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The end of the NHS. (Read 193468 times)

GCW

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#75 Re: The end of the NHS.
July 02, 2014, 12:20:40 am
I'm reasonably well informed.

I thought I was until I got more deeply involved in the running of the CCGs and then you realise you know squat. The path for the NHS has been in place for 20 years, gradually building and conniving. The 2004 contract was part of it, the new contract extends it. Who runs the commissioning boards? 

Sign up to the "Your GP is so battered they haven't the time to care" campaign, it may be your last chance to save the NHS as you know it.   http://bma.org.uk

Sloper

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#76 Re: The end of the NHS.
July 02, 2014, 07:51:00 am
Bottom line is that patient demand is going up


I think this is an interesting point and ties into the A&E (mis-)use.

What is driving the increase in patient demand? 

There has been a slight increase in the population size over the last 50 years, and the standard of medical care in terms of what can be treated is has vastly improved, but this isn't necessarily for the common things, rather its for rare conditions.

Life expectancy has increased as a consequence of improved treatments for communicable diseases and as a consequence the population is ageing well, and the incidence of heart disease, cancer, type II diabetes, dementia (catch all term for the broad spectrum) have all increased as a consequence.

This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

I don't have any real answers, but will say that recommendations for how money is spent within the NHS on different treatments is for the large part governed by The National Institute for Health and Care Excellence (NICE) which takes an evidence base approach.



As an aside the continual Tory v's (Nu-)Labour to-ing and fro-ing bashing is pretty pointless, its clear that current Labour party do not represent the values the party held 70+ years ago when the established the NHS.

Part of the cause of the increase in demand is because there are no charges at the point of use; for many years there was probably a meme that you didn't trouble the doctor unless you were properly unwell, that meme has now mutated into a meme of 'if I don't get it now I'll complain'.

You are of course correct when you say the Tory bashing doesn't help, but the Tories could announce the gold plating of hospitals and the likes of Sam would slate the proposals because it's an ideological drive to fatten the NHS up for sale.

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#77 Re: The end of the NHS.
July 02, 2014, 09:47:41 am
Sloper's on board with the DailyFail. It's them lazy oiks who go to a doctor for nowt.

I'm on board with the evidence: Yes, we have a mere 10m extra people, but the baby boomers are aging, which is costing us.

Growing numbers of elderly people also have an impact on the NHS, where average spending for retired households is nearly double that for non-retired households: in 2007/08 the average value of NHS services for retired households was £5,200 compared with £2,800 for non-retired.  These averages conceal variation across older age groups, with the cost of service provision for the most elderly likely to be much greater than for younger retired people.  The Department of Health estimates that the average cost of providing hospital and community health services for a person aged 85 years or more is around three times greater than for a person aged 65 to 74 years.
http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-money-in-public-services/the-ageing-population/

abarro81

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#78 Re: The end of the NHS.
July 02, 2014, 10:03:39 am
This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

Good post

psychomansam

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#79 Re: The end of the NHS.
July 02, 2014, 10:12:46 am
This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

Good post

Hehe. I was ignoring it. You're right, there are some good points here. Obviously NICE take this into account already, but I agree we need much more focus on it.
I was ignoring it because I was avoiding taking the mick out of slackline, who clearly values his own rationality, for being yet another smoker with a ridiculous and self-deceiving justification for his addiction. But since you've drawn attention to it:
Smoking doesn't prevent you living the last years of your life while watching your mortal coil fall apart. It virtually guarantees it. And makes it happen sooner.

Oh, and because it's Slackline, here's a link to a study: http://www.eurekalert.org/pub_releases/2008-10/jaaj-mwn100908.php

slackline

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#80 Re: The end of the NHS.
July 02, 2014, 10:24:37 am
I was ignoring it because I was avoiding taking the mick out of slackline, who clearly values his own rationality, for being yet another smoker with a ridiculous and self-deceiving justification for his addiction.

I don't need to justify my choice to smoke to anyone, thanks, so quit patronising me. 

There is nothing inherently  wrong with having addictions, everyone does, be it legal (caffeine, gambling, alcohol, tobacco, excessive indulgence in food) or illegal ([INSERT DRUG OF CHOICE]).  As long as you aren't a burden on those around you or society as a whole who gives a shit whether people are deceiving themselves.

But since you've drawn attention to it:
Smoking doesn't prevent you living the last years of your life while watching your mortal coil fall apart. It virtually guarantees it. And makes it happen sooner.


