I'd be intrigued as to how an insurance-based "choice" system would make this less bureacratic

So if you think the organisation of the NHS isn't an issue, why are we lagging behind every other service in western Europe?

It seems to me that the NHS was the envy of the world, but a near 30 year period of governments desperately trying to make it run more like a corporation have turned it into a shadow of its former self.

Are we? Have you got something to back that up? I mean I think the NHS has got problems - the unevenness of treatment across areas, the endless reforms, the problematic internal market, the PFI wastes etc - but I can't see your solutions doing much to eradicate them.

I always find the focus on "problems" in the NHS to be weird. Every time I've had to use the NHS they've been effective, fairly efficient, friendly, everything seems relatively new, and relatively clean. It's much better now than 10 years ago, and it was better then than 10 years before. And it offers a ton more treatments now, too. If there've been times it's been slow, that's because, frankly, fixing me with a dodgy knee is something that should always be lower priority than people with life-threatening or life-changing conditions.

The way people always talk about "failure" or even "problems" means that there's a general widespread feeling that the NHS is a horrible disaster area, and this pervasive attitude is what drives the nonsense pushes for "choice" and partial privatisation and the introduction of insurance premiums, and all that crap.

I personally haven't argued that the NHS is a disaster area, but the British still lag behind most of our neighbours on several important treatment outcomes. We also have fewer doctors per head of population and we still have waiting lists. I could dig out more statistics if I had time.

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"… frankly, fixing me with a dodgy knee is something that should always be lower priority than people with life-threatening or life-changing conditions."

There's no reason why both groups can't be seen to promptly. A friend of mine was in hospital in Germany a week after a skiing accident. I don't think her operation was at the expense of someone more deserving.

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We also have fewer doctors per head of population

There's a debate to be had about why that is, of course.

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We also have fewer doctors per head of population


There's a debate to be had about why that is, of course.

One which could quickly lead into "too many bloody immigrants who we shouldn't even be letting into the wards".

Careful, now, everyone.

An argument easily batted back by pointing out the huge numbers of immigrants staffing the wards

Stumpy - you keep talking about outcomes and shit like that as if there are some magic stats which prove the case, but we've yet to see them. What mechanisms do you measure a health system by?

Well, everyone must be able to use it without fear of the cost. Any system in which fear of cost inhibits use is a failure. But beyond that, there's equality of treatment. We've some way to go on that, but that's precisely because of the attempt to make the NHS more corporate. But do more people die of things in the UK which they'd not die of if we had a different system? Do more people live lives of misery compared to other countries?

For my own part, the NHS is the only thing I can muster anything approximating pride for in this country.

toro toro wrote:

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"A year ago," I said, "I was hospitalised. I'm a foreign national, I was in there for a month, and not once did anybody ask me how I was going to pay for this. In fact, when I enquired, they told me not to worry. My concern was to get better. Any country which can afford to do that, and doesn't, is barbarian. That's socialism, and I am fucking proud to be a fucking socialist."

God bless the NHS.

Seriously: a lump in the throat. That's so very much the case. (Apart, of course, from the subject of the last sentence.)

Let's by all means talk about other approaches to not being barbarian--approaches, for example, that might make the system less of a hostage to the whims of central government. But that principle--you're ill; we'll treat; the money side is sorted--is what it's all about. It was, and remains, a huge victory for Our Side, and there haven't been enough of those that we can afford to take that one for granted.

Posting from an NHS establishment:

Speaking as someone who is currently working on one of those "shit IT systems that don't work and cost millions of £££" and has worked for about half a dozen Government departments, I think i can highlight a few points.

Waste: I have witnessed alot of Waste in the NHS and there are staggering levels of Beaurochracy that you do not get in an equivalent private company.
However, the levels of waste i see are not much more than other Government departments (that have been privatised) such as IND, HMRC, F&C, UKPA or even BT.

Badly delivered IT projects are mainly down to poor management as IT projects are driven for political reasons rather than technical reasons.

I could go into more detail, but there are alot of Journalists on this messageboard so you will have to take my word for it.

If truth be told, the main problem with the NHS wasting money is due to senior management and politicians changing their mind on an almost daily basis and chopping and changing budgets on a whim.
Hence why there are so many middle managers needed to implement it.

I think the NHS is great, but you got to blame the government for allowing numerous private companies to use it as a cash cow.

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Stumpy - you keep talking about outcomes and shit like that as if there are some magic stats which prove the case, but we've yet to see them.

There are plenty of stats, none of them magic. For instance you can go to Eurostat and see that the UK is near the bottom of EU countries for cancer survival rates and trailing behind comparable countries on mortality for respiratory disease and heart disease. In France, for example, you're twice as likely to survive lung cancer than in the UK.

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What mechanisms do you measure a health system by?

Things like mortality rates, waiting times, incidence of hospital acquired infections, surgery volumes, patient outcomes, that kind of thing.

If you prefer to rely on anecdotes (which I personally don't), then I've yet to meet a western European who thinks the NHS is a superior system.

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It was, and remains, a huge victory for Our Side, and there haven't been enough of those that we can afford to take that one for granted.

Well, it was, but it doesn't mean it's an ideal model of universal healthcare. I think you'll find other socialist countries in the EU who didn't copy this model and have better health systems, on both objective and subjective criteria.

You could argue that a lot of those problems are down to the NHS's principles being undermined (which they have in the past 20 years, massively) rather than enacted

E10 Rifle wrote:

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I'd be intrigued as to how an insurance-based "choice" system would make this less bureacratic

I'm not sure I understand how the NHS is run, or what you mean specifically by "insurance-based" here, E10, but in Canada, the state (that is, each province) in effect is the insurer for every single citizen. Usually they pay for this out of general taxation - in a couple of cases there are some premiums that you pay with your taxes (in ontario, if you earn over about $100000/year, for instance). With that, you get a health card. With that health card, you can get most medical services completely free, on demand. There's really very little buraucracy involved. I go to a doctor, the doctor treats me, and gets paid by the state according to the work performed. Doctors can organize themselves into any kind of clinic arrangement and get paid by the state on a fee-for-service basis.

Would this meet your definition?