The NHS Squid

My colleague Dr Tim Morgan has just blogged on the subject of the cost and dysfunctional behaviour of public sector services in general and the NHS in particular:

The menace of the Vampire Squid

I have been writing and talking about the dysfunctional nature of the NHS and the need to curb its spending  rather than treat is a  sacred cow at least since writing the following article for The Daily Telegraph in April 2009:

http://www.telegraph.co.uk/finance/budget/5188649/Too-much-stimulus-could-spell-disaster-for-Dr-Darlings-ailing-patient.html

In it I said ‘At some point someone is going to have to confess that the NHS can only deal with items such as A&E, pregnancy and cancer. Everything else will have to be privately insured. Those who are government employees will have to lose their jobs and/or take pay cuts (not to mention pension cuts). But I doubt Chancellor Darling will be telling us this on Wednesday.’

I hope that the current furore over Mid Staffs NHS disaster may have punctured some of the ridiculous adulation of the NHS. The fact is that better care is available in a number of other countries which have not opted for the NHS free at point of use model: for example France, Holland and Singapore all have superior performance.

Tim Morgan is right. Ironically, seemingly limitless spending and staff has not improved the NHS performance, it has made it worse. But then any decent manager in business could tell you that granting wishes for limitless capital expenditure and/or staffing will make an organisation’s performance worse not better. My favourite anecdote from the NHS farce which illustrates this is the NHS procurement quango whose purpose included saving money and which went about this by leasing luxury cars for its staff including a BMW convertible, an Audi TT and Range Rovers:

http://www.telegraph.co.uk/health/healthnews/9370075/NHS-staff-drive-fleet-of-taxpayer-funded-luxury-cars.html

As the saying goes, if you made it up, no one would believe you.

Perhaps not coincidentally this NHS quango is funded by the Scottish Government.

But my views drew the usual knee jerk from those who would support any aspect of the welfare state or Labour policy no matter how ludicrous. My favourite was the senior Labour politician I met towards the end of 2012 who told me that my views on the NHS were derived from The Daily Mail. It is hard to see how that is possible given that I don’t read The Daily Mail, but I wonder if his strident and mindless defence of the NHS has suffered any revision as a result of recent events. Sadly, probably not, after all why spoil an opinion by considering the facts.

 

Comments

[Stuart]

I am a retired hospital consultant and apolitical. From my experience, your conclusions are entirely accurate.

The terrible tragedy is the near silence from the main political parties about the Mid Staffs report, in order to support the status quo and cover their backs.

[dezzie]

'At some point' may be right. But when Robert Francis QC says it was not his job to 'apportion blame' even though it is self evident that every doctor and nurse with ANY responsibility for those patients that died HAS FAILED IN THEIR DUTY OF CARE, you know we are not anywhere near that point. Millions of words will be written and spoken but until the draft of competition and patient choice really blows, nothing much will change.

[Ken Charman]

I have an original copy of the Beveridge report in my library. I don’t subscribe to the view that it was the blueprint for the Welfare State or that the NHS (Bambi) is what Beveridge intended. In fact Beveridge wrote to the Times to warn of the dangers of setting up a health monopoly when the Labour government was forcing through the highly flawed NHS Act. Beveridge was an insurance guru. He believed that benefits should be funded by insurance (where subscribers were aware of the money relationship between price and coverage). The NHS has never satisfied this test and was doomed from its beginning. The limited range of services it supported was originally aimed at emergency care and infectious disease but health professionals have added constantly to its catalogue and used national pay bargaining power to drive up wages. The GP contract probably constituting the most cynical and poor value labour agreement ever negotiated between a union and incompetent civil servants. As it stands today the NHS is the world’s biggest employer and its greatest monument to market failure
You are right. The link between price and service has to be re-established in order to control spiralling costs of labour and high tech treatment and to convince the public that their own lifestyle choices carry a price. We need a way to link personal neglect of health through over-eating, substance abuse and lack of exercise to personal cost. If conditions of poor health were classified and priced and our democracy functioned effectively, we could set up insurance whereby the public could choose to pay for more or less according to their lifestyle. This does not have to be absolute. We can easily adjust for conditions that are inherited or genetic, or for a gradient in unhealthy lifestyle through marginal pricing. If we feel this is a state function we show the tax cost of funding “free” health care through a list of prices for treating specific conditions and then ask the electorate to vote on those conditions that they feel should be funded entirely by the state. This idea was pursued in the 1990s by the state of Oregon which used standardised disease classifications and costs of treatment in Town Hall meetings to ask citizens what they wanted to cover on 1) state health insurance and 2) what should be left to private insurance. This was a noble effort but it eventually failed in the face of middle class health lobbying .
We need to accept this is not a problem confined to people on lower incomes. Many well-off middle class professionals exploit the situation where the state underwrites their unhealthy lifestyles with blanket health coverage. The money they avoid spending on health insurance funds a property asset bubble, German cars, villas in Spain, trips to high calorie restaurants etc. If were obliged to pay the true cost of private health they would change their behaviour. Demand would quickly drop for expensive and avoidable long term conditions such as cardio-vascular disease, diabetes type 2, liver disease and chronic obstructive pulmonary disease. In addition, private procurement of health services would drive much harder bargains with overpaid Doctors and health suppliers.
Without this reform the NHS (Bambi) will continue to suck money until it runs dry. And this is my prognosis because this debate is unlikely to be won. The health lobby is well organised lobby to provoke emotional press and public reaction to images of pain and suffering regardless of whether individuals were complicit in their own fate. The real losers in this are taxpayers who are denied the information they need to lead healthier lives and are then forced to fund the consequences of a a health industry that is designed to treat illness rather than promote health. Market reformers sit on the side of compassion, social justice and care in this debate – but you would never know it.

