors both intelligent and humorous.
I spent several years commenting on the Guardian site – (under the name LastOfThePelicans.) Sheer intellectual masochism on my part, I know.
In my mind (on my more optimistic days) I was on a mission to civilise – to persuade people that neither side is ‘evil’ – that the “other side” merely have a different approach to finding solutions. But on my more lucid days I probably realised it was a lost cause and I was merely shouting into the wind.
There are plenty of excellent, reasonable posters on the G, trying to introduce a reasoned counter-narrative, but they are ganged-up on and shouted down by the Guardian faithful, annoyed at the interruption to their daily 2-minute hate.
Eventually I was banned – not for anything I’d written per se, but for copying and pasting extracts from earlier Guardian articles where the author had taken a position 180 degrees out from the one they were currently espousing. The moderators didn’t like me exposing the elasticity of their writers’ principles and that their outrage might be put on, just a little bit. Polly Toynbee, Simon Jenkins and the ludicrous Marxist 3rd former, Owen Jones were, unsurprisingly, the worst culprits.
Not reading CIF every day has, for the last six months, been good for the soul.
Private treatment costs an arm & a leg here; my father’s knee replacement was £15,000, that’s a deposit for a small house. If it was say £3,000, then ordinary people could consider accessing treatment outside the NHS, but it isn’t and they can’t. I would gladly pay for treatment if it was affordable. Here in the UK, we have the worst of both worlds when it comes to access to healthcare.
What would make medical care affordable is free market competition, no insurance companies, no government monies. Fat chance.
You’re free to pay for your operation if you wish, you don’t have to use insurance companies so I fail to see how it’s not free market competition
You’re free to pay for your operation if you wish, you don’t have to use insurance companies so I fail to see how it’s not free market competition
What would make medical care affordable is free market competition, no insurance companies, no government monies. Fat chance.
The Tories despise the NHS on principle. It’d be very odd if they didn’t.
Absolute bullocks!
I’m an unapologetic Tory voter, and I have never, ever, despised the NHS, nor have I ever wanted to shut it down. Universal healthcare is essential to all those of us who cannot afford private healthcare. Destroying the NHS would be self-harm.
Do try harder to engage a few brain cells.
Absolute bullocks!
I’m an unapologetic Tory voter, and I have never, ever, despised the NHS, nor have I ever wanted to shut it down. Universal healthcare is essential to all those of us who cannot afford private healthcare. Destroying the NHS would be self-harm.
Do try harder to engage a few brain cells.
You compare superior German model with NHS poorer outcomes, citing growth in investment for NHS and implying that NHS failures are not about money at all. And yet, here are some facts most are unaware of.
Healthcare expenditure per person, 2017 (ons.gov.uk):
UK: £2,989
Germany: £4,432
France: £3,737
Sweden: £3,990
We spend on healthcare less per capita than any other developed European country.
Improving efficiency can only work to a degree, there are some fundamentals one cannot get around. In the UK in 2020 per 1000 population there are 3 physicians (versus 4.5 for Germany), and 2.43 hospital beds (versus 7.82 in Germany). (health.org.uk)
In fact, given how little NHS is funded comparing to Germany, one might argue that NHS’ results and efficiency are close to a miracle as they are.
None of what follows is to denigrate the work done by Doctors and Nurses. But half of the problem is the inability to be able to speak out against waste and inefficiency across the organisation, without someone accusing you of hating nurses or some such twaddle.
Taking the emotion out of the argument would be a start. Just look at some of the figures and see if you think them justifiable.
PFI, actually introduced under Major’s Govt as a way to take some capital spending off the books, was ramped up under Blair & Brown, who saw PFIs as a panacea for all additional spending they wanted to announce without having to fund it. Their “cure” turned out to be, in some cases, more dangerous than the disease.
Some hospital trusts are still spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal.
No wonder Blair & Brown found it easy to fund the NHS when they were putting future generations on the hook to cover the costs rather than paying for it out of the budget.
Of course we need an NHS to be properly run and that requires managers but when you see that over the Blair/Brown years the spending on managers in the NHS went from £189,922,000 in the 1997/98 budget to £1,041,803,000 in the 2009/10 budget, an increase of 449%, you have to ask, “Was that money well spent? Did it proportionally improve the service in any noticeable way?”
Waste and inefficiency in the NHS are scandalous….
But don’t take it from me – listen to Prof Keith Willett, medical director for acute care, who urged staff to stop “fuming” when the system “grinds to a halt” and instead do more to prevent beds being blocked by patients who should have been discharged.
He said too many surgeons were left unable to operate – sometimes on a daily basis – because of a failure to tackle bedblocking, with beds filled by those unable to discharged for want of help at home.
“To have highly skilled surgeons, anaesthetists and nurses sitting around waiting for patients is clearly a ridiculous waste of resources,” He told surgeons to stop “bemoaning” the problem and do more to solve it, with better planning to identify what their own patients need to be discharged swiftly. None of that requires extra resources.
“It will take a rearrangement of time and resource but nothing extra – except the willingness and time to think it through with colleagues” .
Try some of these figures ….
Spending £160 million per annum prescribing aspirin, paracetemol and ibuprofen – all of which can be bought by the recipient at a supermarket for a FRACTION of the cost.
Lord Carter in a report on NHS inefficiencies wrote “Most trusts ‘don’t know what they buy, how much they buy, and what they pay for goods and services’, .. If all the ‘unwarranted variations’ were eradicated, an astonishing £5 billion of the £55.6 billion spent annually by acute hospitals could be saved in the next three years, he concluded.
£220 million wasted each year paying over the odds for energy. Because no one cares to negotiate for the lower tarriffs on offer.
£430 million spent on management consultants
The list goes on and on ….
Paddy, I spent 15 years doing PFI projects. They get a bad press. Building a new hospital should be paid for by future generations. They last 20 – 25 years. The cost of capital was higher than state funding but that was the cost of transferring risks. Principally building hospitals to time and budget and providing long term maintenance and support services to a budget. Some contracts were a disaster, early contracts were expensive (a new market). A number of comlanies went bust from accepting those risks – they were very real.
Sadly I also had 15 years of experience of Government and NHS Trust procurement and I weep recalling some of the stupidity and waste. It turned me from a born socialist to a conservative.
Dr Thomas Sowell frequently tells the story of what turned him from a Marxist to a conservative – it wast working in a government department.
Dr Thomas Sowell frequently tells the story of what turned him from a Marxist to a conservative – it wast working in a government department.
Excellent arguments as usual. Just as an example of waste, I was in A/E with what turned out to be pericarditis. At one point my temperature spiked. The nurse said I’ll just give you some paracetamol for that. The next think she was injecting it into my IV line. I asked her why she had given me it intravenously rather than oralyl and she said she didn’t know, that’s what they always do. I don’t know the cost of IV paracetamol but I doubt if it’s much less than 100 times more expensive than the generic tablets. I shan’t detail the chaos on the overnight observation ward and the many failures that continued in the following 24 hours. Fortunately I wasn’t seriously ill and I managed to escape the following day.
Paddy, I spent 15 years doing PFI projects. They get a bad press. Building a new hospital should be paid for by future generations. They last 20 – 25 years. The cost of capital was higher than state funding but that was the cost of transferring risks. Principally building hospitals to time and budget and providing long term maintenance and support services to a budget. Some contracts were a disaster, early contracts were expensive (a new market). A number of comlanies went bust from accepting those risks – they were very real.
Sadly I also had 15 years of experience of Government and NHS Trust procurement and I weep recalling some of the stupidity and waste. It turned me from a born socialist to a conservative.
Excellent arguments as usual. Just as an example of waste, I was in A/E with what turned out to be pericarditis. At one point my temperature spiked. The nurse said I’ll just give you some paracetamol for that. The next think she was injecting it into my IV line. I asked her why she had given me it intravenously rather than oralyl and she said she didn’t know, that’s what they always do. I don’t know the cost of IV paracetamol but I doubt if it’s much less than 100 times more expensive than the generic tablets. I shan’t detail the chaos on the overnight observation ward and the many failures that continued in the following 24 hours. Fortunately I wasn’t seriously ill and I managed to escape the following day.
Sorry. There is much more up to date information available than 2017. Why did you choose that? Check ONs website that will show a completely different picture – bang up to date.
Because very often articles written in 2020 or later use statistics for 2017 or about for their graphs and tables.
I just checked the latest statistics available from OCED website – the article dated 2020 refers to statistics for “2019 or nearest year” and it is largely the same as I cited for 2017 – the UK spends less per capita on their healthcare than any other developed European country.
Because very often articles written in 2020 or later use statistics for 2017 or about for their graphs and tables.
I just checked the latest statistics available from OCED website – the article dated 2020 refers to statistics for “2019 or nearest year” and it is largely the same as I cited for 2017 – the UK spends less per capita on their healthcare than any other developed European country.
I would add to Paddy Taylor’s observations the fact that it is perhaps unsurprising that richer countries can afford to spend more on a better health system. The UK has fallen down the per capita income rankings – particularly given that we seem to have lost count of exactly how many people are drawing on the resources of the NHS.
A great conclusion to Paddy Taylor’s comment combined with my figures.
There is a perception that the UK is among the richest countries in Europe/in the world and people largely expect to have the same level of healthcare, education etc. as the best performing European countries.
The truth is we can’t really afford it.
A great conclusion to Paddy Taylor’s comment combined with my figures.
There is a perception that the UK is among the richest countries in Europe/in the world and people largely expect to have the same level of healthcare, education etc. as the best performing European countries.
The truth is we can’t really afford it.
None of what follows is to denigrate the work done by Doctors and Nurses. But half of the problem is the inability to be able to speak out against waste and inefficiency across the organisation, without someone accusing you of hating nurses or some such twaddle.
Taking the emotion out of the argument would be a start. Just look at some of the figures and see if you think them justifiable.
PFI, actually introduced under Major’s Govt as a way to take some capital spending off the books, was ramped up under Blair & Brown, who saw PFIs as a panacea for all additional spending they wanted to announce without having to fund it. Their “cure” turned out to be, in some cases, more dangerous than the disease.
Some hospital trusts are still spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal.
No wonder Blair & Brown found it easy to fund the NHS when they were putting future generations on the hook to cover the costs rather than paying for it out of the budget.
Of course we need an NHS to be properly run and that requires managers but when you see that over the Blair/Brown years the spending on managers in the NHS went from £189,922,000 in the 1997/98 budget to £1,041,803,000 in the 2009/10 budget, an increase of 449%, you have to ask, “Was that money well spent? Did it proportionally improve the service in any noticeable way?”
Waste and inefficiency in the NHS are scandalous….
But don’t take it from me – listen to Prof Keith Willett, medical director for acute care, who urged staff to stop “fuming” when the system “grinds to a halt” and instead do more to prevent beds being blocked by patients who should have been discharged.
He said too many surgeons were left unable to operate – sometimes on a daily basis – because of a failure to tackle bedblocking, with beds filled by those unable to discharged for want of help at home.
“To have highly skilled surgeons, anaesthetists and nurses sitting around waiting for patients is clearly a ridiculous waste of resources,” He told surgeons to stop “bemoaning” the problem and do more to solve it, with better planning to identify what their own patients need to be discharged swiftly. None of that requires extra resources.
“It will take a rearrangement of time and resource but nothing extra – except the willingness and time to think it through with colleagues” .
Try some of these figures ….
Spending £160 million per annum prescribing aspirin, paracetemol and ibuprofen – all of which can be bought by the recipient at a supermarket for a FRACTION of the cost.
Lord Carter in a report on NHS inefficiencies wrote “Most trusts ‘don’t know what they buy, how much they buy, and what they pay for goods and services’, .. If all the ‘unwarranted variations’ were eradicated, an astonishing £5 billion of the £55.6 billion spent annually by acute hospitals could be saved in the next three years, he concluded.
£220 million wasted each year paying over the odds for energy. Because no one cares to negotiate for the lower tarriffs on offer.
£430 million spent on management consultants
The list goes on and on ….
Sorry. There is much more up to date information available than 2017. Why did you choose that? Check ONs website that will show a completely different picture – bang up to date.
I would add to Paddy Taylor’s observations the fact that it is perhaps unsurprising that richer countries can afford to spend more on a better health system. The UK has fallen down the per capita income rankings – particularly given that we seem to have lost count of exactly how many people are drawing on the resources of the NHS.
You say: The “brilliant NHS Staff” are saying they need more money – They’re right.
I ask ”do they?” – £132 bn in 2016 and near £200bn today but they need ”even more money” – Money clearly hasnt solved the annual problems of the NHS being on its knees.
Forgive me, but are you not confusing Staffing costs with Operating costs?
The former exarcerbated by inflation-hit wage scales and the need for recruitment
The latter driven by myriad factors around changing demographics (not least, life expectancy) etc and made worse by chronic institutional waste and inefficiency.
I am neither referring to staffing nor operating costs – but the total sum spent on The NHS by the tax payer in each of those years I mentioned.
Check ONS for clarity.
Rob,
Not wishing to be argumentative but you do have to separate them out. They are very different considerations and you’re not being clear-eyed about the ongoing funding issues unless you approach both elements differently.
A balance must be struck or there is no way to allocate funds accordingly.
Rob,
Not wishing to be argumentative but you do have to separate them out. They are very different considerations and you’re not being clear-eyed about the ongoing funding issues unless you approach both elements differently.
A balance must be struck or there is no way to allocate funds accordingly.
I am neither referring to staffing nor operating costs – but the total sum spent on The NHS by the tax payer in each of those years I mentioned.
Check ONS for clarity.
Forgive me, but are you not confusing Staffing costs with Operating costs?
The former exarcerbated by inflation-hit wage scales and the need for recruitment
The latter driven by myriad factors around changing demographics (not least, life expectancy) etc and made worse by chronic institutional waste and inefficiency.
Dear Paddy, you analysis is likely technically correct but there is one elephant in the room: NHS stands for health service. It does very little to create health in the population. Of yes, it does preventative medicine = making diagnoses earlier but that is not the same as creating health. The NHS as much as our medical authorities (who should look a bit harder at themselves than shouting at the government) are caught in a model of ‘treating illness’ a model that serves an economy relating to illness : investment mainly in research that can provide financial returns. Health does not pay as it reduces illness = makes less money for the illness industry.
No country in the world can afford the current ‘modern illness care model with all its technical and other services attached to it’.
In stead of pumping money in the the current NIS (national illness service) which will suit de industry that helped building it, the government should pump money in providing good education and good living conditions and non-chemically grown and prepared food for the population. ALL evidence shows that the main causes for illness are: lac of education, lack of good housing, lack of good food, (these result in people having a purpose in life) . but investing in this does not suit the lobby…
I read in past week an article that said that pharmaceutical corps don’t want to create cures but treatments. If they develop something that cures they deprive themselves of years and years of income from treatments.
As for your main point, that the entire system is based on illness rather than health, I could not agree more. However, for profit corporations have much to answer for here. In Australia for example, moves by governments to label foods according to how good they are for health are stymied by food industry lobbyists.
I read in past week an article that said that pharmaceutical corps don’t want to create cures but treatments. If they develop something that cures they deprive themselves of years and years of income from treatments.
As for your main point, that the entire system is based on illness rather than health, I could not agree more. However, for profit corporations have much to answer for here. In Australia for example, moves by governments to label foods according to how good they are for health are stymied by food industry lobbyists.
“Only an idiot could imagine the Tories want to destroy the NHS.” Sadly an enormous amount of otherwise very sensible left-leaning people absolutely believe this to be the case. Saying that they’re all idiots just can’t be true, it would be like saying that everybody who voted for Brexit is a racist xenophobe (mind you a lot of them believe that, too)
What a great analysis…really needs an article of its own!
I’m a consultant in the NHS and I agree with most of the comments here. I now regard the NHS as an obstacle to better healthcare. The problem summarised is the people with responsibility (clinicians) have no power (over staffing, budgets etc) and those with power have no responsibility (politicians decision makers etc don’t get sued/struck off). I believe I could deliver a better, cheaper service if I could run my department as a private company so that I could decide staffing, where and when surgery and clinics are done etc. I hope (in vain) I can do this before my pay reaches 50% of 2008 levels (my personal exit point).
There’s definitely an issue with staffing & the hard truth is that next to nothing has been done in the lat 10yrs to train sufficient quantities of doctors & nurses. Instead NHS managers have trotted off (with implicit ministerial approval) to poach the best from poorer countries who can ill afford to lost them. But there’s another issue that plagues the NHS – romanticisation. There’s a (mistaken) belief that it’s the best in the world. Maybe 60 or 70 yrs ago that was true, but its not been true for decades. Any politician who tinkers is accused of “privatising our NHS”. All the models elsewhere, especially around Europe are using private sector facilities to deliver care. The question is how best to harness that, without lining the pockets of venture capitalists, something the UK seems to be uniquely good at.
Hmmmm. You do realise that this means that the Labour Party has to admit, to itself, that perhaps, just perhaps, their single great achievement is a complete dud………..?
Excellent analysis, and the key point which i think emerges is that the NHS is failing because it’s politicised.
If, as seems likely, the next government is led by Keir Starmer, it’ll be interesting to see if anything changes whatsoever. It’d probably take a Labour administration to make the necessary structural changes, as the only party with the political capital to do so. We’re at the point in history when that change has become an imperative. I wonder what Toynbee would make of it, except i can’t imagine for one moment that Starmer would have the courage to initiate that change, to something closer to the more successful models. He’ll most likely just spend his time in office blaming the mess on his predecessors, and so on ad infinitum.
Excellent comment. The endless reheated, partisan, simplistic rubbish from the likes of Toynbee are part of the problem. A health system that works best for everyone, from the poorest upwards, should be the sole consideration. A specific funding model dating from the 1940s should not be sacrosanct if it’s no longer fit for purpose. One thing everyone can agree on: this is now really urgent. But what government will have the courage and foresight to deal with it?
Excellent, Paddy.
Question is what do you ignore? Lots.
First its a Beveridge system where insurance, supply and regulation are combined. The recipe for a disaster. Solution is a Bismark system where those three legs are split
Second, you ignore the treat now pay later costs. Pensions
On social care again the cause of the mess is that socialist pension ponzi. People have been asset stripped so cannot pay for social care. The debts are too large for the tax payers to fund, so social care is screwed.
