Axe falls on NHS services

Generali

carolt wrote: »

...when in hospital giving birth to my first 2, I had to share cramped wards with loads of other mothers and their screaming infants.....
....in the UK even the poorest can access top-notch treatment for free.

That isn't top notch treatment! It's well below the standard of state provision in every other country I've experienced. The only thing in favour of the NHS for the user is that they don't charge any money at all for almost all provision. Unfortunately that is also their downfall.

the point I was making - which you deliberately chose to misinterpet

Leave the snide stuff out please. I don't do it to you so please do me the same courtesy.

RenovationMan

Generali wrote: »

It has consistently been my experience of the NHS (with exceptions) from Home Counties villages to some of the grottier bits of Central London. It has been so widespread that I can only assume that you have very low expectations.

Who gives a flying fox about democracy from a health system. I want to get well not exercise my freedom of assembly.

I've always had a good experience of NHS hospitals, both as a patient and as the relative of a patient. I've also worked overseas and had medical insurance and found that the hospital was like a hotel, with all my needs catered for. The flip side of this was that I accompanied a friend who didnt have medical insurance to a clinic and it was absolutely appalling.

I'd rather have a 'lowest common denominator' health service than one where the rich are OK and the poor are not. I've always been offered BUPA via all of the companies I have worked for and refused it. I just dont believe that I should get better medical attention just because Im better off financially than someone else.

princeofpounds

What would worry me about private provision is that at the end of the day private companies take this on in order to make cold, hard profits - not out of the goodness of their hearts or because they care about patient care.

Well I wasn't promoting the idea, just pointing it out as a further alternative - state funded, private provision.

Intuitively I do find i an interesting situation as it would seem to retain the social objectives of universal provision with the market-based efficiency of resource allocation, but the truth of the matter is that I haven't investigated the issue enough to have a firm view. I do know that the NHS is not especially bad value based on a crude outcomes/spend of GDP basis, but then it turns out that spend has remarkably little to do with outcomes on a cross-sectional basis across countries (there are worse private systems than the NHS and better ones on this basis).

So as well as paying for the treatment, you also have to factor in the cost of huge profits for shareholders and huge salaries for company directors, etc.

I've worked in private sechools and sent my children to private nurseries, and been shocked at how the profit motive predominates in a way it just doesn't and can't in the public sector.[/QUOTE]

The problem is I think with your viewpoint is that you see only the evils of profit but not the virtues it can inspire. I don't blame you, it's a common view and superficially attractive, but the (perhaps) ugly truth is that markets (sometimes regulated, sometimes free) have proved the best way to run all sorts of economic systems.

I don't know if that is the case for healthcare. I'm not trying to convert your viewpoint, but I am trying to widen your horizon of considerations.

For instance, it might be worth considering the fact that the pharmaceutical companies, who have developed all kinds of incredible products (which are probably one of the main components in healthcare), have been run as private corporations at almost all points without much contention. The profit motive is also the motive to innovate and improve - it is unlikely we would have seen the same results from a state research institute.

Frankly, I find it impossible to think of a single public service that was nationalised under the Tories and now provides a better, cheaper service for consumers.

Do you mean privatised rather than nationalised? Unfortunately I think as a consumer you aren't in a particularly good position to judge based on your experience, because the nature of state-owned enterprises is often to hide the true cost of services (and often most importantly the cost of necessary investment in those services). Often the apparent expense is nothing more than the revealing of the true cost, which itself is inflated by years of underinvestment.

There are plenty of privatisation success stories - BP, the ports, london buses, the airports, even the utilities. Yes, your experience of utilities as a customer may not still be great but they do not control the price of oil, gas or energy despite being blamed for it each year, and the system has in fact become so strong and competitive that it is viewed as a model for utilities reform worldwide. I spend a lot of time looking at utility systems elsewhere and trust me, we take what we have in the UK for granted.

And there are also failures. I personally don't think that the rail privatisations work well because of the nature of the market - tendering for franchises is not a great control mechanism compared to consumer choice.

carolt

Generali wrote: »

That isn't top notch treatment! It's well below the standard of state provision in every other country I've experienced. The only thing in favour of the NHS for the user is that they don't charge any money at all for almost all provision. Unfortunately that is also their downfall.



Leave the snide stuff out please. I don't do it to you so please do me the same courtesy.

I think your flying fox was fairly snide, actually - and you did deliberately choose to misinterpet my point, as I find it impossible to believe that someone of your intelligence could have thought I was referring to some sort of abstract democracy rather than quality of healthcare.

As I said, we obviously differ in what we call top-notch. I didn't go into hospital to give birth worrying about whether or not I'd have to share a ward - what mattered to me was the quality of the medical care, not the 'hotel-style' services. If I'd wanted to pay more for a private room, BTW, that option was open to me - but I didn't because I couldn't have cared less.