[Len Karpinski]

Terry I am not with you on this one. What do you expect if one of the biggest organisations in Europe is led by someone whose sole qualification is a history degree from Bristol Polytechnic? Its interesting to note why the BBC is being so protective of him by giving this story minimal coverage as he is exactly not one their own, non public school, non university even. I am not being snobbish but you would expect him to at least him to have some sort of management/leadership qualification.

As I often trumpet how great Singapore is on your blog I would have some reservations about their healthcare system. I have a friend who is a doctor who works now in Singapore and has done some time in the NHS too. She tells me that that the Singapore model often reflects the American one in that its "business", so the patient will often be billed unnecessarily for procedures that would only be used in the UK in extreme circumstances

Anyway all good capitalists should be in favour of socialised medicine, as Sir David Nicholson would have told you when he was a member of the Communist Party, as the capitalist class needs a fit and healthy workforce so that it can exploit it ruthlessly for its own advantage.

[John pd]

I hope you've had your breakfast before reading this Terry, because this will probably make you spit it.

The 2nd largest fleet of cars in the world?
The UK govt disability fleet.
1st largest?
The Chinese Army.
3rd largest?
The Russian Army.

www.bogpaper.com/2013/01/07/marx-toynbee-voice/

[John pd]

Sorry Terry, one to upset your lunch:
Govt cuts?

John Redwood's diary 25 Feb 2013:
"Govt moves to increase spending again"

Regards,
JD.

[John pd]

Terry hi.

Would you care to have a go at James Delingpole's challenge to explain why govt stimulus doesn't work?

www.bogpaper.com & go to Delingpole on Friday: Govts can't spend their way out of recession by stimulating demand.

Cheers.
JD.

[Grumpy Oldman]

'The fact is that better care is available in a number of other countries which have not opted for the NHS free at point of use model: for example France, Holland and Singapore all have superior performance.'

What is interesting is that bastion of capitalism, the USA, doesn't

[John pd]

Terry hi,
Hope you & Dr. Tim are well.

Great news, for a change.

Allan Savory has learned how to green our deserts & reverse climate change by grazing domestic cattle.

& he's proved it on 5 continents & over 15 million hectares since 1985.

www.wattsupwiththat.com & go to "A bridge in the climate debate..."

Best news this year.

Regards,
JD.

[Rebecca McFarland]

http://pro.moneyweek.com/myk-eob/EMYKP326/?a=5&o=74329&s=77179&u=781007&l=274161&r=MC&g=0

I know they're trying to sell the magazine but there's some pretty frightening stuff in here - would love to read your opinion on their theories on this blog - how frightened should we be? Thanks.

[John pd]

Terry & Tim hi.

Crony corporatism at a level which can only be called evil.

www.rt.com/usa/monsanto-protection-act-may-be-voted-for-this-week-in-congress-271/

Max Keiser has moved to UK as he believes us likely to implode as the moneyweek article in Rebecca McFarland's post above predicts.

His Christmas show, after nuptial celebrations with Stacy Herbert is a good laugh & takes a healty swipe at Bono & Tony Blair. Show no. 384. On www.rt.com

Regards,
JD.

[John pd]

Terry & Tim hi.
I'm sick in my stomach typing this.

www.youtube.com/watch?feature=player_embedded&v=84v1SA3UgRk

or go to youtube & type in Kevin Edwards & Justice for Linda Evans.

Child stealing in & by the UK.

The depths of incompetence, illegality & depravity within our NHS, SS,(Social Services), local authorities & legal system. 1 hr 9 mins. A must.

Please pass this just as widely as you can.

[John pd]

Terry hi.

Regarding my previous comments about the BBC trying to influence our kids' minds, Horrible Histories was first published 1993,(page 83),
so that's 20 years, not 10.

Regards,
JD.

[John pd]

Re my comment above,a simpler link that works is:
www.youtube.com/watch?v=84v1SAzUgRk
Terrifying.
Or go on youtube & just type in Bonnie Lewis.

Thumbfingered as usual.

Just as important:
www.youtube.com/watch?v=8QGgKaZdlwy

Brian Gerrish, NWO, Banksters, Useless Political Parties & Common Purpose.
1 hr 37 mins.

www.cpexposed.com

Areal eyeopener.

We live in interesting times.
Regards,
JD.

[John pd]

Great news. Dr Matt Ridley, who has not long been elevated to the House of Lords, & who's excellent website is:
www.rationaloptimist.com
gives a speech at the Royal Society:
www.wattsupwiththat.com/2013/03/14/a-must-watch-greening-the-planet-dr-matt-ridley/

Dr Ridley believes that we have now reached "peak land", ie no more land need be put under the plow, thanks to improvements in plant genetics, farming techniques & fertilisers etc.

He also believes, in the above video, that CO2 is aiding planet wide plant growth.

[John pd]

Matt Ridley also believes that world population will peak in about 25 years,I think, & then decline naturally as developing countries prosper.
Also:
www.overpopulationisamyth.com

Regards,
JD.