The next problem is the NHS as a religion. ie. If you lose the NHS, you will get the US system. Actually on the avoidable deaths count, that is an improvement. Instead go Swiss or Dutch, 1 or 2 in the world. The NHS doesn’t make divison one. Second you would be back in Victorian times. Yeah right, as if the rest of the wold is stuck there.
The NHS is dead as are significant numbers of its patients as a result of its treatment. But the victim pays.
You have hit the nail on the head and most sensible people would agree if only we could take the “politics”out of it!
I am afraid you are being illogical. The evidence clearly shows that the UK spends less on health care than other countries. A further problem is that the spending has fluctuated with above inflation increases over certain periods following by below inflation increases. On top of that there have been many attempts to reorganise the system in an attempt to increase efficiency.
The core problem remains insufficient, erratic funding and it seems perverse to focus on changing the system yet again before addressing the the funding issue.
One often missed area is primary care, where funding has been severely constrained. This chronic underfunding of GP services has had a particularly damaging effect by sabotaging preventative care and increasing the load on hospitals.
My wife and I are medical doctors and after austerity was introduced in 2010 we could see that the NHS was doomed. We took out private insurance for our family and will continue to rely on this. A two tier system is inevitable as long as we keep electing Tories.
John Pilger made an excellent documentary called “The Dirty War on the NHS”. Just google or YouTube for it.
Cracking post Paddy.
By the way, you wouldn’t happen to comment BTL at the guardian woud you? If you don’t already maybe give it a go – it would be a very wecome voice of sanity amongst all the drivel. (I would though estimate a very short spell until the censors shut your account down 🙂 )
Private treatment costs an arm & a leg here; my father’s knee replacement was £15,000, that’s a deposit for a small house. If it was say £3,000, then ordinary people could consider accessing treatment outside the NHS, but it isn’t and they can’t. I would gladly pay for treatment if it was affordable. Here in the UK, we have the worst of both worlds when it comes to access to healthcare.
The Tories despise the NHS on principle. It’d be very odd if they didn’t.
You compare superior German model with NHS poorer outcomes, citing growth in investment for NHS and implying that NHS failures are not about money at all. And yet, here are some facts most are unaware of.
Healthcare expenditure per person, 2017 (ons.gov.uk):
UK: £2,989
Germany: £4,432
France: £3,737
Sweden: £3,990
We spend on healthcare less per capita than any other developed European country.
Improving efficiency can only work to a degree, there are some fundamentals one cannot get around. In the UK in 2020 per 1000 population there are 3 physicians (versus 4.5 for Germany), and 2.43 hospital beds (versus 7.82 in Germany). (health.org.uk)
In fact, given how little NHS is funded comparing to Germany, one might argue that NHS’ results and efficiency are close to a miracle as they are.
You say: The “brilliant NHS Staff” are saying they need more money – They’re right.
I ask ”do they?” – £132 bn in 2016 and near £200bn today but they need ”even more money” – Money clearly hasnt solved the annual problems of the NHS being on its knees.
Dear Paddy, you analysis is likely technically correct but there is one elephant in the room: NHS stands for health service. It does very little to create health in the population. Of yes, it does preventative medicine = making diagnoses earlier but that is not the same as creating health. The NHS as much as our medical authorities (who should look a bit harder at themselves than shouting at the government) are caught in a model of ‘treating illness’ a model that serves an economy relating to illness : investment mainly in research that can provide financial returns. Health does not pay as it reduces illness = makes less money for the illness industry.
No country in the world can afford the current ‘modern illness care model with all its technical and other services attached to it’.
In stead of pumping money in the the current NIS (national illness service) which will suit de industry that helped building it, the government should pump money in providing good education and good living conditions and non-chemically grown and prepared food for the population. ALL evidence shows that the main causes for illness are: lac of education, lack of good housing, lack of good food, (these result in people having a purpose in life) . but investing in this does not suit the lobby…
“Only an idiot could imagine the Tories want to destroy the NHS.” Sadly an enormous amount of otherwise very sensible left-leaning people absolutely believe this to be the case. Saying that they’re all idiots just can’t be true, it would be like saying that everybody who voted for Brexit is a racist xenophobe (mind you a lot of them believe that, too)
What a great analysis…really needs an article of its own!
I’m a consultant in the NHS and I agree with most of the comments here. I now regard the NHS as an obstacle to better healthcare. The problem summarised is the people with responsibility (clinicians) have no power (over staffing, budgets etc) and those with power have no responsibility (politicians decision makers etc don’t get sued/struck off). I believe I could deliver a better, cheaper service if I could run my department as a private company so that I could decide staffing, where and when surgery and clinics are done etc. I hope (in vain) I can do this before my pay reaches 50% of 2008 levels (my personal exit point).
There’s definitely an issue with staffing & the hard truth is that next to nothing has been done in the lat 10yrs to train sufficient quantities of doctors & nurses. Instead NHS managers have trotted off (with implicit ministerial approval) to poach the best from poorer countries who can ill afford to lost them. But there’s another issue that plagues the NHS – romanticisation. There’s a (mistaken) belief that it’s the best in the world. Maybe 60 or 70 yrs ago that was true, but its not been true for decades. Any politician who tinkers is accused of “privatising our NHS”. All the models elsewhere, especially around Europe are using private sector facilities to deliver care. The question is how best to harness that, without lining the pockets of venture capitalists, something the UK seems to be uniquely good at.
Hmmmm. You do realise that this means that the Labour Party has to admit, to itself, that perhaps, just perhaps, their single great achievement is a complete dud………..?
The irreproachable St Polly of Toynbee launched into the same topic the other day with her customary impartiality and rigour – setting up the premise of her article with the sort of neutral, searching question one has come to expect of this paragon of journalistic objectivity:
“Who do you believe: the brilliant NHS staff who treated my cancer, or ministers who spin and lie?”
Catnip to the Guardian faithful. But none stopped to consider that the answer to Polly’s question was that they might both be right.
The “brilliant NHS Staff” are saying they need more money – They’re right.
Politicians are pointing out that the NHS cannot go on requiring ever more money to be poured into it, that we cannot afford it. They too are right.
Even Wes Streeting admits the system is broken. If a Tory says such a thing they will be dismissed by the media and accused of hating nurses and wanting to sell off the NHS or some such nonsense, but when a Labour Health Sec says it then maybe even the Guardian should sit up and take notice.
Why is it that, when looking at a Govt’s record on Health, journalists reporting on the NHS only ever focus on inputs, rather than outcomes? A Govt’s health policy is only measured by what monies they make available rather than the outcomes the NHS delivers.
We want a Health service to achieve better outcomes, surely? If we can do that by more efficient means, then we should.
The UK media, of both left and right, routinely praise the German model – and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy – it steers a path (in broad terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation – and that is that if the Govt tried to copy, say, the German Healthcare model in this country then Ms Toynbee, the Guardian and the BBC would go into meltdown as all their fevered dreams of “selling off the NHS” would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories want to destroy the NHS. They may have different ideas about how to improve it, and some of their ideas have certainly been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform – AND IT DOES – then we’ll get no closer to a solution. We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
The BBC & Guardian have railed against private healthcare contracts as the “tide of privatisation.” But the NHS has for many years outsourced a variety of services – in fact spending on private outsourced services rose faster under the last Labour Govt than under the coalition or Tories, but why let facts get in the way of the narrative?
Under the coalition Govt, which is when this argument really hotted up, we are actually talking about a growth from 4.5% to less than 6%. Hardly an earth-shattering increase. Yet (from both sides – and most particularly the media) the issue is weaponised to the point that no Govt dares touch it, dares even to suggest that a major reform of the whole funding model is the only thing that will save it.
I’m a huge supporter of the NHS – which means I want it to reform so it can survive.
People who pretend the NHS can limp on needing vastly more money year on year just to try and stand still do not really support the NHS. What they say they wish for, will surely bring about its demise.
Polly in her mosr recent screed glibly suggests – The government ignores the one quick fix for the NHS: good funding and decent pay for social care. For someone who has been writing about the NHS for so long that seems a childishly simple view, and one that cannot withstand the mereset scrutiny.
Would the NHS be better if more money was spent on it? In the short term, and if it was targeted, then of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term – not simply look good for whoever is currently in No 10, who’ll get the plaudits whilst saddling future generations with the cost.
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally – unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of those “brilliant NHS” workers and worthy of a C21st developed nation.
The problem with the NHS, like the problem with housing or roads or sewers, is that the system can’t respond to population increases. The unprecedented growth in the UK’s population since 2004 has not resulted in a corresponding rise in tax revenue (because the immigrants are low paid) and so we have more people chasing the same services. Do that for 20 years and you end up here.
Correct. But the now desperate supporters of this crumbling 1940s monster monolith will NEVER speak of the huge impact of uncontrolled mass migration via free movement of peoples. They just talk about the oldies. The NHS demanded we be imprisoned for two years to save it and its shame at having got rid of hospital beds for efficiency, and now it is broken by its insane covid-only obsession. It resisted tech in favour of fax machines, allowed greed to envelop the Bye Bye at 55 no show 100k GPs, turned itself into a fully feminized (1m out of 1.2m) workforce in a country without childcare provision, making modern health care work impossible & ‘anti women’. It is a Third World horror story. Stop talking about the NHS as our religion. Only BBC propaganda sustains this grubby cynical lie.
Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out – because they were younger.
The biggest issue for the NHS is an aging population and the failure to sort Social care. That is not driven at all by recent immigration. Who’s going to work in Social care for minimum wage? Yep you got it – immigrants.
Now I concur immigration not been well managed too, especially recently. Needs proper plan and proper national discussion, esp if we aren’t going to raise wages and train more of our own.
Nonetheless your practical suggestions?
Don’t know how old you are, but I’ll place a bet – if you/we live long enough we’ll be v grateful for that non indigenous kind care worker who comes to help us with toileting etc when we are frail and old and can’t manage ourselves. Remember that.
People still glibly insist that “Immigrants put in more than they take out.” A statement that has been roundly and soundly debunked many times over – though probably never reported on the BBC or Guardian as it defies the Blairite orthodoxy on the benefits of limitless immigration.
Young, able-bodied immigrants do, indeed, contribute more than they extract.
However, factor in their spouses, their off-spring, the fact that these once-young migrants will age and no longer contribute, not to mention the monies that migrants receive that are sent overseas and not spent here, or the child benefit that was being paid for children living in other EU countries and the picture becomes rather different.
Nobody seems to be able to agree on anything like an exact figure but overall migration to the UK is a massively greater cost to the exchequer than a benefit. Any increase in GDP has to be weighed against the size of population and the provision of services.
So, when you say “Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out ” ….. take a look at some of the most comprehensive research done pre the 2016 referendum:
….The OECD found an average annual net fiscal cost of £4.3 billion in the years 2007 to 2009. Thus, on average, EU migrants paid £4.3 billion less in taxes than they received in benefits and services.
…. Centre for Research and Analysis on Migration (CReAM) at University College London found that all migrants were a net fiscal cost of £14.8 billion in the financial year 2011/12.
…. Using similar methodology to CReAM, research by Migration Watch UK found that all migrants were a net fiscal cost of £13 billion in 2014/15.
…… Recent migrants from non-EU countries were also a net cost to the Exchequer in both analyses. CReAM estimated a net cost of £2.2 billion in 2011/12 meanwhile Migration Watch estimated a cost of £3.8 billion in 2014/15.
By all means lets have the debate, but let us be clear : You cannot possibly sustain a generous welfare state whilst you do not have control of immigration.
Immigration has had an enormous impact on Britain, much of it very positive – but to pretend it has come at no cost or that the rise in population due to immigration has had no negative impact on the provision of healthcare is ludicrous.
It is impossible to find effective solutions when ideology blinds you to one of the more obvious causes of a problem.
Superb. And so scary. The dogma and Groupthink mania that holds both university ‘researchers’ AND the BBC ‘journalists’ in thrall mean we are being fed a diet of Newspeak lies about the cost benefits of mass uncontrolled migration and multiculturalism. We cannot access and share Truth on anything to do with them. It triggers their terror/ phobia about any form of discrimination. Our society is more and more akin to a stale 1970s socialist Soviet satellite country like East Germany. No free speech. A detached self enriching ruling Politburo/Blob presiding over a warped sick economy clinging to political nostrums they know have failed. An unhappy increasingly oppressed people who KNOW the truth but have lost all faith in the System and stay stumm to avoid the prying state police.
Plus you have to be earning 35000 £p.a. To be a net contributor.
I would just add that the last time I checked you had to earn £48K pa to be a net contributor the UK assuming no dependents.
I assume some immigrants are net contributors but not very many.
Slightly narrow judgment on contribution isn’t it? Firstly how many Businesses making sufficient to pay tax reliant on low wages and providing you/I with services we want/need? Secondly VAT, all other non direct taxes etc, often more regressive.
Not so clear cut is it when you actually have to think about it.
There is a debate here but it’s more complicated than over simplistic calculations and presentations.
That was the conclusion of the study.
Since there is no VAT on food and only 5% on energy most people pay still contribute very little.
What other indirect taxes do you think those earning less than £48K actually pay or did this thought just pop into your head?
Low wage immigration keeps the wages for the rest of us down. It is just a Ponzi scheme and it will crash.
It really is that simple
That was the conclusion of the study.
Since there is no VAT on food and only 5% on energy most people pay still contribute very little.
What other indirect taxes do you think those earning less than £48K actually pay or did this thought just pop into your head?
Low wage immigration keeps the wages for the rest of us down. It is just a Ponzi scheme and it will crash.
It really is that simple
Slightly narrow judgment on contribution isn’t it? Firstly how many Businesses making sufficient to pay tax reliant on low wages and providing you/I with services we want/need? Secondly VAT, all other non direct taxes etc, often more regressive.
Not so clear cut is it when you actually have to think about it.
There is a debate here but it’s more complicated than over simplistic calculations and presentations.
Yep it’s about the balance. But also some of what you’ve quoted about seems a little selective. For example the CReAM authors actually said – ‘Our analysis thus suggests that – rather than being a drain on the UK’s fiscal system – immigrants arriving since the early 2000s have made a net contributions to its public finances, a reality that contrasts starkly with the view often maintained in public debate’.
Thing is it’s not actually a straight-forward calculation and many assumptions have to be made.
Fascinating of course though that Truss-economics seemed to indicate we needed quite a bit for growth, hence the spasms on the Right about exactly what we do need to do.
At some point let’s hope a sensible debate can occur.
CReAM’s analysis looked at contributions to the exchequer, against what was taken from the exchequer in the form of various benefits.
However it did not factor in the costs of providing services. Added to which, CReAM was working on 2011 figures that proved a huge underestimation. The ONS in 2021 revised their figures quite dramatically – they’d long suggested net inward migration stood at approx 300, 000 per year. When EU residents started registering, the ONS revised that figure upwards – their latest ‘best guess’ is that a million extra people are added every 19 months.
If you take immigration figures and add to those the children born to immigrants you will find that fully 82% of the population increase since 2001 has been due to immigration.
I’m not someone who gets overly twitchy at the thought of immigration – as long as we have control over who we allow in and grant the right to stay. But numbers really do matter. Every additional child requires schooling, every additional family requires housing, every rise in population has an attendant cost – it is only when you factor all that against what is added to the coffers or to GDP that you can assess the cost/benefit.
Yep a debate isn’t there about the right level.
The issue for us is our population isn’t replacing currently on it’s own. Whether that’s an issue part of the debate and broader understanding needed. Our demographic issues aren’t as acute as say the Germans, but they may head that way medium term. How many youngsters now starting families later, or at all, due to cost of living problems? Not a quick fix whatever the diagnosis. That replacement rate is then an increasing issue for tax revenue and labour force. Maybe some AI and other societal changes can make a difference and allow a sensible contraction, but we haven’t got those yet.
Slightly separate but on assumption we do need a reasonable amount of immigration, I do wish there was a well considered naturalisation process if you want to settle permanently. Albeit not easy to determine what ‘basics’ that should cover other than obvious decent command of the language (can’t be too onerous of course or we’ll all start failing it!)
Yep a debate isn’t there about the right level.
The issue for us is our population isn’t replacing currently on it’s own. Whether that’s an issue part of the debate and broader understanding needed. Our demographic issues aren’t as acute as say the Germans, but they may head that way medium term. How many youngsters now starting families later, or at all, due to cost of living problems? Not a quick fix whatever the diagnosis. That replacement rate is then an increasing issue for tax revenue and labour force. Maybe some AI and other societal changes can make a difference and allow a sensible contraction, but we haven’t got those yet.
Slightly separate but on assumption we do need a reasonable amount of immigration, I do wish there was a well considered naturalisation process if you want to settle permanently. Albeit not easy to determine what ‘basics’ that should cover other than obvious decent command of the language (can’t be too onerous of course or we’ll all start failing it!)
CReAM’s analysis looked at contributions to the exchequer, against what was taken from the exchequer in the form of various benefits.
However it did not factor in the costs of providing services. Added to which, CReAM was working on 2011 figures that proved a huge underestimation. The ONS in 2021 revised their figures quite dramatically – they’d long suggested net inward migration stood at approx 300, 000 per year. When EU residents started registering, the ONS revised that figure upwards – their latest ‘best guess’ is that a million extra people are added every 19 months.
If you take immigration figures and add to those the children born to immigrants you will find that fully 82% of the population increase since 2001 has been due to immigration.
I’m not someone who gets overly twitchy at the thought of immigration – as long as we have control over who we allow in and grant the right to stay. But numbers really do matter. Every additional child requires schooling, every additional family requires housing, every rise in population has an attendant cost – it is only when you factor all that against what is added to the coffers or to GDP that you can assess the cost/benefit.
And if we got rid of HS2 there would be much more money available – and didn’t have to pay£4.5 billions putting dinghy boat immigrants in 4 star hotels – and stopped sending enormous – who knows how much but far north if £7 billion to Ukraine – money spent on EDI – Exclusion of white people – Discrimination against white people – Inequity for white people – unconscious bus training throughout the institutions – the list goes on.
