Can the UK afford the NHS (in its current form)?

[Deleted User]

Generali wrote: »

I wouldn't argue that either but I do think that the NHS manages to provide a terrible service at a price that is escalating alarmingly basically because of a dogmatic adherence to a model of delivery.

The NHS is a government department that provides healthcare. The CQC is a government department that upholds standards. The PHSO is a government department that investigates complaints. The government decides which government departments have what powers over the government.

What could possibly go wrong?

Filo25

Generali wrote: »

I wouldn't argue that either but I do think that the NHS manages to provide a terrible service at a price that is escalating alarmingly basically because of a dogmatic adherence to a model of delivery.

The price is escalating rapidly unortunately because that is what healthcare costs have tended to do so over time, and we have an aging population, with a growing obesity epidemic still to face.

Ultimately by international standards its not a hugely expensive service, and I would imagine costs like PFI contracts will continue to weigh on the public sector purse whether we completely restructure healthcare or not.

Ultimately assuming we want to have universal cover, however we choose to structure it healthcare is likely to take up an increasing proportion of GDP for the forseeable future.

Obviously different people may end up paying for it, but somebody will still have to.

And I will add that clearly PFI contracts were an expensive mistake, which were entered into for purely political reasons to manipulate the amount of government deficit which was shown (personally I would rather split government spending into current and capital anyway)

kabayiri

Pennywise wrote: »

Let's hope they've been sacked and never work within the public sector again then if they're so incompetent, and likewise the numpties in HR/management who recruited people without a clue.

People have been outwitted by clever sales consultants for years. I wouldn't say it's particularly public sector, but there does seem to be an attitude from suppliers that there is more "room for profit" on PS deals.

An example. How about buying a £2m mainframe a couple of decades ago and then after disagreements, finding out you do not have the rights to put your own software on said mainframe!

Seriously, some of these sales people are sharks masquerading as men and women in suits.

kabayiri

Filo25 wrote: »

...
And I will add that clearly PFI contracts were an expensive mistake, which were entered into for purely political reasons to manipulate the amount of government deficit which was shown (personally I would rather split government spending into current and capital anyway)

I wouldn't have gone so far.

I think PFI has use in certain circumstances, but good implementation is absolutely key. It's easy to give the procurement role to people who are inexperienced or up against time pressures.

Perhaps for political reasons, there was too much of a rush into some of these contracts.

kabayiri

Generali wrote: »

I wouldn't argue that either but I do think that the NHS manages to provide a terrible service at a price that is escalating alarmingly basically because of a dogmatic adherence to a model of delivery.

Is the fact that it's a singular entity also a hindrance I wonder?

What's wrong with smaller regional services, allowed to pilot different delivery models?

Why are we to assume the health service needs in Newcastle are the same as those in London?

Filo25

kabayiri wrote: »

I wouldn't have gone so far.

I think PFI has use in certain circumstances, but good implementation is absolutely key. It's easy to give the procurement role to people who are inexperienced or up against time pressures.

Perhaps for political reasons, there was too much of a rush into some of these contracts.

For me the issue ultimately with PFI was that it was primarily motivated by the political desire to keep debt of the government books, even though the government could ultimately fund that debt more cheaply than the private companies who ended up taking it on and making a healthy profit of the back of it.

kabayiri

Filo25 wrote: »

For me the issue ultimately with PFI was that it was primarily motivated by the political desire to keep debt of the government books, even though the government could ultimately fund that debt more cheaply than the private companies who ended up taking it on and making a healthy profit of the back of it.

Show me the opening of a new major hospital without a politician stood in front, cutting the ribbon, and reaping the accolades.

Things like education and health have been used as political tools to promote different parties for too long. They should have policies defined on much longer timescales than a single term of office.

CLAPTON

Filo25 wrote: »

The price is escalating rapidly unortunately because that is what healthcare costs have tended to do so over time, and we have an aging population, with a growing obesity epidemic still to face.

Ultimately by international standards its not a hugely expensive service, and I would imagine costs like PFI contracts will continue to weigh on the public sector purse whether we completely restructure healthcare or not.

Ultimately assuming we want to have universal cover, however we choose to structure it healthcare is likely to take up an increasing proportion of GDP for the forseeable future.

Obviously different people may end up paying for it, but somebody will still have to.

And I will add that clearly PFI contracts were an expensive mistake, which were entered into for purely political reasons to manipulate the amount of government deficit which was shown (personally I would rather split government spending into current and capital anyway)

I thought that one of the main features of PFI was that it shifted the costs from the capital account (highly visible and counting towards the budget deficit) to the current account (spread over 30 years).

Filo25

CLAPTON wrote: »

I thought that one of the main features of PFI was that it shifted the costs from the capital account (highly visible and counting towards the budget deficit) to the current account (spread over 30 years).

It does, but you end up financing it through private companies with higher costs of capital than the state has, plus their margin on top.

Basically done as window dressing so that we didn't show large deficits when the initial investments were made, but end up paying more than we should in the long run

Generali

kabayiri wrote: »

Is the fact that it's a singular entity also a hindrance I wonder?

What's wrong with smaller regional services, allowed to pilot different delivery models?

Why are we to assume the health service needs in Newcastle are the same as those in London?

One of the many good things about the Australian system is that you can take your health insurance and Medicare card to any number of providers until you find a doctor you can work with.

There is much less of the parent/child relationship that the NHS tries to force on patients (Mummy knows best, take your medicine and go to bed) and more of an adult/adult relationship instead. You are encouraged, and required, to take control of your health which I think is one of the things that leads to better outcomes.

I also get to decide what's important to me. If I want to spend some extra money on getting a better outcome because it's really important to me that I get to play another season of cricket then I can top up my treatment and that's just normal, for example I could buy another 6 physio treatments beyond the standard heavily subsidised 6. If I just want the standard levels of treatment then that's normal too.