I'd much rather have a system like ours where the treatment is good but the facilities shared or a bit tired, than one with expensive, 5 star facilities which I had to pay for the nose for and many couldn't afford.

You obviously have a different point of view on it. Possibly coloured by the fact that you could easily afford private treament whilst you lived here? Possibly not.

Certainly a very different set of priorities.

carolt

princeofpounds wrote: »

Well I wasn't promoting the idea, just pointing it out as a further alternative - state funded, private provision.

Intuitively I do find i an interesting situation as it would seem to retain the social objectives of universal provision with the market-based efficiency of resource allocation, but the truth of the matter is that I haven't investigated the issue enough to have a firm view. I do know that the NHS is not especially bad value based on a crude outcomes/spend of GDP basis, but then it turns out that spend has remarkably little to do with outcomes on a cross-sectional basis across countries (there are worse private systems than the NHS and better ones on this basis).


The problem is I think with your viewpoint is that you see only the evils of profit but not the virtues it can inspire. I don't blame you, it's a common view and superficially attractive, but the (perhaps) ugly truth is that markets (sometimes regulated, sometimes free) have proved the best way to run all sorts of economic systems.

I don't know if that is the case for healthcare. I'm not trying to convert your viewpoint, but I am trying to widen your horizon of considerations.

For instance, it might be worth considering the fact that the pharmaceutical companies, who have developed all kinds of incredible products (which are probably one of the main components in healthcare), have been run as private corporations at almost all points without much contention. The profit motive is also the motive to innovate and improve - it is unlikely we would have seen the same results from a state research institute.




Do you mean privatised rather than nationalised? Unfortunately I think as a consumer you aren't in a particularly good position to judge based on your experience, because the nature of state-owned enterprises is often to hide the true cost of services (and often most importantly the cost of necessary investment in those services). Often the apparent expense is nothing more than the revealing of the true cost, which itself is inflated by years of underinvestment.

There are plenty of privatisation success stories - BP, the ports, london buses, the airports, even the utilities. Yes, your experience of utilities as a customer may not still be great but they do not control the price of oil, gas or energy despite being blamed for it each year, and the system has in fact become so strong and competitive that it is viewed as a model for utilities reform worldwide. I spend a lot of time looking at utility systems elsewhere and trust me, we take what we have in the UK for granted.

And there are also failures. I personally don't think that the rail privatisations work well because of the nature of the market - tendering for franchises is not a great control mechanism compared to consumer choice.

Thanks for this post; lots of interesting food for thought there.

You're right, when you say I tend to see "only the evils of profit but not the virtues it can inspire."

I'm not sure that the example of pharmaceutical research translates into providing a routine service like healthcare. I agree that "The profit motive is also the motive to innovate" but would argue that innovation isn't really what's required in running a national health service.

Feel free to try to change my mind here - any more examples?

Generali

RenovationMan wrote: »

I've always had a good experience of NHS hospitals, both as a client and as the relative of a client. I've also worked overseas and had medical insurance and found that the hospital was like a hotel, with all my needs catered for. The flip side of this was that I accompanied a friend who didnt have medical insurance to a clinic and it was absolutely appalling.

I'd rather have a 'lowest common denominator' health service than one where the rich are OK and the poor are not. I've always been offered BUPA via all of the companies I have worked for and refused it. I just dont believe that I should get better medical attention just because Im better off financially than someone else.

I'm glad you've had a good experience of the NHS.

The thing I've found is that the paid for by patients health services mean everyone (or near as dammit) gets a much higher level of provision than under the NHS.

It seems a little odd to me that you would deliberately take a pay cut in order to use state provision. Some British people seem to have a bit of a 'hair shirt' attitude to health and education provision.

A._Badger

carolt wrote: »

Frankly, I find it impossible to think of a single public service that was nationalised under the Tories and now provides a better, cheaper service for consumers.

BT. Do you remember Post Office Telephones? The weeks long wait before they would graciously connect a line? The absolute lack of choice? The appalling service?

Objections to 'the profit motive' are bizarre, at best. Do people believe doctors work for free?

carolt

No, I'm afraid I don't remember post office telephones - before I was born, I assume?
I don't object to the profit motive in an ideological sense - if I thought it worked, I'd support it.

I am just aware that, for example, trains are far more expensive and less efficient than before they were privatised. For example.

And your doctors perform well on their 100K or whatever it is, even though in a fully private system they could earn far more.

I think the problem with a private system isn't just that the greed of individuals is given free rein, it's that at its heart, the reason d'etre of the service is profit, not service. I've seen things happen in the private education system that would never happen in the state education system - because the priority there ultimately isn't education, or the welfare of children, but bums on seats. Profits. True but sad.

StevieJ

I wouldn't worry! the Tories have promised to increase spending on the NHS

carolt

So where's it going, then?