Superb. And so scary. The dogma and Groupthink mania that holds both university ‘researchers’ AND the BBC ‘journalists’ in thrall mean we are being fed a diet of Newspeak lies about the cost benefits of mass uncontrolled migration and multiculturalism. We cannot access and share Truth on anything to do with them. It triggers their terror/ phobia about any form of discrimination. Our society is more and more akin to a stale 1970s socialist Soviet satellite country like East Germany. No free speech. A detached self enriching ruling Politburo/Blob presiding over a warped sick economy clinging to political nostrums they know have failed. An unhappy increasingly oppressed people who KNOW the truth but have lost all faith in the System and stay stumm to avoid the prying state police.
Plus you have to be earning 35000 £p.a. To be a net contributor.
I would just add that the last time I checked you had to earn £48K pa to be a net contributor the UK assuming no dependents.
I assume some immigrants are net contributors but not very many.
Yep it’s about the balance. But also some of what you’ve quoted about seems a little selective. For example the CReAM authors actually said – ‘Our analysis thus suggests that – rather than being a drain on the UK’s fiscal system – immigrants arriving since the early 2000s have made a net contributions to its public finances, a reality that contrasts starkly with the view often maintained in public debate’.
Thing is it’s not actually a straight-forward calculation and many assumptions have to be made.
Fascinating of course though that Truss-economics seemed to indicate we needed quite a bit for growth, hence the spasms on the Right about exactly what we do need to do.
At some point let’s hope a sensible debate can occur.
And if we got rid of HS2 there would be much more money available – and didn’t have to pay£4.5 billions putting dinghy boat immigrants in 4 star hotels – and stopped sending enormous – who knows how much but far north if £7 billion to Ukraine – money spent on EDI – Exclusion of white people – Discrimination against white people – Inequity for white people – unconscious bus training throughout the institutions – the list goes on.
People still glibly insist that “Immigrants put in more than they take out.” A statement that has been roundly and soundly debunked many times over – though probably never reported on the BBC or Guardian as it defies the Blairite orthodoxy on the benefits of limitless immigration.
Young, able-bodied immigrants do, indeed, contribute more than they extract.
However, factor in their spouses, their off-spring, the fact that these once-young migrants will age and no longer contribute, not to mention the monies that migrants receive that are sent overseas and not spent here, or the child benefit that was being paid for children living in other EU countries and the picture becomes rather different.
Nobody seems to be able to agree on anything like an exact figure but overall migration to the UK is a massively greater cost to the exchequer than a benefit. Any increase in GDP has to be weighed against the size of population and the provision of services.
So, when you say “Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out ” ….. take a look at some of the most comprehensive research done pre the 2016 referendum:
….The OECD found an average annual net fiscal cost of £4.3 billion in the years 2007 to 2009. Thus, on average, EU migrants paid £4.3 billion less in taxes than they received in benefits and services.
…. Centre for Research and Analysis on Migration (CReAM) at University College London found that all migrants were a net fiscal cost of £14.8 billion in the financial year 2011/12.
…. Using similar methodology to CReAM, research by Migration Watch UK found that all migrants were a net fiscal cost of £13 billion in 2014/15.
…… Recent migrants from non-EU countries were also a net cost to the Exchequer in both analyses. CReAM estimated a net cost of £2.2 billion in 2011/12 meanwhile Migration Watch estimated a cost of £3.8 billion in 2014/15.
By all means lets have the debate, but let us be clear : You cannot possibly sustain a generous welfare state whilst you do not have control of immigration.
Immigration has had an enormous impact on Britain, much of it very positive – but to pretend it has come at no cost or that the rise in population due to immigration has had no negative impact on the provision of healthcare is ludicrous.
It is impossible to find effective solutions when ideology blinds you to one of the more obvious causes of a problem.
Therein lies the main issue with having an open border policy. Of course, it would be ideal to offer world class healthcare to every human being on the planet. As it would to also have a 2 bedroom flat, 2 automobiles, color television and a 2 week paid, all-inclusive holiday in the Caribbean. Somewhere along the line, politicians convinced enough of us that world-class healthcare is a basic human right. I’m not arguing that it is not. However, providing such benefits would require a vastly different economic model, one which includes a strictly enforced totalitarian approach. Unless you sign up for this, or it is enforced against your will, it will simply never happen in a free society. Like Thomas Sowell proclaimed, “There are no solutions. There are only tradeoffs.”
And going green and having to import all of our fuel and energy – with associated costs – is in no way sensible.
And going green and having to import all of our fuel and energy – with associated costs – is in no way sensible.
Correct. But the now desperate supporters of this crumbling 1940s monster monolith will NEVER speak of the huge impact of uncontrolled mass migration via free movement of peoples. They just talk about the oldies. The NHS demanded we be imprisoned for two years to save it and its shame at having got rid of hospital beds for efficiency, and now it is broken by its insane covid-only obsession. It resisted tech in favour of fax machines, allowed greed to envelop the Bye Bye at 55 no show 100k GPs, turned itself into a fully feminized (1m out of 1.2m) workforce in a country without childcare provision, making modern health care work impossible & ‘anti women’. It is a Third World horror story. Stop talking about the NHS as our religion. Only BBC propaganda sustains this grubby cynical lie.
Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out – because they were younger.
The biggest issue for the NHS is an aging population and the failure to sort Social care. That is not driven at all by recent immigration. Who’s going to work in Social care for minimum wage? Yep you got it – immigrants.
Now I concur immigration not been well managed too, especially recently. Needs proper plan and proper national discussion, esp if we aren’t going to raise wages and train more of our own.
Nonetheless your practical suggestions?
Don’t know how old you are, but I’ll place a bet – if you/we live long enough we’ll be v grateful for that non indigenous kind care worker who comes to help us with toileting etc when we are frail and old and can’t manage ourselves. Remember that.
Therein lies the main issue with having an open border policy. Of course, it would be ideal to offer world class healthcare to every human being on the planet. As it would to also have a 2 bedroom flat, 2 automobiles, color television and a 2 week paid, all-inclusive holiday in the Caribbean. Somewhere along the line, politicians convinced enough of us that world-class healthcare is a basic human right. I’m not arguing that it is not. However, providing such benefits would require a vastly different economic model, one which includes a strictly enforced totalitarian approach. Unless you sign up for this, or it is enforced against your will, it will simply never happen in a free society. Like Thomas Sowell proclaimed, “There are no solutions. There are only tradeoffs.”
The problem with the NHS, like the problem with housing or roads or sewers, is that the system can’t respond to population increases. The unprecedented growth in the UK’s population since 2004 has not resulted in a corresponding rise in tax revenue (because the immigrants are low paid) and so we have more people chasing the same services. Do that for 20 years and you end up here.
If the NHS got more money it would only waste it on inclusivity training, diversity hiring and middle manager pensions. The entire thing needs to be gutted as it is beyond hope.
I think quite a few in the service would concur with the inclusivity training costs point, but it’s tiny sum in the overall. In fact I have a suspicion the reason the SoS doesn’t just close it all down, which they could, is Govt likes a headline it can use. Nonetheless point taken.
What’s your suggestion on how we replace the whole thing?
If you bear in mind that we cannot just shut everything down and that there will be terrible resistance to any change, then what we need is a political machine with enough moral strength to impose proper privatisation and remove unnecessary political ‘oversight’.
It’s very difficult to change GPs at the moment, and very difficult to shop around for speedier treatment. It is very difficult to sue for malpractice. Privatise the NHS, fund the New Health Services from insurance (like many of the continental health services) and eventually the deadwood and overmanning will be reduced as health services compete for trade.
It would take years to bear fruit and probably see the political death of many politicians – but if we don’t do something the whole shebang will collapse.
We’ll disagree ACH on whether private insurance the answer, but that aside a practical solution has to be politically deliverable. Otherwise we aren’t engaging with the challenge and it’s just an academic debate. Herein lies the problem for our politicians to some degree.
I increasingly think something in a hypothecated social insurance model, coupled with an OBR type equivalent on workforce planning to reduce political short termism. But even this really difficult to sell as folks will be worried and conflate social insurance with privatising (rightly or wrongly).
As regards GPs, I think you are missing the paradox in your comment. Most GPs remain the one element still private – they are private practitioners largely running their own business. But they are usually dependent on per capita payments from the NHS. The debate is about actually ‘nationalising’ them so certain ways of working can be insisted upon.
I was think of the French system of state regulated health insurance which is not quite the same as purely private insurance.
As for GPs, yes they typically run their own businesses or practices but are contracted to the NHS on a capitation basis rather than a services delivered basis. GPs are paid whether they see their patients or not.
Yep something in the French system, although daresay not quite the direction the NHS detractors might welcome.
And yes the capitation payment for GPs is way out of date and needs changing. Insufficient incentives as you say. I think Govt and NHS leadership concur and have for some time, but be a proper fight with the BMA etc and they got more than enough on their plate right now.
Yep something in the French system, although daresay not quite the direction the NHS detractors might welcome.
And yes the capitation payment for GPs is way out of date and needs changing. Insufficient incentives as you say. I think Govt and NHS leadership concur and have for some time, but be a proper fight with the BMA etc and they got more than enough on their plate right now.
Some 15 years ago when I was young and had hair I worked for a US Multinational Corporation. They gave myself and my Family here in the UK assess to free private health Insurance (paid for in Benefits in Kind). One day I received a Letter from my Provider Western Provident Association who were taking Private Hospitals to task for charging £10 for a plaster that you put on cuts and were making a stand against them overcharging. I have long been back in the NHS but worry on a national scale of private insurance this profiteering would take hold.
Agree AM. Profit in itself isn’t a bad thing though, and private providers have to make a return. There is though a tendency to over treatment/’diagnostic creep’, which fine if affordable, but much less so if not. One of the reasons the UK system is macro-efficient is our doctors aren’t paid fee for service in the NHS. They are salaried (bar some GPs). So no incentive to do extra potentially needless tests etc. Because the relationship with a patient is asymmetric as regards knowledge, and often choice is pretty limited too esp for emergency care, you have to trust all the decisions. That doesn’t play entirely well in a private market and is one reason US total healthcare costs massively above the UKs as proportion of GDP, yet still so many uncovered or hugely stressed by all the clauses/sub clauses in their cover policies that can change. US is brill at leading edge care esp for those who can pay. But it isn’t a v macro efficient model at all.
Obviously the other thing in the UK is the private healthcare sector does not train any doctors or nurses. The NHS and education sector does that. So one could argue that’s a v significant cross subsidy. Same with teaching of course.
Agree AM. Profit in itself isn’t a bad thing though, and private providers have to make a return. There is though a tendency to over treatment/’diagnostic creep’, which fine if affordable, but much less so if not. One of the reasons the UK system is macro-efficient is our doctors aren’t paid fee for service in the NHS. They are salaried (bar some GPs). So no incentive to do extra potentially needless tests etc. Because the relationship with a patient is asymmetric as regards knowledge, and often choice is pretty limited too esp for emergency care, you have to trust all the decisions. That doesn’t play entirely well in a private market and is one reason US total healthcare costs massively above the UKs as proportion of GDP, yet still so many uncovered or hugely stressed by all the clauses/sub clauses in their cover policies that can change. US is brill at leading edge care esp for those who can pay. But it isn’t a v macro efficient model at all.
Obviously the other thing in the UK is the private healthcare sector does not train any doctors or nurses. The NHS and education sector does that. So one could argue that’s a v significant cross subsidy. Same with teaching of course.
I was think of the French system of state regulated health insurance which is not quite the same as purely private insurance.
As for GPs, yes they typically run their own businesses or practices but are contracted to the NHS on a capitation basis rather than a services delivered basis. GPs are paid whether they see their patients or not.
Some 15 years ago when I was young and had hair I worked for a US Multinational Corporation. They gave myself and my Family here in the UK assess to free private health Insurance (paid for in Benefits in Kind). One day I received a Letter from my Provider Western Provident Association who were taking Private Hospitals to task for charging £10 for a plaster that you put on cuts and were making a stand against them overcharging. I have long been back in the NHS but worry on a national scale of private insurance this profiteering would take hold.
We’ll disagree ACH on whether private insurance the answer, but that aside a practical solution has to be politically deliverable. Otherwise we aren’t engaging with the challenge and it’s just an academic debate. Herein lies the problem for our politicians to some degree.
I increasingly think something in a hypothecated social insurance model, coupled with an OBR type equivalent on workforce planning to reduce political short termism. But even this really difficult to sell as folks will be worried and conflate social insurance with privatising (rightly or wrongly).
As regards GPs, I think you are missing the paradox in your comment. Most GPs remain the one element still private – they are private practitioners largely running their own business. But they are usually dependent on per capita payments from the NHS. The debate is about actually ‘nationalising’ them so certain ways of working can be insisted upon.
If you bear in mind that we cannot just shut everything down and that there will be terrible resistance to any change, then what we need is a political machine with enough moral strength to impose proper privatisation and remove unnecessary political ‘oversight’.
It’s very difficult to change GPs at the moment, and very difficult to shop around for speedier treatment. It is very difficult to sue for malpractice. Privatise the NHS, fund the New Health Services from insurance (like many of the continental health services) and eventually the deadwood and overmanning will be reduced as health services compete for trade.
It would take years to bear fruit and probably see the political death of many politicians – but if we don’t do something the whole shebang will collapse.
I think quite a few in the service would concur with the inclusivity training costs point, but it’s tiny sum in the overall. In fact I have a suspicion the reason the SoS doesn’t just close it all down, which they could, is Govt likes a headline it can use. Nonetheless point taken.
What’s your suggestion on how we replace the whole thing?
If the NHS got more money it would only waste it on inclusivity training, diversity hiring and middle manager pensions. The entire thing needs to be gutted as it is beyond hope.
Any organisation with 200 Diversity Officers and hiring a Director of Lived Experience on £115 grand plus benefits cannot be very short of money.
Agree, although it’s c£10m at most and NHS £180B so less than 0.05%. So we ain’t solving the funding problem by stopping this, but nonetheless.
It’s true that the cost is not a big deal in the scale of things but I think it shows a lack of focus on what the NHS is supposed to do which is to care for and treat patients. The managers in the NHS are only focussed on meeting targets and I have no doubt that there is a target for diversity and inclusiveness. I think the rot set in when hospitals changed from being medic led to being manager led.
There isn’t a target SE, despite the mythology. But many health organisations have a much greater degree of diversity than in other industries (and always been much the case). So equipping employees in some broader diversity understanding has some logic esp when you are struggling with short staffing and recruitment/retention. But it’s overdone and the roles referred to are overpaid, can add little and occasionally can create more tension than they solve. So I’m in general agreement not a priority right now but we that also we don’t understate functioning in a highly diverse work environment does have some unique challenges where we can do better.
Thankfully I don’t go into hospital very often but when I do it’s clear that the NHS workforce is extraordinarily diverse and I don’t think that’s come about because they have a diversity officer. It’s because they need all the people they can get with the right medical and nursing skills.
My point was that the spending on diversity officers is a symptom of an organisation which has forgotten what it’s there for. And actually although we say it’s not much money, really, if a hospital has a choice between getting a diversity officer and a nurse then it absolutely should be the nurse every time.
I live in the area served by the Shrewsbury and Telford hospitals trust where there has been a huge scandal over deaths in the maternity department. It’s not the first scandal of this type and it won’t be the last. And all those wonderful targets did nothing to prevent the deaths of those mothers and babies. It happened because the NHS has forgotten what it’s supposed to be doing.
V much agree.
V much agree.
Thankfully I don’t go into hospital very often but when I do it’s clear that the NHS workforce is extraordinarily diverse and I don’t think that’s come about because they have a diversity officer. It’s because they need all the people they can get with the right medical and nursing skills.
My point was that the spending on diversity officers is a symptom of an organisation which has forgotten what it’s there for. And actually although we say it’s not much money, really, if a hospital has a choice between getting a diversity officer and a nurse then it absolutely should be the nurse every time.
I live in the area served by the Shrewsbury and Telford hospitals trust where there has been a huge scandal over deaths in the maternity department. It’s not the first scandal of this type and it won’t be the last. And all those wonderful targets did nothing to prevent the deaths of those mothers and babies. It happened because the NHS has forgotten what it’s supposed to be doing.
There isn’t a target SE, despite the mythology. But many health organisations have a much greater degree of diversity than in other industries (and always been much the case). So equipping employees in some broader diversity understanding has some logic esp when you are struggling with short staffing and recruitment/retention. But it’s overdone and the roles referred to are overpaid, can add little and occasionally can create more tension than they solve. So I’m in general agreement not a priority right now but we that also we don’t understate functioning in a highly diverse work environment does have some unique challenges where we can do better.
It’s true that the cost is not a big deal in the scale of things but I think it shows a lack of focus on what the NHS is supposed to do which is to care for and treat patients. The managers in the NHS are only focussed on meeting targets and I have no doubt that there is a target for diversity and inclusiveness. I think the rot set in when hospitals changed from being medic led to being manager led.
Agree, although it’s c£10m at most and NHS £180B so less than 0.05%. So we ain’t solving the funding problem by stopping this, but nonetheless.
Any organisation with 200 Diversity Officers and hiring a Director of Lived Experience on £115 grand plus benefits cannot be very short of money.
Imagine if all the money, time and effort that was thrown in to psy-oping people to “stay at home”, “keep your distance”, and “get vaccinated” had been spent on delivering practical ways to empower people to eat healthy, get & stay fit, and strengthen their immune systems through natural means? The £37bn or £1,330 per EVERY SINGLE UK HOUSEHOLD that went up the wall on entirely useless “test and trace” alone could have bought home gym equipment, a bicycle, and / or a multi-year gym membership, along with enough vitamin D supplements for every winter of the 2020s for every single one of those households. What a monumentally stupid waste of resources and life.
Let us never forget the delusional herd mentality and moral panic that descended, enabling fundamentally good people to make very, very bad decisions that allowed corporate spivs to get rich(er) quick. Those responsible, at all levels (which means almost all of us – no-one is whiter than white) must now, in the cold light of day, admit to the mistakes that they made and so allow lessons to be learnt from this catastrophic policy failure, and try to make sure it never happens ever again. Gratifying though it would be to see the likes of Whitty and Hancock squirm under the bright lights of a police-led investigation, there must now be some kind of sanction-free, no-blame exercise that happens after a plane crash to work out exactly what went wrong and why.
There is a public Inquiry AH albeit pretty slow moving at the moment. Hopefully will pick up pace during 23. And it is vital lessons are learned and accountability for decisions that were potentially negligent surfaced.
The amount wasted on ineffective PPE, Test & Trace, and Covid loans that turned out to be fraud etc not lost on NHS at all. That would solve all the current pay dispute issues and more were that wasted money still available.
However you won’t find many frontline NHS workers who didn’t support the first lockdown at least. The service was overwhelmed and something needed to be done to slow the rate of transmission. If anything we may have acted a couple of wks late and then had to hold it down for longer. The subsequent Lockdown in Dec 20 and through early 21, more questionable, but again the population immunity was limited as vaccine only beginning then to roll out. Nonetheless by then we’d all had more time to prepare, esp schools. We also had more info and data on the virus. Hopefully they’ll really dig into this.
Seems not Andrew. I saw the video of Tory MP Andrew Bridgen addressing Parliament over the ever increasing population of people in the UK suffering adverse effects of Mrna vaccines. I hadn’t realised the AstraZeneca vaccine has been withdrawn. In total there were five MP’s who attended the whole house. Never let it be said the Political class have their voters interests at heart..
There is a public Inquiry AH albeit pretty slow moving at the moment. Hopefully will pick up pace during 23. And it is vital lessons are learned and accountability for decisions that were potentially negligent surfaced.
The amount wasted on ineffective PPE, Test & Trace, and Covid loans that turned out to be fraud etc not lost on NHS at all. That would solve all the current pay dispute issues and more were that wasted money still available.
However you won’t find many frontline NHS workers who didn’t support the first lockdown at least. The service was overwhelmed and something needed to be done to slow the rate of transmission. If anything we may have acted a couple of wks late and then had to hold it down for longer. The subsequent Lockdown in Dec 20 and through early 21, more questionable, but again the population immunity was limited as vaccine only beginning then to roll out. Nonetheless by then we’d all had more time to prepare, esp schools. We also had more info and data on the virus. Hopefully they’ll really dig into this.
Seems not Andrew. I saw the video of Tory MP Andrew Bridgen addressing Parliament over the ever increasing population of people in the UK suffering adverse effects of Mrna vaccines. I hadn’t realised the AstraZeneca vaccine has been withdrawn. In total there were five MP’s who attended the whole house. Never let it be said the Political class have their voters interests at heart..
Imagine if all the money, time and effort that was thrown in to psy-oping people to “stay at home”, “keep your distance”, and “get vaccinated” had been spent on delivering practical ways to empower people to eat healthy, get & stay fit, and strengthen their immune systems through natural means? The £37bn or £1,330 per EVERY SINGLE UK HOUSEHOLD that went up the wall on entirely useless “test and trace” alone could have bought home gym equipment, a bicycle, and / or a multi-year gym membership, along with enough vitamin D supplements for every winter of the 2020s for every single one of those households. What a monumentally stupid waste of resources and life.
Let us never forget the delusional herd mentality and moral panic that descended, enabling fundamentally good people to make very, very bad decisions that allowed corporate spivs to get rich(er) quick. Those responsible, at all levels (which means almost all of us – no-one is whiter than white) must now, in the cold light of day, admit to the mistakes that they made and so allow lessons to be learnt from this catastrophic policy failure, and try to make sure it never happens ever again. Gratifying though it would be to see the likes of Whitty and Hancock squirm under the bright lights of a police-led investigation, there must now be some kind of sanction-free, no-blame exercise that happens after a plane crash to work out exactly what went wrong and why.
Three ;points
Increasing the UK population by 10m in the last twenty years has much to do with those per capita spending figures.
Monopolies invariably are bad employers and poor service providers.
In Europe the money starts with the patients- so doctors see patients as an income and want to see them. In the NHS the patients are a cost.
Three ;points
Increasing the UK population by 10m in the last twenty years has much to do with those per capita spending figures.
Monopolies invariably are bad employers and poor service providers.
In Europe the money starts with the patients- so doctors see patients as an income and want to see them. In the NHS the patients are a cost.
I know that the UK spends less per person than other countries for our health service but is it possible to say how much we pay individually for health services compared with other countries? I think Germany has an Insurance based system. So a German would know exactly how much he’s paying for his health needs. In the UK the cost to the individual is a hidden part the tax and NI he pays. Would it be possible to say how much extra we would have to pay individually for the UK to spend as much on health per person as Germany?
Everyone seems to agree that the NHS is underfunded but there seems to be an assumption that this is simply because the Government is just being stingy but the money has to come from somewhere.
Given that millions of people in this country pay zero tax the English taxpayer likely pays more person than on the continent. The NHS isn’t underfunded in the slightest. It just has a vast parasitic bureaucracy around it draining billions.
Numbers, numbers…can you supply some data about the vast bureaucracy, and maybe even some comparative data with your favoured models?
The German medical system has10% non medical staff. The NHS had 48%. See NHS Digital.
No you’ve probably mixed up data sources and what was being counted and depends what you mean by non medical. The 52% medical is doctors and nurses but excludes AHPs, HCAs, porters, catering, receptioning, cleaning, transport etc. The Germans will of course have all that too as their Docs ain’t making the beds, sweeping the floors and cooking the dinners!
NHS has one of the lowest admin percentages in western world – 2-4% depending what you include/exclude. Whether what it has is optimally deployed and delivering a different question. But the reason it’s so low overall is predominantly because it’s not got the admin tail associated with running an insurance and payments chasing system – which is massive in the US.
As they say a little knowledge can be dangerous.
No you’ve probably mixed up data sources and what was being counted and depends what you mean by non medical. The 52% medical is doctors and nurses but excludes AHPs, HCAs, porters, catering, receptioning, cleaning, transport etc. The Germans will of course have all that too as their Docs ain’t making the beds, sweeping the floors and cooking the dinners!
NHS has one of the lowest admin percentages in western world – 2-4% depending what you include/exclude. Whether what it has is optimally deployed and delivering a different question. But the reason it’s so low overall is predominantly because it’s not got the admin tail associated with running an insurance and payments chasing system – which is massive in the US.
As they say a little knowledge can be dangerous.
The German medical system has10% non medical staff. The NHS had 48%. See NHS Digital.
Bit of a fact free comment there RW. We spend less on NHS as proportion of GDP than Western European equivalents. We’ve significantly lower rate of doctors and nurses per population. Of course there is some waste too, but the big macro differences make the big difference as we’d expect.
It’s true we’ve had an NHS internal market waste alot of time and energy and add bureaucracy, and be good if we junked that. It was a right leaning policy mind.
What Social Insurance might do is make the contribution more transparent, hypothecated and reduce short term political interference. But it is just a different form of tax. I suspect we may head in this direction a bit more long term
My son lives and works in Germany (he is English ) he pays almost 50% tax this might have a lot to do with the fact that healthcare is superb and also the cost of childcare is very low in comparison to the UK. I am an Englishman living in Spain , I had to take out private health insurance to become a resident of Spain. I am 68 years old. two years ago I started feeling a pain in my left knee so went privately to a doctor . I was sent for a scan and was told that far from being my knee, it was my hip that needed replacing..I was asked when I would like it done and as the pain was guite bad I said as soon as possible .From going to the doctors to having surgery was 6 weeks . I also have a Spanish health service card which was transfered from the UK to Spain so I can use either system but privately is quicker. My point in this is that an element of privatisation and Spanish national health are far superior than what is happening in the NHS and must be inevitable for the UK. You do not receive free prescriptions as a pensioner but the meds a far cheaper than UK . The other big rip off in the UK is Pensions ,which politicians call benefits which they are not as most people have paid in their own money along with their employers contribution..This needs to be addressed also so paying into a private pension for the length of your working life would give you a far better pension than what you receive from the state.
My son lives and works in Germany (he is English ) he pays almost 50% tax this might have a lot to do with the fact that healthcare is superb and also the cost of childcare is very low in comparison to the UK. I am an Englishman living in Spain , I had to take out private health insurance to become a resident of Spain. I am 68 years old. two years ago I started feeling a pain in my left knee so went privately to a doctor . I was sent for a scan and was told that far from being my knee, it was my hip that needed replacing..I was asked when I would like it done and as the pain was guite bad I said as soon as possible .From going to the doctors to having surgery was 6 weeks . I also have a Spanish health service card which was transfered from the UK to Spain so I can use either system but privately is quicker. My point in this is that an element of privatisation and Spanish national health are far superior than what is happening in the NHS and must be inevitable for the UK. You do not receive free prescriptions as a pensioner but the meds a far cheaper than UK . The other big rip off in the UK is Pensions ,which politicians call benefits which they are not as most people have paid in their own money along with their employers contribution..This needs to be addressed also so paying into a private pension for the length of your working life would give you a far better pension than what you receive from the state.
Numbers, numbers…can you supply some data about the vast bureaucracy, and maybe even some comparative data with your favoured models?
Bit of a fact free comment there RW. We spend less on NHS as proportion of GDP than Western European equivalents. We’ve significantly lower rate of doctors and nurses per population. Of course there is some waste too, but the big macro differences make the big difference as we’d expect.
It’s true we’ve had an NHS internal market waste alot of time and energy and add bureaucracy, and be good if we junked that. It was a right leaning policy mind.
What Social Insurance might do is make the contribution more transparent, hypothecated and reduce short term political interference. But it is just a different form of tax. I suspect we may head in this direction a bit more long term
The figures I can find are as follows (all in US$)
The Germans spend 13% of their $4.26 trillion GDP on healthcare, which is a spending of $554 billion. They have a population of 83.2 million so spend $6656 per capita on healthcare.
By contrast the UK spends 12% of their $3.13 trillion GDP on healthcare, which is a spending of $375 billion. The UKs population is 67.3 million so that makes $5580 per capita.
So therefore the UK only spends around 80% compared to the Germans, and this is after a massive boost. Only 5 years ago it was around 66%.
Between 2015 and 2019 the Germans also spent triple in terms of GDP compared to the UK on infrastructure such as hospitals and beds to increase capacity
If, as you say, we spend 12% of our GDP on healthcare, as against the Germans 13%, we’re pretty similar – their figure is only around 8% higher than ours. In terms of funding affordability, isn’t that the key indicator? In order to spend as much per capita as Germany, we’d need to grow the economy substantially, or pay a much higher rate of tax than the Germans wouldn’t we?
Thanks Mike, that was the point I was trying to make earlier. People say we should spend more on the NHS but without saying where the extra money is going to come from. I don’t know but I suspect that these days we simply don’t generate enough wealth in the UK to pay for everything we want. So that means paying more tax. I think the insurance model Germany has is better because everyone knows exactly how much they are spending and where it’s being spent, ie only on health. You want a better health service? fine but your premiums will rise. It’s clear.
As I understand it in the German system you have to register with one of the insurance companies. You don’t need a medical and they can’t turn you down. They do provide for people who cannot afford the premiums. Everyone is covered. Also I’ve read that the insurance companies help to ensure value for money because they can shop around for the services they want. It also means that there is less argument about private or public because the insurance companies will use whichever fits the bill. I’m quite sure that the German system is far from perfect but it’s got to be better than the NHS.
we could levy an additional tax on public sector employees
That’s an idea but if we pay public sector employees more then we’d get more back in tax anyway – win-win.
Joke.
But they would be happy because they would get the pay rises they want (deserve)
Exactly.
Exactly.
But they would be happy because they would get the pay rises they want (deserve)
That’s an idea but if we pay public sector employees more then we’d get more back in tax anyway – win-win.
Joke.
we could levy an additional tax on public sector employees
Yes exactly. But we could get more out of what we fund now if we sorted Social care. Massive discharge bottlenecks out to social care are impacting adversely on the NHS service that can be provided because it blocks beds that could be used for other care. However that involves a different funding model for social care too and is not cost free. But if it was sorted we might find that the NHS performs much better for what we invest in it.
Of course the added narrative in the UK was we were promised a substantial increase in NHS funding as a Brexit dividend – something like £350m a day or £18B p.a. That’s looking a bit sick itself now.
Health spending 2016: £195B per annum
Health spending 2021: £276B per annum
Brexit dividend: £81B or £221M per day.
You removed Covid funding as non recurring, and most didn’t go to NHS anyway (went to T&T and PPE companies), albeit was run out of DHSC (which is not the same as NHS and a common mistake). But even then I can’t see where you get your numbers as nothing published anything like those. Source?
The recurring sum for 22-23 was £180B.
Remember the £350m p.w was extra not instead of too. But aside the more pertinent point relates to your figures, which I only hope were correct!
Source: ONS Total Healthcare Expenditure.
If we compare 2016 to 2019 (pre-Covid) the increase was £9B per annum. This is arguably funded by the reduction in our contribution to the EU coffers – down to £3B per annum (net) from £13B (net) in 2016 (the three billion covers pension liabilities and runs to 2027).
I don’t think it is far fetched to say that by not paying EU subs we have been able to put that money into the NHS.
Obviously Covid makes this spending incredibly hard to untangle.
Source: ONS Total Healthcare Expenditure.
If we compare 2016 to 2019 (pre-Covid) the increase was £9B per annum. This is arguably funded by the reduction in our contribution to the EU coffers – down to £3B per annum (net) from £13B (net) in 2016 (the three billion covers pension liabilities and runs to 2027).
I don’t think it is far fetched to say that by not paying EU subs we have been able to put that money into the NHS.
Obviously Covid makes this spending incredibly hard to untangle.
You removed Covid funding as non recurring, and most didn’t go to NHS anyway (went to T&T and PPE companies), albeit was run out of DHSC (which is not the same as NHS and a common mistake). But even then I can’t see where you get your numbers as nothing published anything like those. Source?
The recurring sum for 22-23 was £180B.
Remember the £350m p.w was extra not instead of too. But aside the more pertinent point relates to your figures, which I only hope were correct!
It was a suggestion to spend an extra £350m a WEEK, and not a promise as it wasn’t a government suggestion or in any party’s manifesto.
We spend £1.5B a week more on Health than we did in 2016. Over FOUR times what Vote Leave suggested was possible. Not sure we could have fitted all those noughts on the side of the bus!
And removing inflation and what was already in the forecast?
And removing inflation and what was already in the forecast?
I know it was always a bit of satire. That fella with the blond messy hair, think he became PM briefly didn’t he, stood in front of that Bus and announced ‘…this is what we’re gonna do when we take back control, we’re gonna give the NHS £350m extra a wk bah, bah’.
At least you recognise it was deliberately misleading. Now if only it’d stopped there…
It amazes me how annoyed some Remainers continue to be. You would have thought they would have got over losing a vote long ago. Like the ScotsNats it seems they never do. Maybe they never will!
Annoyed not the emotion. Consistent and continual insistence on accountability closer.
You should welcome that, otherwise you’ll never get any of the alleged dividends.
Fair enough J
Fair enough J
Annoyed not the emotion. Consistent and continual insistence on accountability closer.
You should welcome that, otherwise you’ll never get any of the alleged dividends.
It amazes me how annoyed some Remainers continue to be. You would have thought they would have got over losing a vote long ago. Like the ScotsNats it seems they never do. Maybe they never will!
We spend £1.5B a week more on Health than we did in 2016. Over FOUR times what Vote Leave suggested was possible. Not sure we could have fitted all those noughts on the side of the bus!
I know it was always a bit of satire. That fella with the blond messy hair, think he became PM briefly didn’t he, stood in front of that Bus and announced ‘…this is what we’re gonna do when we take back control, we’re gonna give the NHS £350m extra a wk bah, bah’.
At least you recognise it was deliberately misleading. Now if only it’d stopped there…
Health spending 2016: £195B per annum
Health spending 2021: £276B per annum
Brexit dividend: £81B or £221M per day.
It was a suggestion to spend an extra £350m a WEEK, and not a promise as it wasn’t a government suggestion or in any party’s manifesto.
1% of GDP is an incredible amount of money, in the UK it would increase the budget by over $30 billion annually which would raise the UKs spending from 80% of the Germans to 90%. There’s only around 1% of GDP difference in the military spending of the UK and Germany and the gulf between them is vast.
As I’ve shown even after the much trumpeted increases to the health system budget, the Germans are still spending 20% more per capita and the UK system is starting from a long way behind them in terms of funding
Thanks Mike, that was the point I was trying to make earlier. People say we should spend more on the NHS but without saying where the extra money is going to come from. I don’t know but I suspect that these days we simply don’t generate enough wealth in the UK to pay for everything we want. So that means paying more tax. I think the insurance model Germany has is better because everyone knows exactly how much they are spending and where it’s being spent, ie only on health. You want a better health service? fine but your premiums will rise. It’s clear.
As I understand it in the German system you have to register with one of the insurance companies. You don’t need a medical and they can’t turn you down. They do provide for people who cannot afford the premiums. Everyone is covered. Also I’ve read that the insurance companies help to ensure value for money because they can shop around for the services they want. It also means that there is less argument about private or public because the insurance companies will use whichever fits the bill. I’m quite sure that the German system is far from perfect but it’s got to be better than the NHS.
Yes exactly. But we could get more out of what we fund now if we sorted Social care. Massive discharge bottlenecks out to social care are impacting adversely on the NHS service that can be provided because it blocks beds that could be used for other care. However that involves a different funding model for social care too and is not cost free. But if it was sorted we might find that the NHS performs much better for what we invest in it.
Of course the added narrative in the UK was we were promised a substantial increase in NHS funding as a Brexit dividend – something like £350m a day or £18B p.a. That’s looking a bit sick itself now.
1% of GDP is an incredible amount of money, in the UK it would increase the budget by over $30 billion annually which would raise the UKs spending from 80% of the Germans to 90%. There’s only around 1% of GDP difference in the military spending of the UK and Germany and the gulf between them is vast.
As I’ve shown even after the much trumpeted increases to the health system budget, the Germans are still spending 20% more per capita and the UK system is starting from a long way behind them in terms of funding
If, as you say, we spend 12% of our GDP on healthcare, as against the Germans 13%, we’re pretty similar – their figure is only around 8% higher than ours. In terms of funding affordability, isn’t that the key indicator? In order to spend as much per capita as Germany, we’d need to grow the economy substantially, or pay a much higher rate of tax than the Germans wouldn’t we?
You know….aaaggghhh
Thanks Anna, please tell me why I’m wrong. Honestly, this is a subject which interests me and I’m very willing to be corrected.
Thanks Anna, please tell me why I’m wrong. Honestly, this is a subject which interests me and I’m very willing to be corrected.
Given that millions of people in this country pay zero tax the English taxpayer likely pays more person than on the continent. The NHS isn’t underfunded in the slightest. It just has a vast parasitic bureaucracy around it draining billions.
The figures I can find are as follows (all in US$)
The Germans spend 13% of their $4.26 trillion GDP on healthcare, which is a spending of $554 billion. They have a population of 83.2 million so spend $6656 per capita on healthcare.
By contrast the UK spends 12% of their $3.13 trillion GDP on healthcare, which is a spending of $375 billion. The UKs population is 67.3 million so that makes $5580 per capita.
So therefore the UK only spends around 80% compared to the Germans, and this is after a massive boost. Only 5 years ago it was around 66%.
Between 2015 and 2019 the Germans also spent triple in terms of GDP compared to the UK on infrastructure such as hospitals and beds to increase capacity
You know….aaaggghhh
I know that the UK spends less per person than other countries for our health service but is it possible to say how much we pay individually for health services compared with other countries? I think Germany has an Insurance based system. So a German would know exactly how much he’s paying for his health needs. In the UK the cost to the individual is a hidden part the tax and NI he pays. Would it be possible to say how much extra we would have to pay individually for the UK to spend as much on health per person as Germany?
Everyone seems to agree that the NHS is underfunded but there seems to be an assumption that this is simply because the Government is just being stingy but the money has to come from somewhere.
The politicisation of the NHS is a factor, but it’s too unspecific a diagnosis. Question is what do we mean by that and what do we do?
Firstly though worth remembering that things were comparatively pretty good 10+ yrs ago – maximum elective waits were 18wks not 18months! Cancer targets were being consistently met. And 95%+ of patients attending A&E were seen within 4hrs. Therefore what happened? Well with an aging population we needed to keep investing (65yrs+ now have an ave of 2 chronic conditions to manage) and finally sort the long term capacity problem in Social care. Instead we did neither, for variable reasons, but nonetheless no surprise therefore we ended up where we are. (Also worth noting we cut public health and did little to drive health and well being, which might have forestalled some demand, albeit not for ever because we all get old and frail at some point and then we generate a lot more cost in care)
Let’s assume UK population has no appetite to vote for private insurance model. It doesn’t work well in the US, costs are much higher, fee for service generates different economic problems, and not everyone has cover. So the debate is really about a move towards the Social Insurance model of Germany, France, Netherlands etc. It would de-couple some of the politicisation but not entirely. We’d pay more overall as proportion of GDP if those Models are anything to go by. Furthermore the Treasury would have to acquiesce and allow long term workforce modelling and planning as that requires alignment with education sector capacity planning. This is what also happens in these countries and is one of the most stark problems in the UK. We’ve blocked it. A theme not just prevalent in health care of course. Our politics struggles with longer term planning per se.
There is a debate here to had though, but Author again does what a lot of Unherd articles do – a confirmatory bias headline with a diagnosis many will nod in agreement with, but without any real proposed interventions/suggestions. It’s just left hanging. It’s again arguably one of the other modern malaises – the ability to critique is well ahead of the ability to construct.
The politicisation of the NHS is a factor, but it’s too unspecific a diagnosis. Question is what do we mean by that and what do we do?
Firstly though worth remembering that things were comparatively pretty good 10+ yrs ago – maximum elective waits were 18wks not 18months! Cancer targets were being consistently met. And 95%+ of patients attending A&E were seen within 4hrs. Therefore what happened? Well with an aging population we needed to keep investing (65yrs+ now have an ave of 2 chronic conditions to manage) and finally sort the long term capacity problem in Social care. Instead we did neither, for variable reasons, but nonetheless no surprise therefore we ended up where we are. (Also worth noting we cut public health and did little to drive health and well being, which might have forestalled some demand, albeit not for ever because we all get old and frail at some point and then we generate a lot more cost in care)
Let’s assume UK population has no appetite to vote for private insurance model. It doesn’t work well in the US, costs are much higher, fee for service generates different economic problems, and not everyone has cover. So the debate is really about a move towards the Social Insurance model of Germany, France, Netherlands etc. It would de-couple some of the politicisation but not entirely. We’d pay more overall as proportion of GDP if those Models are anything to go by. Furthermore the Treasury would have to acquiesce and allow long term workforce modelling and planning as that requires alignment with education sector capacity planning. This is what also happens in these countries and is one of the most stark problems in the UK. We’ve blocked it. A theme not just prevalent in health care of course. Our politics struggles with longer term planning per se.
There is a debate here to had though, but Author again does what a lot of Unherd articles do – a confirmatory bias headline with a diagnosis many will nod in agreement with, but without any real proposed interventions/suggestions. It’s just left hanging. It’s again arguably one of the other modern malaises – the ability to critique is well ahead of the ability to construct.
I recall meeting an IT ” consultant” at a dinner party who regaled us all with the racket that saw him and his circle, via tame headhunters get paid thousands of pounds per day for doing nothing. I remember speaking to a former Army friend, hired into NHS admin who discovered that vast sums were being paid to suppliers of the likes of bin bags, photocopier paper, at sometimes 10 x the going rate…. Why had no government done anything about this, that also goes on in every other public sector?
Absolutely.
Of course, the MOD is one of the most notorious government departments and wastes
£millions if not £billions.
Government must be kept as small as possible
to prevent waste and corruption.
The bigger a government grows, the more corrupt it becomes.
Added to that, most politicians are incompetent, venal and corrupt.
If Labour wins the next GE, that will be entirely
the fault of the leadership of the “Conservative”
party.
Look forward to Max Headroom and
Angela ( rag doll ) Rayner the fishwife,
leading the free world.
Absolutely.
Of course, the MOD is one of the most notorious government departments and wastes
£millions if not £billions.
Government must be kept as small as possible
to prevent waste and corruption.
The bigger a government grows, the more corrupt it becomes.
Added to that, most politicians are incompetent, venal and corrupt.
If Labour wins the next GE, that will be entirely
the fault of the leadership of the “Conservative”
party.
Look forward to Max Headroom and
Angela ( rag doll ) Rayner the fishwife,
leading the free world.
I recall meeting an IT ” consultant” at a dinner party who regaled us all with the racket that saw him and his circle, via tame headhunters get paid thousands of pounds per day for doing nothing. I remember speaking to a former Army friend, hired into NHS admin who discovered that vast sums were being paid to suppliers of the likes of bin bags, photocopier paper, at sometimes 10 x the going rate…. Why had no government done anything about this, that also goes on in every other public sector?
Alongside demographic pressures (aging population, immigration) the biggest other single cost to the NHS is the availability of treatments undreamed of back when the NHS was founded, the majority of which are very expensive due to their development costs. The perfect example in the news today: a new treatment for Type 1 diabetes (the type with the genetic not the lifestyle component). There are about 100,000 Type 1 diabetics in England alone, and the cost of the new treatment, which involves a system of automated insulin delivery is £6000. So that’d be an upfront cost of £600m to the NHS. That might be offset by savings on day-to-day management, but it’s virtually unaffordable as things stand unless the initial cost can be renegotiated.
Multiply this new treatment by those becoming available across a range of diseases, particularly all the different types of cancer, and you can immediately see where the funding issue has led the NHS. It’s become a black hole, absolutely insatiable however much money is thrown in its direction. All these new treatments take management skills and infrastructure to work effectively too.
The upshot is that healthcare is already a lottery, depending not just on where you live but what type of illness you contract. Rationing is the great hidden variable in the current system, which commentators such as Toynbee haven’t got a clue about or even take into consideration when banging on in dramatic leftie fashion to raise their own profile at the expense of the potential for change which would actually benefit the population. I don’t have the figures for how far ahead other developed countries are in the provision of new medicines and treatments, but i’d be surprised if we’re not behind the curve in the UK, despite having world-leading research going on.
Well-expressed. Calling out rationing as the “great hidden variable” is saying the quiet part out loud, isn’t it?
Well-expressed. Calling out rationing as the “great hidden variable” is saying the quiet part out loud, isn’t it?
Alongside demographic pressures (aging population, immigration) the biggest other single cost to the NHS is the availability of treatments undreamed of back when the NHS was founded, the majority of which are very expensive due to their development costs. The perfect example in the news today: a new treatment for Type 1 diabetes (the type with the genetic not the lifestyle component). There are about 100,000 Type 1 diabetics in England alone, and the cost of the new treatment, which involves a system of automated insulin delivery is £6000. So that’d be an upfront cost of £600m to the NHS. That might be offset by savings on day-to-day management, but it’s virtually unaffordable as things stand unless the initial cost can be renegotiated.
Multiply this new treatment by those becoming available across a range of diseases, particularly all the different types of cancer, and you can immediately see where the funding issue has led the NHS. It’s become a black hole, absolutely insatiable however much money is thrown in its direction. All these new treatments take management skills and infrastructure to work effectively too.
The upshot is that healthcare is already a lottery, depending not just on where you live but what type of illness you contract. Rationing is the great hidden variable in the current system, which commentators such as Toynbee haven’t got a clue about or even take into consideration when banging on in dramatic leftie fashion to raise their own profile at the expense of the potential for change which would actually benefit the population. I don’t have the figures for how far ahead other developed countries are in the provision of new medicines and treatments, but i’d be surprised if we’re not behind the curve in the UK, despite having world-leading research going on.
Comment to UnHerd moderators: suggest combine Paddy Taylor’s comments and publish as a separate analysis on this platform. Important stuff, could really make a difference.
Comment to UnHerd moderators: suggest combine Paddy Taylor’s comments and publish as a separate analysis on this platform. Important stuff, could really make a difference.
The author is a BBC presenter who advocates unspecified structural reform. It is a pity that she didn’t go on to wonder “why have there been no documentaries explaining to the British people how French, German, Swedish etc. health systems actually work?” Why no interviews with notoriously left-wing French or Swedish politicans to explain why they don’t have a problem with co-payments and aren’t mortified by two-tier systems? The answer, it seems to me, is that Panorama and Dispatches journalists have no interest in examining better health care systems. To them, the NHS is not a health care system at all; rather, it is a system which imposes equality in that we all die together and no one gets better treatment than anyone else.
The continental health care systems actually work.
The UK should be modelling the health service
on these systems.
They work because they receive much more funding. If the UK matched their levels of funding for a decade and still had much worse outcomes then I’d agree it would be worth looking at the system, however currently I don’t believe it’s a fair comparison
No.
NHS funding has increased year on year,
not just in cash terms but real terms.
Much of the NHS money is wasted
They are still recruiting diversity officers, FFS.
That increased funding means the UK only spends 20% less than the Germans per capita on its healthcare system rather than the 33% it was 5 years ago. The Germans on the past have also spent much, much more on capacity so don’t have the backlogs the UK is now seeing
That increased funding means the UK only spends 20% less than the Germans per capita on its healthcare system rather than the 33% it was 5 years ago. The Germans on the past have also spent much, much more on capacity so don’t have the backlogs the UK is now seeing
No.
NHS funding has increased year on year,
not just in cash terms but real terms.
Much of the NHS money is wasted
They are still recruiting diversity officers, FFS.
They work because they receive much more funding. If the UK matched their levels of funding for a decade and still had much worse outcomes then I’d agree it would be worth looking at the system, however currently I don’t believe it’s a fair comparison
Yes it has been deified by many, playing well into the modern primary concerns of safety and saving/extending life. Hence not up for rational debate.
The continental health care systems actually work.
The UK should be modelling the health service
on these systems.
Yes it has been deified by many, playing well into the modern primary concerns of safety and saving/extending life. Hence not up for rational debate.
The author is a BBC presenter who advocates unspecified structural reform. It is a pity that she didn’t go on to wonder “why have there been no documentaries explaining to the British people how French, German, Swedish etc. health systems actually work?” Why no interviews with notoriously left-wing French or Swedish politicans to explain why they don’t have a problem with co-payments and aren’t mortified by two-tier systems? The answer, it seems to me, is that Panorama and Dispatches journalists have no interest in examining better health care systems. To them, the NHS is not a health care system at all; rather, it is a system which imposes equality in that we all die together and no one gets better treatment than anyone else.
Socialism does not work and the NHS is the proof. If it did we would let the government run the supermarkets, hotels, holiday companies. Imagine a booking a holiday and arrive to find there wasn’t a bed for you, etc, etc.
What a sweeping statement.
In the interests of balance, if the private sector was universally wonderful, the defence forces would be privatised.
A moderate approach is to accept that a mixed approach has advantages, instead of the angry absolutism of the “privatise everything” / “nationalise everything” extremists.
Alan is 100%correct and everyone knows that.
All military procurement comes from PRIVATE companies.
Remember when the government manufactured our cars ?
Alan is 100%correct and everyone knows that.
All military procurement comes from PRIVATE companies.
Remember when the government manufactured our cars ?
What a sweeping statement.
In the interests of balance, if the private sector was universally wonderful, the defence forces would be privatised.
A moderate approach is to accept that a mixed approach has advantages, instead of the angry absolutism of the “privatise everything” / “nationalise everything” extremists.
Socialism does not work and the NHS is the proof. If it did we would let the government run the supermarkets, hotels, holiday companies. Imagine a booking a holiday and arrive to find there wasn’t a bed for you, etc, etc.
No one talks about the real cause of the problems though do they…? A massive increase in population over the last 30 years, the majority of which is foreign immigration . These newcomers have bigger families, more health problems and place a huge burden on the NHS ( not to mention other services) , which has not ( of course – the cost would be exhorbitant) expanded accordingly. They also pay less tax as the majority, if they work, are in low paid jobs or in the black economy. The scale of immigration to the UK has far outstripped the ablity of our infrastrcuture to cope, and despite being told it is necessary to fill all the job vacancies, we still do not have the staff in the NHS ( Or other areas of employment). Of course, there is no way to remove those who have already come and still they pour in, so its only going to get worse and worse, no matter what money any colour government throws at it. The NHS is a black hole voraciously sucking in money and never improving. Yes, the staff are great, but funding it at the level required would be impossible. Yet somehow, the vast majority of people in the UK seem to have their blinkers on regarding this holiest of cows….90% of population growth in the last 20 years is caused by excessive immigration. It needs to stop.
Exactly right.
Total rot. Immigrants tend to be predominantly young, single and male….so much less of a burden on the NHS than, for example, boomers.
Exactly right.
Total rot. Immigrants tend to be predominantly young, single and male….so much less of a burden on the NHS than, for example, boomers.
No one talks about the real cause of the problems though do they…? A massive increase in population over the last 30 years, the majority of which is foreign immigration . These newcomers have bigger families, more health problems and place a huge burden on the NHS ( not to mention other services) , which has not ( of course – the cost would be exhorbitant) expanded accordingly. They also pay less tax as the majority, if they work, are in low paid jobs or in the black economy. The scale of immigration to the UK has far outstripped the ablity of our infrastrcuture to cope, and despite being told it is necessary to fill all the job vacancies, we still do not have the staff in the NHS ( Or other areas of employment). Of course, there is no way to remove those who have already come and still they pour in, so its only going to get worse and worse, no matter what money any colour government throws at it. The NHS is a black hole voraciously sucking in money and never improving. Yes, the staff are great, but funding it at the level required would be impossible. Yet somehow, the vast majority of people in the UK seem to have their blinkers on regarding this holiest of cows….90% of population growth in the last 20 years is caused by excessive immigration. It needs to stop.
I also have been thinking about the similarities between the macro of the NHS crisis and the micro of its impact on individuals, and I’d add a few things. We have a number of unfortunate factors colluding:
Dependence on a nanny state leading to a passive mindset, generally expecting the government or someone else to fix things. Example: my sweet uncle waiting months to see a physio for his debilitating back pain when he could well afford one himself, but the principle is more important. This passivity is reflected in a plethora of everyday things like people not looking for work because by coming off benefits and working full-time they would end up with less at the end of the month, so why bother?
Cultural dependence on the allopathic model which still, in this day and age, insists on treating symptoms which, in so many instances, sit at the end of a long list of lifestyle choices. See point 1 for why people don’t join the dots. It’s a bottomless pit that even a well-functioning NHS would struggle to deal with.
As mentioned in the article, the obvious conundrums that come from living longer. I work as a live-in carer, so I have first-hand experience of that. Also, when one thinks how badly some elderly are treated, especially those barely aware that they exist, one has to wonder if it’s all not just to make ourselves feel saintly. Probably it’s a massive psychological defense against our own mortality.
Cultural hyper-sensitivity, which is a collusion of having things easy (UK is rich compared to other countries) and having to all finally share the sandpit (a bit more). In the NHS this plays out, for example, in the splitting of one job into three to make sure the PC demographics add up and/or choosing a less qualified people to fill quotas. I believe this is supposed to be changing but the damage has been done and will takes ages to wash out of the system – if it ever does. Once a person is in a job (even if they’re not needed or are doing it badly) it’s virtually impossible to remove them.
Also within the NHS, bad/outdated people and systems management, nepotism, and whistle-blowing systems that don’t work because you WILL be found out and pay for your ‘career-limiting’ choice to be ethical.
Suppliers take advantage of NHS procurement by loading prices. At the same time, this is not helped by payment delays and complicated payment systems.
These thoughts are based on things I hear from friends and acquaintances in the NHS as well as in my professional caring circles.
I believe this crisis can be an opportunity for society to evolve to become more self-sufficient, more accountable, and less fear-based, and for critical thinking to be truly valued over expedience.
I also have been thinking about the similarities between the macro of the NHS crisis and the micro of its impact on individuals, and I’d add a few things. We have a number of unfortunate factors colluding:
Dependence on a nanny state leading to a passive mindset, generally expecting the government or someone else to fix things. Example: my sweet uncle waiting months to see a physio for his debilitating back pain when he could well afford one himself, but the principle is more important. This passivity is reflected in a plethora of everyday things like people not looking for work because by coming off benefits and working full-time they would end up with less at the end of the month, so why bother?
Cultural dependence on the allopathic model which still, in this day and age, insists on treating symptoms which, in so many instances, sit at the end of a long list of lifestyle choices. See point 1 for why people don’t join the dots. It’s a bottomless pit that even a well-functioning NHS would struggle to deal with.
As mentioned in the article, the obvious conundrums that come from living longer. I work as a live-in carer, so I have first-hand experience of that. Also, when one thinks how badly some elderly are treated, especially those barely aware that they exist, one has to wonder if it’s all not just to make ourselves feel saintly. Probably it’s a massive psychological defense against our own mortality.
Cultural hyper-sensitivity, which is a collusion of having things easy (UK is rich compared to other countries) and having to all finally share the sandpit (a bit more). In the NHS this plays out, for example, in the splitting of one job into three to make sure the PC demographics add up and/or choosing a less qualified people to fill quotas. I believe this is supposed to be changing but the damage has been done and will takes ages to wash out of the system – if it ever does. Once a person is in a job (even if they’re not needed or are doing it badly) it’s virtually impossible to remove them.
Also within the NHS, bad/outdated people and systems management, nepotism, and whistle-blowing systems that don’t work because you WILL be found out and pay for your ‘career-limiting’ choice to be ethical.
Suppliers take advantage of NHS procurement by loading prices. At the same time, this is not helped by payment delays and complicated payment systems.
These thoughts are based on things I hear from friends and acquaintances in the NHS as well as in my professional caring circles.
I believe this crisis can be an opportunity for society to evolve to become more self-sufficient, more accountable, and less fear-based, and for critical thinking to be truly valued over expedience.
The problem with Our NHS is that it is a gubmint program.
And there is this law called Chantrill’s Law:
“Government programs cannot work because you can never reform them.”
Over to you, Sherlock.
The problem with Our NHS is that it is a gubmint program.
And there is this law called Chantrill’s Law:
“Government programs cannot work because you can never reform them.”
Over to you, Sherlock.
I think you hit the nail on the head there. The NHS’ mission statement has moved on entirely from its founding priorities. While I see the rationale behind the ‘ounce of prevention’ approach, it quickly becomes swallowed up by a reductio ad absurdum: why not, for instance, micromanage every aspect of the patient’s diet, exercise regimen, work, leisure, etc, in a manner which ensures optimal long-term health, surrounding them with a team of consultants?
It should be the individual who “micromanages” decisions about their health. And bears some of the costs from knowingly self-inflicted conditions (whether through tax, insurance or payment).
I think it’s critically important that we do put more effort into preventative healthcare. We all know that providing stuff for free (the NHS model) creates additional demand and rewards some behaviours that we should not. The NHS model undermines personal responsibility. This is – for me – a fatal flaw.
Preventative healthcare does not have to mean bullying people into not smoking or drinking. It could mean making people take more responsibility for their own decisions and health – after all a significant proportion of health treatments are a direct result of “lifestyle choices”. Is it really reasonable to expect others to pick up the tab for self-inflicted costs ?
Of course, a lot of these people might be effectively paying for their care through massive taxes on tobacco and alcohol. But I’m not sure that fully covers all the costs. It certainly does not for voluntary obesity.
“It should be the individual who “micromanages” decisions about their health.”
In theory, yes.
But ignores the inconvenient fact that people are generally poorly educated and gullible and are bombarded with junk food, vape, cig and booze advertising.
People are so manipulated by drug and junk food pushers that they barely know which way is up.
The rational actor approach presupposes a relatively neutral environment wherein ordinary people are not routinely lied to by drug pushers and junk food vendors.
Yes, there are always exceptions. But if we can get more people to take greater personal responsibility, then at least we can make some progress. The fact that there are difficulties and hard cases and we cannot force a “one size fits all” model (and why should we expect or demand that ?) is no excuse to do nothing.
I’m frankly fed up with the “it’s all too difficult, so we won’t bother trying to change – just give us more money instead” line we get.
While we never hear NHS managers explaining why their business is in permanent crisis (the business they are well paid to manage) and letting the politicians take the flak, we will make no progress. Nor while people like Matthew Taylor, in his sinecure as chief executive at the NHS Confederation (what experience and qualifications does he have for this role ?) treating the job as a PR operation rather than taking responsibility and providing leadership. What exactly do the top managers running the NHS do ? No one running a failing private business would be allowed to be invisible like this.
I didn’t realize that drug and junk food pushers were in charge of primary education in the UK.
Yes, there are always exceptions. But if we can get more people to take greater personal responsibility, then at least we can make some progress. The fact that there are difficulties and hard cases and we cannot force a “one size fits all” model (and why should we expect or demand that ?) is no excuse to do nothing.
I’m frankly fed up with the “it’s all too difficult, so we won’t bother trying to change – just give us more money instead” line we get.
While we never hear NHS managers explaining why their business is in permanent crisis (the business they are well paid to manage) and letting the politicians take the flak, we will make no progress. Nor while people like Matthew Taylor, in his sinecure as chief executive at the NHS Confederation (what experience and qualifications does he have for this role ?) treating the job as a PR operation rather than taking responsibility and providing leadership. What exactly do the top managers running the NHS do ? No one running a failing private business would be allowed to be invisible like this.
I didn’t realize that drug and junk food pushers were in charge of primary education in the UK.
“It should be the individual who “micromanages” decisions about their health.”
In theory, yes.
But ignores the inconvenient fact that people are generally poorly educated and gullible and are bombarded with junk food, vape, cig and booze advertising.
People are so manipulated by drug and junk food pushers that they barely know which way is up.
The rational actor approach presupposes a relatively neutral environment wherein ordinary people are not routinely lied to by drug pushers and junk food vendors.
It should be the individual who “micromanages” decisions about their health. And bears some of the costs from knowingly self-inflicted conditions (whether through tax, insurance or payment).
I think it’s critically important that we do put more effort into preventative healthcare. We all know that providing stuff for free (the NHS model) creates additional demand and rewards some behaviours that we should not. The NHS model undermines personal responsibility. This is – for me – a fatal flaw.
Preventative healthcare does not have to mean bullying people into not smoking or drinking. It could mean making people take more responsibility for their own decisions and health – after all a significant proportion of health treatments are a direct result of “lifestyle choices”. Is it really reasonable to expect others to pick up the tab for self-inflicted costs ?
Of course, a lot of these people might be effectively paying for their care through massive taxes on tobacco and alcohol. But I’m not sure that fully covers all the costs. It certainly does not for voluntary obesity.
I think you hit the nail on the head there. The NHS’ mission statement has moved on entirely from its founding priorities. While I see the rationale behind the ‘ounce of prevention’ approach, it quickly becomes swallowed up by a reductio ad absurdum: why not, for instance, micromanage every aspect of the patient’s diet, exercise regimen, work, leisure, etc, in a manner which ensures optimal long-term health, surrounding them with a team of consultants?
The NHS’s problem is generic.
There are two ways to ration demand: by price and/or by waiting line.
If you make stuff free, people line up, and then they complain about long lines and about how to make the system more “efficient.” An easy way to relieve the waiting time is to impose some fees … but then care is no longer free.
So, choose your poison. And accept the consequences.
The NHS’s problem is generic.
There are two ways to ration demand: by price and/or by waiting line.
If you make stuff free, people line up, and then they complain about long lines and about how to make the system more “efficient.” An easy way to relieve the waiting time is to impose some fees … but then care is no longer free.
So, choose your poison. And accept the consequences.
“As early as 2013, the UK was already spending less than any other G7 country except Italy on healthcare. In 2017, when France spent £3,737 per head, and Germany £4,432, we spent £2,989.”
Is this actually true or are the figures bein fiddled by those with a vested interest. For example, the UK figures will not include the cost of social care but I expect there in no such distinction for other countries.
What is true is with 1.7m employees the NHS is the third or fourth largest employer on the planet and the annual budget is in excess of £160b
If you want to dispute the figures then you need to find your own, or at least prove that the others include provisions that the UK number has left out.
Just posting guesswork to try and prove a point doesn’t cut it
Why do YOU post guesswork then ?
They are wasting billions on diversity officers.
That is according to you, just fine.
Where have I posted guesswork? All my comments have contained figures of how much is spent on different systems, rather than guessing about what it is spent on
Where have I posted guesswork? All my comments have contained figures of how much is spent on different systems, rather than guessing about what it is spent on
Why do YOU post guesswork then ?
They are wasting billions on diversity officers.
That is according to you, just fine.
If you want to dispute the figures then you need to find your own, or at least prove that the others include provisions that the UK number has left out.
Just posting guesswork to try and prove a point doesn’t cut it
“As early as 2013, the UK was already spending less than any other G7 country except Italy on healthcare. In 2017, when France spent £3,737 per head, and Germany £4,432, we spent £2,989.”
Is this actually true or are the figures bein fiddled by those with a vested interest. For example, the UK figures will not include the cost of social care but I expect there in no such distinction for other countries.
What is true is with 1.7m employees the NHS is the third or fourth largest employer on the planet and the annual budget is in excess of £160b
I am so broed with the various spokespeople for The NHS coming out each and every winter with ”The NHS is on its knees – and we should pump more money in’ – crying wolf (either now or in the past) has not done The NHS any favours.
Pumping money in will not get a single new Doctor or Nurses to the front line any time soon. (I agree more training palces are required).
2016 (famous for the £350m a week for NHS that remoners cannot let go) NHS spending then was about £132bn pa
2022 in this current year the spending on NHS is closer to £200bn – (lets say in round figures) not the £350m a week but more than £1bn A WEEK EXTRA and yet, here we are all over again – ”More Money is needed as the dastardly Tories have starved it”
Huh!
Something needs to change and its not necessarily ”Even More cash”.
I am so broed with the various spokespeople for The NHS coming out each and every winter with ”The NHS is on its knees – and we should pump more money in’ – crying wolf (either now or in the past) has not done The NHS any favours.
Pumping money in will not get a single new Doctor or Nurses to the front line any time soon. (I agree more training palces are required).
2016 (famous for the £350m a week for NHS that remoners cannot let go) NHS spending then was about £132bn pa
2022 in this current year the spending on NHS is closer to £200bn – (lets say in round figures) not the £350m a week but more than £1bn A WEEK EXTRA and yet, here we are all over again – ”More Money is needed as the dastardly Tories have starved it”
Huh!
Something needs to change and its not necessarily ”Even More cash”.
Just read this article in Reduxx “England’s NHS To Spend £100,000 On “Trans Inclusive Maternity” Program”. Where is this money coming from when the system is said to be collapsing? https://reduxx.info/englands-nhs-to-spend-100000-on-trans-inclusive-maternity-program/?fbclid=IwAR38bopvUNjCFcbGEwGQAJgqNfBsiNlxNLf4g-wWudLkaHL5q3fXOOrSlrw
Just read this article in Reduxx “England’s NHS To Spend £100,000 On “Trans Inclusive Maternity” Program”. Where is this money coming from when the system is said to be collapsing? https://reduxx.info/englands-nhs-to-spend-100000-on-trans-inclusive-maternity-program/?fbclid=IwAR38bopvUNjCFcbGEwGQAJgqNfBsiNlxNLf4g-wWudLkaHL5q3fXOOrSlrw
The deeper question, which is hardly ever addressed, is why are so many people, so ill, so much of the time?
Maybe it’s because the the UK has an epidemic of poor diet, lack of exercise, toxic lifestyles and purposelessness, all taking place within a moral vacuum. The NHS cannot do anything about these things. We could sacrifice 100% of GDP at its altar and it would not make a scrap of difference.
I sincerely believe that most people in the UK are stark, staring mad and the sanctification of the NHS is one manifestation of this. I suppose its understandable, we have nothing else left of value so we cling onto our self-identity as good people because we have the NHS. But to me it’s all rather sad and pathetic.
The deeper question, which is hardly ever addressed, is why are so many people, so ill, so much of the time?
Maybe it’s because the the UK has an epidemic of poor diet, lack of exercise, toxic lifestyles and purposelessness, all taking place within a moral vacuum. The NHS cannot do anything about these things. We could sacrifice 100% of GDP at its altar and it would not make a scrap of difference.
I sincerely believe that most people in the UK are stark, staring mad and the sanctification of the NHS is one manifestation of this. I suppose its understandable, we have nothing else left of value so we cling onto our self-identity as good people because we have the NHS. But to me it’s all rather sad and pathetic.
The usual Beeb out of date nonsense. The UK is the fourth largest spender in the EU, with the worst outcomes outside Rumania. Italy, Denmark, and the Netherlands, are among EU countries who spend less per capita with better results.i appreciate UNHERD tries to provide articles outside the centre right box, but surely a truly expert analysis would have made more sense.
I very quickly found this
https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/
There are at least 10 EU countries spending more per capita than the UK in 2020. Do you have a better source of information?
I very quickly found this
https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/
There are at least 10 EU countries spending more per capita than the UK in 2020. Do you have a better source of information?
The usual Beeb out of date nonsense. The UK is the fourth largest spender in the EU, with the worst outcomes outside Rumania. Italy, Denmark, and the Netherlands, are among EU countries who spend less per capita with better results.i appreciate UNHERD tries to provide articles outside the centre right box, but surely a truly expert analysis would have made more sense.
But the government has just taken out a ten year contract with Moderna – which Rishi Sunak and his wife are invested in the British Virgin Island offshore tax haven – for their vaccines.
No conflict if interest there then
But the government has just taken out a ten year contract with Moderna – which Rishi Sunak and his wife are invested in the British Virgin Island offshore tax haven – for their vaccines.
No conflict if interest there then
In my eyes it doesn’t matter which system you use, if you’re not willing to fund it properly it isn’t going to function. If the German model had been stuck with the UKs levels of funding for the last 40 years it would be in much the same state.
There has been a history of under-spending on buildings and equipment for the NHS. Germany spent more than three times more per year as a share of GDP than the UK between 2015 and 2019 on infrastructure.
Despite recent increases the UKs healthcare spending per capita is only 80% of the Germans, and as recently as 2017 it was only roughly 66%. It’s no wonder the the Germans have 50% more doctors per capita and 3 times as many beds.
The lack of social care adds even more strain onto an already creaking system.
I’m not going to pretend the UK system is perfect, it appears too top heavy and too political, but until it’s funded to the same levels as it’s peers abroad I find comparisons to be largely meaningless
The Government (of the day) can match our neighbours funding and even exceed it but it will be a total waste if the money is not targetted properly. Wastage of tools and materials (Over-ordered, badly stored and well out-of-date items) must also be considered as a financial loss.
I’d wager every health service worldwide has a good deal of waste. There is a lot of gear they have to have in stock, not all of it will be needed before it’s expiration date
I’d wager every health service worldwide has a good deal of waste. There is a lot of gear they have to have in stock, not all of it will be needed before it’s expiration date
But the UK spends more p.c. than Denmark, Italy, the Netherlands and Spain.
I very quickly found this
https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/
There are at least 10 EU countries spending more per capita than the UK in 2020, including Denmark and the Netherlands. Do you have a better source of information?
So what ? That puts us in the middle for the EU. I looked at the data – we’re ahead of Finland, Japan, Korea, Iceland, Australia, New Zealand and around level with Ireland and Beligium. Well ahead of Italy and Spain. And this is a disaster ? Why ?
People need to stop measuring inputs and focus on outputs. Why and how are Japan and Korea getting much better results at much lower cost ?
But hang on a moment – do we really trust that data ? According to the chart, US health spending is $10.5bn public and only $1.6bn private !!! Really ? The public:private ratio there makes no sense – it’s even higher (lower % of private healthcare spending) than in the UK.
Thanks Tony, interesting that the UK spends about 25% more than Spain on this chart and yet everything I’ve heard about Spanish health care has been good.
Quite.
Quite.
So what ? That puts us in the middle for the EU. I looked at the data – we’re ahead of Finland, Japan, Korea, Iceland, Australia, New Zealand and around level with Ireland and Beligium. Well ahead of Italy and Spain. And this is a disaster ? Why ?
People need to stop measuring inputs and focus on outputs. Why and how are Japan and Korea getting much better results at much lower cost ?
But hang on a moment – do we really trust that data ? According to the chart, US health spending is $10.5bn public and only $1.6bn private !!! Really ? The public:private ratio there makes no sense – it’s even higher (lower % of private healthcare spending) than in the UK.
Thanks Tony, interesting that the UK spends about 25% more than Spain on this chart and yet everything I’ve heard about Spanish health care has been good.
I very quickly found this
https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/
There are at least 10 EU countries spending more per capita than the UK in 2020, including Denmark and the Netherlands. Do you have a better source of information?
“There has been a history of under-spending on buildings and equipment for the NHS”.
The evidence of my eyes tells me you are wrong there. Every where I look shiny new hospitals and GP surgeries. It’s like money is going out of fashion.
Which brings me to the point whether the figures for UK expenditure on health spending take into account the off the books stuff such as PPI
The UK population has increased around 8% since the Tories came to power, I’d wager the NHS capacity in terms of beds hasn’t risen by the same amount. Just because you’ve seen a couple of hospitals built doesn’t mean there hasn’t been underspending. As I pointed out the Germans spent more than triple in terms of GDP compared to the UK on healthcare infrastructure between 2015-2019 to improve capacity.
Yes but does this take into account PFI which is off book
And there are new hospital’s and GP surgeries all over the place and you have to question whether the old buildings really required replacement
Yes but does this take into account PFI which is off book
And there are new hospital’s and GP surgeries all over the place and you have to question whether the old buildings really required replacement
The UK population has increased around 8% since the Tories came to power, I’d wager the NHS capacity in terms of beds hasn’t risen by the same amount. Just because you’ve seen a couple of hospitals built doesn’t mean there hasn’t been underspending. As I pointed out the Germans spent more than triple in terms of GDP compared to the UK on healthcare infrastructure between 2015-2019 to improve capacity.
The Government (of the day) can match our neighbours funding and even exceed it but it will be a total waste if the money is not targetted properly. Wastage of tools and materials (Over-ordered, badly stored and well out-of-date items) must also be considered as a financial loss.
But the UK spends more p.c. than Denmark, Italy, the Netherlands and Spain.
“There has been a history of under-spending on buildings and equipment for the NHS”.
The evidence of my eyes tells me you are wrong there. Every where I look shiny new hospitals and GP surgeries. It’s like money is going out of fashion.
Which brings me to the point whether the figures for UK expenditure on health spending take into account the off the books stuff such as PPI
In my eyes it doesn’t matter which system you use, if you’re not willing to fund it properly it isn’t going to function. If the German model had been stuck with the UKs levels of funding for the last 40 years it would be in much the same state.
There has been a history of under-spending on buildings and equipment for the NHS. Germany spent more than three times more per year as a share of GDP than the UK between 2015 and 2019 on infrastructure.
Despite recent increases the UKs healthcare spending per capita is only 80% of the Germans, and as recently as 2017 it was only roughly 66%. It’s no wonder the the Germans have 50% more doctors per capita and 3 times as many beds.
The lack of social care adds even more strain onto an already creaking system.
I’m not going to pretend the UK system is perfect, it appears too top heavy and too political, but until it’s funded to the same levels as it’s peers abroad I find comparisons to be largely meaningless
The article’s conclusion is not wrong but the author’s facts are very out of date. A decade ago the UK spent less than comparable countries on health. This is no longer the case. In GDP terms the UK is mid-table.
Neither is the NHS obviously understaffed. Compared with 2019 there are 10% more consultants, 15% more junior doctors, 8% more nurses and 14% more senior managers. Not forgetting all the extra Equality and Diversity managers.
And the NHS’s problems are replicated across Europe, despite the different ways health systems are organised.
https://www.telegraph.co.uk/business/2023/01/08/not-just-nhs-health-services-imploding-europe/
The article’s conclusion is not wrong but the author’s facts are very out of date. A decade ago the UK spent less than comparable countries on health. This is no longer the case. In GDP terms the UK is mid-table.
Neither is the NHS obviously understaffed. Compared with 2019 there are 10% more consultants, 15% more junior doctors, 8% more nurses and 14% more senior managers. Not forgetting all the extra Equality and Diversity managers.
And the NHS’s problems are replicated across Europe, despite the different ways health systems are organised.
https://www.telegraph.co.uk/business/2023/01/08/not-just-nhs-health-services-imploding-europe/
The blunt truth is when health care is free hospitals and doctors will be overwhelmed by patients who in previous times stayed home and either died or got better.
The blunt truth is when health care is free hospitals and doctors will be overwhelmed by patients who in previous times stayed home and either died or got better.
Ignore this comment. It is a test to see why I can post from my phone but not my pc.
Ignore this comment. It is a test to see why I can post from my phone but not my pc.
There is a lot of comment that the system of ‘insurance’-based funding of healthcare is better than the government direct funding but I would like to know why. They both give ‘free’ care at point of need, but in the UK that is funded by general taxation and inother comparable countries (we need to exclude the disaster that is the USA) – exactly how? How do these systems work and, crucially, why are they better and more efficient (are they?) than what would logically seem to be the most efficient way whereby there is no leakage of profit to the private sector.
This is a genuine question. I surmise that despite the good comments by some on this thread that might be too much to answer in a comment, but can anyone link to a reputable, hopefully politically neutralish site or article which will explain? I don’t suppose that I am the only one keen to know more!
I have used the Italian, French and Belgian system. The Belgian was the best. You join a mutuelle, a non profit making entity, but you can only join after you have worked legally for six months, paying into the system. The mutuelles pay 80% of medical costs and full in-hospital costs. Most people have a top up insurance for the rest, and the mutuelles have a price maximum, which means doctors tend to keep within it. Costs are rather transparent. A friend had an outpatient surgery to remove a basal skin carcinoma. An excellent cancer surgeon performed the operation, on three days notice from the dermatologist, The cost was 167 euros, the bill broken down into operating room rent, labour cost of doctor and nurse, and medicines used. She had to buy bandages and painkillers herself for aftercare, reimbursable at 80%. Interestingly, the biopsy cost almost as much as the op, being another 150 euros. I suspect a day cancer op in the private sector in the UK would cost more, but welcome info from readers.
That’s not free healthcare then surely, if you have to pay 20% of the costs yourself?
Of course it isn’t. There is no such thing as “free healthcare”. Someone, somewhere is paying for it. In the UK, it seems to be normal and acceptable that people expect to pay *nothing* and someone else will pick up the tab. This really has to change. Something for nothing is not sustainable. Or moral. Or fair.
Above all, we need to stop lying to ourselves that there is something “fair” about a “something for nothing” welfare system.
If you read Anna’s comment carefully, you will note that the 20% is usually covered by insurance. Those who cannot pay the 20% do not have to (at least, not in France from my experience in the mid 1990s). Hospital costs (so emergency care) is fully covered. People in France are generally happy with their system. It works. You could get aGP appointment the same day.
Stop being pedantic. Free at point of use then if it makes you feel better.
So that was my question, do Belgians have to take out private insurance on top of the state run system to pay the remaining 20% of their healthcare bills, and what happens if they don’t have it?
But it is not simply a pedantic linguistic point. It is the concept that people should get something for nothing that needs challenging.
I don’t know about Belgium. You’ll have to research that part yourself. I’m sure the information is out there – do some research !
Certainly, in France the 20% part was means tested – those who couldn’t afford the 20%/insurance didn’t have to pay it/could recliam it. Of course, there was probably French paperwork/bureaucracy involved. I didn’t test this – I just paid the 20% on the one occasion I went to a GP. It wasn’t very much.
Ask yourself the question: “do I hear screams of outrage from France about how unfair the health system is and people clamouring to have the NHS instead ?”. I certainly don’t. My job was transferred from the UK to France for 2 years in the mid 1990s with a group of other British people. There were no complaints about the French healthcare system. The concensus was that is was better.
The lack of curiosity about other systems is telling. Normal business routinely benchmark their performance and practices against competitors and strive to improve if they aren’t good enough. There is no such discipline on the NHS. Accepting low standards guarantees low performance.
Of course it’s being pedantic, everybody knows what I meant by free healthcare without your petty point scoring.
You also say that paying 20% isn’t a big deal, whilst that may be the case for GP visits it would be completely different if you needed major surgery after a car accident, which is the point I’m trying to make. In France do you have to have private medical insurance to cover this extra 20%? If so that means the French system not only costs the state/taxpayer more per head than the NHS but also only funds 80% requiring more expense for individuals on top.
I’m not saying the NHS is perfect, far from it I believe we expect too much from it for the budget it has, my point you seem to be cherry picking the good parts of foreign healthcare systems and ignoring the drawbacks
Honestly, I’m not trying to score points. Sorry if it comes across that way. There is a serious point behind all this that I’m trying to make.
Actually, you’ll find we are in agreement on some things here. I’ve learned something from you (later comments) and am by no means an expert here.
Again, I cannot help you with all the details on European systems. But you will note from all the personal experiences recorded here that the feedback on them is very positive. This tells us something.
Again, if the French system was broken in the manner you query, where are the complaints ?
Absolutely, I agree about the “expectation gap”. The media encourage this and the politicians are too cowardly to face up to the choices needed.
We need to better define what we need (rather than want) from the NHS and then start making decisions based on that. The distinction between needs (strictly medical) and wants (consumer, cosmetic, optional) being rather important here. But that would require the UK public to be honest about this and stop expecting something for nothing. My original point.
Above all, we need to stop lying to ourselves about the NHS being the envy of the world. It is not.
There’s actually an article on the BBC today about the French healthcare system strangely enough, and the problems they are facing. A chronic lack of doctors have left many rural areas with no GPs at all, and over half their doctors are over the age of 55 (compared to 15% in the UK). They’re also facing massive strikes from nurses and other healthcare workers due to unsafe staffing levels so I don’t think it’s as good a system as many on here portray, despite it receiving more funding than the UK model.
I’m not pretending the NHS doesn’t have problems, it definitely needs reform but I still believe it’s a lack of funding, as well as awful social care provisions that cause the bulk of its problems rather than the manner it is funded
There’s actually an article on the BBC today about the French healthcare system strangely enough, and the problems they are facing. A chronic lack of doctors have left many rural areas with no GPs at all, and over half their doctors are over the age of 55 (compared to 15% in the UK). They’re also facing massive strikes from nurses and other healthcare workers due to unsafe staffing levels so I don’t think it’s as good a system as many on here portray, despite it receiving more funding than the UK model.
I’m not pretending the NHS doesn’t have problems, it definitely needs reform but I still believe it’s a lack of funding, as well as awful social care provisions that cause the bulk of its problems rather than the manner it is funded
Honestly, I’m not trying to score points. Sorry if it comes across that way. There is a serious point behind all this that I’m trying to make.
Actually, you’ll find we are in agreement on some things here. I’ve learned something from you (later comments) and am by no means an expert here.
Again, I cannot help you with all the details on European systems. But you will note from all the personal experiences recorded here that the feedback on them is very positive. This tells us something.
Again, if the French system was broken in the manner you query, where are the complaints ?
Absolutely, I agree about the “expectation gap”. The media encourage this and the politicians are too cowardly to face up to the choices needed.
We need to better define what we need (rather than want) from the NHS and then start making decisions based on that. The distinction between needs (strictly medical) and wants (consumer, cosmetic, optional) being rather important here. But that would require the UK public to be honest about this and stop expecting something for nothing. My original point.
Above all, we need to stop lying to ourselves about the NHS being the envy of the world. It is not.
Of course it’s being pedantic, everybody knows what I meant by free healthcare without your petty point scoring.
You also say that paying 20% isn’t a big deal, whilst that may be the case for GP visits it would be completely different if you needed major surgery after a car accident, which is the point I’m trying to make. In France do you have to have private medical insurance to cover this extra 20%? If so that means the French system not only costs the state/taxpayer more per head than the NHS but also only funds 80% requiring more expense for individuals on top.
I’m not saying the NHS is perfect, far from it I believe we expect too much from it for the budget it has, my point you seem to be cherry picking the good parts of foreign healthcare systems and ignoring the drawbacks
But it is not simply a pedantic linguistic point. It is the concept that people should get something for nothing that needs challenging.
I don’t know about Belgium. You’ll have to research that part yourself. I’m sure the information is out there – do some research !
Certainly, in France the 20% part was means tested – those who couldn’t afford the 20%/insurance didn’t have to pay it/could recliam it. Of course, there was probably French paperwork/bureaucracy involved. I didn’t test this – I just paid the 20% on the one occasion I went to a GP. It wasn’t very much.
Ask yourself the question: “do I hear screams of outrage from France about how unfair the health system is and people clamouring to have the NHS instead ?”. I certainly don’t. My job was transferred from the UK to France for 2 years in the mid 1990s with a group of other British people. There were no complaints about the French healthcare system. The concensus was that is was better.
The lack of curiosity about other systems is telling. Normal business routinely benchmark their performance and practices against competitors and strive to improve if they aren’t good enough. There is no such discipline on the NHS. Accepting low standards guarantees low performance.
Stop being pedantic. Free at point of use then if it makes you feel better.
So that was my question, do Belgians have to take out private insurance on top of the state run system to pay the remaining 20% of their healthcare bills, and what happens if they don’t have it?
Of course it isn’t. There is no such thing as “free healthcare”. Someone, somewhere is paying for it. In the UK, it seems to be normal and acceptable that people expect to pay *nothing* and someone else will pick up the tab. This really has to change. Something for nothing is not sustainable. Or moral. Or fair.
Above all, we need to stop lying to ourselves that there is something “fair” about a “something for nothing” welfare system.
If you read Anna’s comment carefully, you will note that the 20% is usually covered by insurance. Those who cannot pay the 20% do not have to (at least, not in France from my experience in the mid 1990s). Hospital costs (so emergency care) is fully covered. People in France are generally happy with their system. It works. You could get aGP appointment the same day.
That’s not free healthcare then surely, if you have to pay 20% of the costs yourself?
I think this I can help here.
A number of my European colleagues (who are assigned for spells in the UK) say that if the do not feel they are getting a good service from a hospital or doctor they can just switch and no one think twice about doing so.
But apparently GPs in France have to work a harder for significantly less money. Just like the good old days before the NHS.
None of my European colleagues think much of the NHS and cannot see why we persist with it. Even those who do not earn much pay for private health cover rather than go through the NHS. One of the things they seem to find most off-putting is the attitude of NHS staff, including the doctors.
So the UK already has a massive shortage of GPs (which in turn puts strain on the hospitals as people who can’t see their doctor then turn up at A&E) and your solution increase this number is to cut their pay and increase their workload? Im sure they’ll be queuing up to join!
One suggestion is to increase the supply. Training of doctors is currently limited by some strange agreement between the BMA and the government. Whilst further education has massively expanded and all sorts of new universities and degree courses have appeared and – we are assured – educational standards have risen, somehow the number of medical degree places has not increased.
Why is that ?
This seems like a basic planning and management failure. Not helped by restrictive practices from the BMA.
Instead, we seem to think it a good idea to asset strip poor countries of their doctors.
Let’s start training more doctors here.
The last Labour government gave doctors an absurdly large pay rise which was not needed. Normal supply and demand would take care of the salaries if medical degrees were not rationed.
We really must get away from this awful culture of rationing in health. Rationing degree places in this case.
But what are your solutions here ? Lots of questions. Any ideas ?
A quick check suggests that the number of medical degrees in 2010 was around 8800 and in 2022 that was around 8800. There was a large increase between 2002 and 2008. But basically nothing since then.
Why not ?
I cannot believe that there are not enough qualified candidates in the UK to increase that to 12000 – or even 16000.
We might as well get people at universities studying something useful.
And then someone decided to make up “nursing degrees”. Thereby increasing the cost of nursing for no clear benefit. Unless we are going to create an intermediate qualification between doctor and nurse (and that might be worth doing – but I do not see it being discussed), this credentialism would just seem to be a waste of time and money and a large opportunity cost for healthcare in the UK
Again it’s a lack of funding on the part of the government. Rather than pay to train doctors it’s cheaper simply to import them.
I don’t see that as a fault of the NHS setup though, I see that as a fault of the government.
I think you are substantially correct. It appears there is a government cap on medical school training places which has been reset to 7500 in 2022. It was allowed to increase to 10000 in 2020 and 2021. So it clearly is possible to train more doctors. No excuse for the government here.
I’m not clear why there needs to be a cap at all. Market forces ought to balance supply and demand. But we don’t allow that.
It’s not a lack of funding. It’s money being spent on the wrong things. Too much on PFI wastage, wasteful purchasing, destructive overheads like “diversity”, shiny new buildings and horse therapy for nurses (yes – that happened during Covid in one hospitaI I know of).
Nothing that professional management couldn’t fix.
I do also find that the BMA voted against increasing medical training back in July 2008 : “Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.” Which is a complete disgrace and arguably against the ethics of their profession to operate a professional closed shop against the interests of their patients. But perhaps that was a one-off and no logner their position ?
I would have thought medical students could get loans like the rest of the student population
That is not the problem. The government has a cap on the total places. They then claim that there is not the capacity to train more doctors. After proving that they can raise the limit from 8000 to 10000 ! Madness.
Tens, possibly hundreds of thousands of students are taking degrees of little value for which they will never pay back the loans. That’s money down the drain. Plus lost value from the work they might otherwise have been doing. And we “cannot afford” to train 2000 more doctors ? After blowing billions on bailing out bankers and Covid support fraud ?
There is no shortage of money. Only a shortage of sense and good management.
That is not the problem. The government has a cap on the total places. They then claim that there is not the capacity to train more doctors. After proving that they can raise the limit from 8000 to 10000 ! Madness.
Tens, possibly hundreds of thousands of students are taking degrees of little value for which they will never pay back the loans. That’s money down the drain. Plus lost value from the work they might otherwise have been doing. And we “cannot afford” to train 2000 more doctors ? After blowing billions on bailing out bankers and Covid support fraud ?
There is no shortage of money. Only a shortage of sense and good management.
I would have thought medical students could get loans like the rest of the student population
I think you are substantially correct. It appears there is a government cap on medical school training places which has been reset to 7500 in 2022. It was allowed to increase to 10000 in 2020 and 2021. So it clearly is possible to train more doctors. No excuse for the government here.
I’m not clear why there needs to be a cap at all. Market forces ought to balance supply and demand. But we don’t allow that.
It’s not a lack of funding. It’s money being spent on the wrong things. Too much on PFI wastage, wasteful purchasing, destructive overheads like “diversity”, shiny new buildings and horse therapy for nurses (yes – that happened during Covid in one hospitaI I know of).
Nothing that professional management couldn’t fix.
I do also find that the BMA voted against increasing medical training back in July 2008 : “Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.” Which is a complete disgrace and arguably against the ethics of their profession to operate a professional closed shop against the interests of their patients. But perhaps that was a one-off and no logner their position ?
A quick check suggests that the number of medical degrees in 2010 was around 8800 and in 2022 that was around 8800. There was a large increase between 2002 and 2008. But basically nothing since then.
Why not ?
I cannot believe that there are not enough qualified candidates in the UK to increase that to 12000 – or even 16000.
We might as well get people at universities studying something useful.
And then someone decided to make up “nursing degrees”. Thereby increasing the cost of nursing for no clear benefit. Unless we are going to create an intermediate qualification between doctor and nurse (and that might be worth doing – but I do not see it being discussed), this credentialism would just seem to be a waste of time and money and a large opportunity cost for healthcare in the UK
Again it’s a lack of funding on the part of the government. Rather than pay to train doctors it’s cheaper simply to import them.
I don’t see that as a fault of the NHS setup though, I see that as a fault of the government.
I never said that but funny you should mention it.
There are a couple of issues here.
A friend of mine works as a financial advisor for a bank and counts GPs amongst his clients. Their pension is so good that they can no longer get tax relief on their contributions by the time they reach their mid 40s so many decide to semi-retire or retire altogether.
A lot of GPs are women and it seems that a significant percentage of them chose to become GPs because they have have decided at some point they will not want to continue to work full-time.
They are not over-worked. Far from it.
As other people have pointed out, there would be people queuing up to go to medical school and earn £100k pa plus but for the Faustian pact struck between the medical profession and the Government that allows the profession to limit places at medical school. If you look at the literature for the period prior to the NHS there was a major issue for the profession was that they were not being paid what they thought they were worth because there was a free market for their services and they had to compete like the rest of us with all manner of works organizations an societies employing doctors for the benefit of their members
One of the reasons why people go to A&E rather than their GP is that GP trend to be lazy and not give a toss (not like the old days). This has been my invariable experience (and I could tell some horror stories) and on of the main drivers for my European colleagues going private
Indeed – the much complained about “problem” of doctors pensions is because they are so exceptionally large compared to most of the rest of us ! Remember that the tax relief rules were changed for everyone and not only for doctor’s. So if doctors are vastly over-represented in those impacted, it tells us something.
I do have some sympathy with those affected by the tax relief changes (doctors included). The tax change here was stupid and effectively retrospective. I think George Osborne’s work again. Or perhaps Philip Hammond’s. HMRC would do better to raise the tax on the pension after it is drawn or put more tax on huge tax free lump sums.
What I find particularly offensive about [many of] the doctors’ position is that they are campaigning for protection from the changes for doctors and not for everyone affected. So while the tax system does treat everyone equally here, they now want to get a tax break at the expense of the rest of us.
Indeed – the much complained about “problem” of doctors pensions is because they are so exceptionally large compared to most of the rest of us ! Remember that the tax relief rules were changed for everyone and not only for doctor’s. So if doctors are vastly over-represented in those impacted, it tells us something.
I do have some sympathy with those affected by the tax relief changes (doctors included). The tax change here was stupid and effectively retrospective. I think George Osborne’s work again. Or perhaps Philip Hammond’s. HMRC would do better to raise the tax on the pension after it is drawn or put more tax on huge tax free lump sums.
What I find particularly offensive about [many of] the doctors’ position is that they are campaigning for protection from the changes for doctors and not for everyone affected. So while the tax system does treat everyone equally here, they now want to get a tax break at the expense of the rest of us.
One suggestion is to increase the supply. Training of doctors is currently limited by some strange agreement between the BMA and the government. Whilst further education has massively expanded and all sorts of new universities and degree courses have appeared and – we are assured – educational standards have risen, somehow the number of medical degree places has not increased.
Why is that ?
This seems like a basic planning and management failure. Not helped by restrictive practices from the BMA.
Instead, we seem to think it a good idea to asset strip poor countries of their doctors.
Let’s start training more doctors here.
The last Labour government gave doctors an absurdly large pay rise which was not needed. Normal supply and demand would take care of the salaries if medical degrees were not rationed.
We really must get away from this awful culture of rationing in health. Rationing degree places in this case.
But what are your solutions here ? Lots of questions. Any ideas ?
I never said that but funny you should mention it.
There are a couple of issues here.
A friend of mine works as a financial advisor for a bank and counts GPs amongst his clients. Their pension is so good that they can no longer get tax relief on their contributions by the time they reach their mid 40s so many decide to semi-retire or retire altogether.
A lot of GPs are women and it seems that a significant percentage of them chose to become GPs because they have have decided at some point they will not want to continue to work full-time.
They are not over-worked. Far from it.
As other people have pointed out, there would be people queuing up to go to medical school and earn £100k pa plus but for the Faustian pact struck between the medical profession and the Government that allows the profession to limit places at medical school. If you look at the literature for the period prior to the NHS there was a major issue for the profession was that they were not being paid what they thought they were worth because there was a free market for their services and they had to compete like the rest of us with all manner of works organizations an societies employing doctors for the benefit of their members
One of the reasons why people go to A&E rather than their GP is that GP trend to be lazy and not give a toss (not like the old days). This has been my invariable experience (and I could tell some horror stories) and on of the main drivers for my European colleagues going private
So the UK already has a massive shortage of GPs (which in turn puts strain on the hospitals as people who can’t see their doctor then turn up at A&E) and your solution increase this number is to cut their pay and increase their workload? Im sure they’ll be queuing up to join!
I have used the Italian, French and Belgian system. The Belgian was the best. You join a mutuelle, a non profit making entity, but you can only join after you have worked legally for six months, paying into the system. The mutuelles pay 80% of medical costs and full in-hospital costs. Most people have a top up insurance for the rest, and the mutuelles have a price maximum, which means doctors tend to keep within it. Costs are rather transparent. A friend had an outpatient surgery to remove a basal skin carcinoma. An excellent cancer surgeon performed the operation, on three days notice from the dermatologist, The cost was 167 euros, the bill broken down into operating room rent, labour cost of doctor and nurse, and medicines used. She had to buy bandages and painkillers herself for aftercare, reimbursable at 80%. Interestingly, the biopsy cost almost as much as the op, being another 150 euros. I suspect a day cancer op in the private sector in the UK would cost more, but welcome info from readers.
I think this I can help here.
A number of my European colleagues (who are assigned for spells in the UK) say that if the do not feel they are getting a good service from a hospital or doctor they can just switch and no one think twice about doing so.
But apparently GPs in France have to work a harder for significantly less money. Just like the good old days before the NHS.
None of my European colleagues think much of the NHS and cannot see why we persist with it. Even those who do not earn much pay for private health cover rather than go through the NHS. One of the things they seem to find most off-putting is the attitude of NHS staff, including the doctors.
There is a lot of comment that the system of ‘insurance’-based funding of healthcare is better than the government direct funding but I would like to know why. They both give ‘free’ care at point of need, but in the UK that is funded by general taxation and inother comparable countries (we need to exclude the disaster that is the USA) – exactly how? How do these systems work and, crucially, why are they better and more efficient (are they?) than what would logically seem to be the most efficient way whereby there is no leakage of profit to the private sector.
This is a genuine question. I surmise that despite the good comments by some on this thread that might be too much to answer in a comment, but can anyone link to a reputable, hopefully politically neutralish site or article which will explain? I don’t suppose that I am the only one keen to know more!
Two tiers by default suits the government whether “Tory” – Sunaks Social Democrats – or “Electable Labour” – like Heath’s Tory party. Only then can an insurance based contribution system be built from the ground up for those in wages – whilst migrants and claimants still get freebies. Thats what they do in France, Aus, Spain and Germany and it works as well if not better than our system. Most of the money thrown at NHS goes back to private suppliers or the pockets of management regardless of who does the throwing!
Two tiers by default suits the government whether “Tory” – Sunaks Social Democrats – or “Electable Labour” – like Heath’s Tory party. Only then can an insurance based contribution system be built from the ground up for those in wages – whilst migrants and claimants still get freebies. Thats what they do in France, Aus, Spain and Germany and it works as well if not better than our system. Most of the money thrown at NHS goes back to private suppliers or the pockets of management regardless of who does the throwing!
Hasn’t spending on the NHS increased for decades? Even if it hasn’t kept pace with other countries, it should be better now that it was in the 90s.
While the NHS had serious problems I those years, things don’t seem to have got better. In fact, it seems worse.
The social care issue seems relevant. It would help if old people who needed support had somewhere to go. Their children could help but this is often very difficult. Would I give up work to look after my elderly father? God help me, I hope it never comes to that.
What bothers me is that the seems to be an expectation that people shouldn’t have to sell their homes to pay for social care. I don’t understand that. If my father needed this, of course, we would sell the house to pay. The state’s role is to help those with no wealth.
The population is much larger and older than it was in the 90’s, and healthcare much more advanced and new procedures much more expensive. As recently as 2017 the UK was only spending 2/3 of what the Germans were paying for their healthcare system
Larger means more money. Older, yes, that disproportionately means higher costs.
It only means more money if the healthcare budget has kept pace on a per capita basis. A bigger population also means more expenditure too of course
It only means more money if the healthcare budget has kept pace on a per capita basis. A bigger population also means more expenditure too of course
Larger means more money. Older, yes, that disproportionately means higher costs.
Bang on. I really don’t understand why those with housing wealth should expect not to be means tested, whilst those with other financial wealth would be. The health service is not there to protect the inheritances (unearned income) of the well off.
I am not saying here that people should be forced to sell or move out of their own homes. Simply that housing wealth should not be treated differently from any other wealth.
The population is much larger and older than it was in the 90’s, and healthcare much more advanced and new procedures much more expensive. As recently as 2017 the UK was only spending 2/3 of what the Germans were paying for their healthcare system
Bang on. I really don’t understand why those with housing wealth should expect not to be means tested, whilst those with other financial wealth would be. The health service is not there to protect the inheritances (unearned income) of the well off.
I am not saying here that people should be forced to sell or move out of their own homes. Simply that housing wealth should not be treated differently from any other wealth.
Hasn’t spending on the NHS increased for decades? Even if it hasn’t kept pace with other countries, it should be better now that it was in the 90s.
While the NHS had serious problems I those years, things don’t seem to have got better. In fact, it seems worse.
The social care issue seems relevant. It would help if old people who needed support had somewhere to go. Their children could help but this is often very difficult. Would I give up work to look after my elderly father? God help me, I hope it never comes to that.
What bothers me is that the seems to be an expectation that people shouldn’t have to sell their homes to pay for social care. I don’t understand that. If my father needed this, of course, we would sell the house to pay. The state’s role is to help those with no wealth.
You might as well write an article on why Socialism isn’t actually a good idea.
You might as well write an article on why Socialism isn’t actually a good idea.
A generic question: how can modern insurance schemes and welfare states survive in the age of population decline? For healthcare, you can’t raise productivity because care can be so consuming. For social payments, there can only be so many who work and pay into the system. At some point, the math just doesn’t work. I think the world is very near that point.
They can if they are contributory and funded. The original sin of our system is that it is unfunded (contributions are not invested into a fund to accumulate and grow) and there is no link between contributions and benefits. That cannot survive. And good riddance. Then we can move on to a proper funded, contributory system and not the immoral (borrowing from the future) “something for nothing” Ponzi system we have now.
It won’t if there is unlimited demand for a ‘free’ service. If we pay or at least contribute, there should be less waste and more money available to pay for care, and a market incentive to respond to this.
They can if they are contributory and funded. The original sin of our system is that it is unfunded (contributions are not invested into a fund to accumulate and grow) and there is no link between contributions and benefits. That cannot survive. And good riddance. Then we can move on to a proper funded, contributory system and not the immoral (borrowing from the future) “something for nothing” Ponzi system we have now.
It won’t if there is unlimited demand for a ‘free’ service. If we pay or at least contribute, there should be less waste and more money available to pay for care, and a market incentive to respond to this.
A generic question: how can modern insurance schemes and welfare states survive in the age of population decline? For healthcare, you can’t raise productivity because care can be so consuming. For social payments, there can only be so many who work and pay into the system. At some point, the math just doesn’t work. I think the world is very near that point.
A fairly useless whingeathon that states the bleeding obvious and offers no suggestion of a solution.
I suppose its progress that the left are starting to recognise reform is needed, but we need ideas not moaning abut how terrible everything is at the moment
A fairly useless whingeathon that states the bleeding obvious and offers no suggestion of a solution.
I suppose its progress that the left are starting to recognise reform is needed, but we need ideas not moaning abut how terrible everything is at the moment
There is surely a problem with the blinkered log-jam process that keeps people in hospital beds because there is deemed to be insufficient subsequent care available to them. Is this not a case where the lesser of two evils should apply? Take a patient who is waiting in a hospital bed to be released and compare their situation with that of a person lying for hours in an ambulance. Who needs the bed more? It may well be the latter. But the NHS seems to be bound by process thinking (presumably introduced by management consultants: I know, I used to be one but not in the NHS) with no escape other than breaking the rules – for which sanctions and reprimands would be handed out.
The NHS budget has increased sharply in recent years, and the plan is to spend about £160 billion next year. We are assured that this increase is necessary because of our ageing population and high “health care” inflation. Still, we have a service with fewer MRI units and CT scanners than in almost every other developed country, fewer hospital beds than in most advanced economies and fewer doctors and nurses than in most other countries. I suspect some of this budget is being siphoned off; PFI and other commercial contracts [such as test and trace] have wasted billions, and further privatisation will add to this financial “black hole”. The problem is that we don’t know what is happening because information about these contracts is protected under the cloak of “commercial confidentiality”. The NHS will continue to suffer until this protection is removed.
Question: Why are you using 2013 figures? They are 10 years out of date.
Question: Why are you using 2013 figures? They are 10 years out of date.
Here is my 2020 blog post on asset-stripping the NHS:
https://ayenaw.com/2020/07/30/asset-stripping-the-nhs/
Clear, precise, and well-thought-out. Brilliant!
I’ll read your blog properly later.
But a quick scan came across this line:
“The Tories are committed to selling the NHS to the Americans for 2 reasons”.
Nonsense. If they are, they’ve been spectactularly incompetent since 1979 in failing to do so !
Since 2010, the Coalition/Conservative governments have thrown ever more public money at the NHS. I’m not aware of any significant parts being “sold to the Americans”. Nor indeed, why the Americans would want to buy any of it.
If you are in the business of making lots of money from running hospitals, of course you would welcome an opportunity for taking over lots of hospitals that you can make more money from.
If you are in the business of making lots of money from running hospitals, of course you would welcome an opportunity for taking over lots of hospitals that you can make more money from.
Clear, precise, and well-thought-out. Brilliant!
I’ll read your blog properly later.
But a quick scan came across this line:
“The Tories are committed to selling the NHS to the Americans for 2 reasons”.
Nonsense. If they are, they’ve been spectactularly incompetent since 1979 in failing to do so !
Since 2010, the Coalition/Conservative governments have thrown ever more public money at the NHS. I’m not aware of any significant parts being “sold to the Americans”. Nor indeed, why the Americans would want to buy any of it.
Here is my 2020 blog post on asset-stripping the NHS:
https://ayenaw.com/2020/07/30/asset-stripping-the-nhs/
Accepting the reality of a private health sector operating alongside and often in symbiosis with the NHS also requires a serious review into how the private sector’s insurance industry functions. In my experience, the largest insurance provider, apparently a mutual, seeks to recover the cost of the previous year’s claims in the next year’s premiums. This is not insurance but deferred payment.
Accepting the reality of a private health sector operating alongside and often in symbiosis with the NHS also requires a serious review into how the private sector’s insurance industry functions. In my experience, the largest insurance provider, apparently a mutual, seeks to recover the cost of the previous year’s claims in the next year’s premiums. This is not insurance but deferred payment.
“Only an idiot could imagine the Tories want to destroy the NHS.” Really? I am 68 and every time the Tories have been in government they have starved the NHS. They have always loathed it and they brought in the ridiculous ‘marketisation’ under that nice ‘cuddly’ (extremely right-wing) Ken Clarke which required a huge bureaucracy to be created simply so different NHS departments could ‘bill’ each other. Insane. The Tory game plan is following that which was used to privatise railways. At one point, around 1985, the Paris Metro received more subsidy than British Rail, the London Underground and the National Bus service combined. Because BR was totally focused on safety cuts were made to ‘inessentials’ like cleaning. As the railways got grimier and grimier and services deteriorated the Tories said that proved state owned railways did ‘not work’. All over the world the evidence was to the contrary. Look what we have now. Already NHS hospitals are telling people go private to avoid waiting lists. This has always been the aim. As those who can afford it go private the Tories will then use that as the reason for cutting funding further. They are following the ssame policy with the BBC. Food banks are no different from the 1930’s soup kitchens. Ever since Thatcher came to power the long term aim of the Tories, in which they are succeeding, is to destroy every public funded service that is not run for profit. Like the railways they don’t care if billions of public money are spent on them as long as these funds can be diverted into the pockets of private sharholders.
Ken Clarke may have had ridiculous policies or seemed cuddly but he was definitely NOT ‘extremely right-wing’. I know the term far right is just thrown at anyone the mainstream left don’t like but Ken Clarke! He was a wet idiot.
Completely and utterly wrong……Spending on the HNS is now:
Health spending 2016: £195B per annum
Health spending 2021: £276B per annum
Unfortunately, there is not a sustainable or affordable level of investment that will EVER allow the system to cope as we would wish, as there are simply to many people and the numbers keep rising at a rate that we cannot keep up with.
Your ridiculous student politics idea of the evil Tories “starving” the NHS are laughable.
Ken Clarke may have had ridiculous policies or seemed cuddly but he was definitely NOT ‘extremely right-wing’. I know the term far right is just thrown at anyone the mainstream left don’t like but Ken Clarke! He was a wet idiot.
Completely and utterly wrong……Spending on the HNS is now:
Health spending 2016: £195B per annum
Health spending 2021: £276B per annum
Unfortunately, there is not a sustainable or affordable level of investment that will EVER allow the system to cope as we would wish, as there are simply to many people and the numbers keep rising at a rate that we cannot keep up with.
Your ridiculous student politics idea of the evil Tories “starving” the NHS are laughable.
“Only an idiot could imagine the Tories want to destroy the NHS.” Really? I am 68 and every time the Tories have been in government they have starved the NHS. They have always loathed it and they brought in the ridiculous ‘marketisation’ under that nice ‘cuddly’ (extremely right-wing) Ken Clarke which required a huge bureaucracy to be created simply so different NHS departments could ‘bill’ each other. Insane. The Tory game plan is following that which was used to privatise railways. At one point, around 1985, the Paris Metro received more subsidy than British Rail, the London Underground and the National Bus service combined. Because BR was totally focused on safety cuts were made to ‘inessentials’ like cleaning. As the railways got grimier and grimier and services deteriorated the Tories said that proved state owned railways did ‘not work’. All over the world the evidence was to the contrary. Look what we have now. Already NHS hospitals are telling people go private to avoid waiting lists. This has always been the aim. As those who can afford it go private the Tories will then use that as the reason for cutting funding further. They are following the ssame policy with the BBC. Food banks are no different from the 1930’s soup kitchens. Ever since Thatcher came to power the long term aim of the Tories, in which they are succeeding, is to destroy every public funded service that is not run for profit. Like the railways they don’t care if billions of public money are spent on them as long as these funds can be diverted into the pockets of private sharholders.