There is no "nice" way to die, and so what if it happens sooner, by not smoking you also virtually guarantee your mortal coil is guaranteed to fall apart too.  At least you won't be a burden on your relatives or society as a whole.

psychomansam

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#81 Re: The end of the NHS.
July 02, 2014, 10:35:00 am
There are reasons to suggest you do need a justification. You're supporting a harmful industry and implicitly normalising a form of long-term self harm for a start. Someone who loves you might have their own reasons. But hey, most people drink excessively and you could say the same for that.
However, I wasn't suggesting you do need a justification. I was just saying you attempted one, poorly.

I also wasn't making an argument about addictions in general, as much as they're philosophically interesting.

I was stating the obvious about the likely effects of smoking on your quality of life, while backing that up with evidence. You are continuing to ignore this, in an apparent state of denial.

slackline

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#82 Re: The end of the NHS.
July 02, 2014, 11:13:09 am
There is no denial here, I know full well what the effects of smoking are thanks what with being a medical statistician.  You know nothing about the quality of my health/life and how my smoking affects it (you don't know how much I smoke either, simply that I do).  Despite knowing the problems associated with smoking I still choose to do so.


Regardless it wasn't an attempt to justify why I choose to smoke.  I was stating that using "you'll live longer" as a reason not to smoke is pointless because everyone dies and having an ageing population because we're all supposed to be living healthier lives is creating huge problems for society.


And yes most things are philosophically interesting, but thinking about things really deeply rarely gets much done.

psychomansam

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#83 Re: The end of the NHS.
July 02, 2014, 04:26:17 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

GCW

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#84 Re: The end of the NHS.
July 02, 2014, 04:48:26 pm
Believe what you like, let's review it in five years.   :shrug:

Sloper

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#85 Re: The end of the NHS.
July 02, 2014, 05:18:41 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.

psychomansam

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#86 Re: The end of the NHS.
July 02, 2014, 07:30:49 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.

Ah, so the problem with the NHS is that it's not profitable enough. Of course. Presumably we should move more toward the US model? They, after all, have a hugely profitable health sector.

Or perhaps the problem is one of creating the right interfaces between public and private in a mixed economy - creating the right balance of power between public interest and private capital.

Frankly, I don't think any of these are the problem. The health service is already highly cost-efficient. If it's starting to get overwhelmed, then what it really needs a bit more money.

I'd start by getting rid of the high-interest debt crippling lots of hospitals.

slackline

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#87 Re: The end of the NHS.
July 02, 2014, 07:57:04 pm
Ah, so the problem with the NHS is that it's not profitable enough.

Its actually quite useful for the NHS to generate some profit as they can then invest in research via their research arm, the National Institute for Health Research which has any number of funding streams (Health Technology Assessment, Research for Patient Benefit, Efficacy and Mechanism Evaluation etc.) or  funding the Research Design Service which exists to assist and improve clinicians and researchers research grant proposals to the various NIHR funding streams so that the quality of the research funded and conducted is higher.

More profit would mean more research could be funded, leading to improved care, treatment and services.

psychomansam

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#88 Re: The end of the NHS.
July 02, 2014, 10:44:44 pm
Ah, so the problem with the NHS is that it's not profitable enough.

Its actually quite useful for the NHS to generate some profit as they can then invest in research via their research arm, the National Institute for Health Research which has any number of funding streams (Health Technology Assessment, Research for Patient Benefit, Efficacy and Mechanism Evaluation etc.) or  funding the Research Design Service which exists to assist and improve clinicians and researchers research grant proposals to the various NIHR funding streams so that the quality of the research funded and conducted is higher.

More profit would mean more research could be funded, leading to improved care, treatment and services.

Interesting. A good argument for encouraging health tourism perhaps? That said, I'm all for funding research, but there's no reason it actually needs a different source of funding than the rest of the NHS. Of course, there's a much bigger debate about how medical research should be funded and distributed.

Sloper

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#89 Re: The end of the NHS.
July 03, 2014, 12:15:56 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.

Ah, so the problem with the NHS is that it's not profitable enough. Of course. Presumably we should move more toward the US model? They, after all, have a hugely profitable health sector.

Or perhaps the problem is one of creating the right interfaces between public and private in a mixed economy - creating the right balance of power between public interest and private capital.

Frankly, I don't think any of these are the problem. The health service is already highly cost-efficient. If it's starting to get overwhelmed, then what it really needs a bit more money.

I'd start by getting rid of the high-interest debt crippling lots of hospitals.

No the problem is not that the NHS is 'not profitable enough' it is because the majority of the services that it offers are not suited to making a profit. Of course in the short term one can export parts of the service to non NHS providers who may make a profit, but this extraction will only be viable in the short term and is not the same as a 'privatisation'.

You seem to be picking a fight with yourself here; I am not advocating the sale of the NHS or that we should move towards a system which reflects the US system, I know that's what you'd like to believe I think, but your confections know no bounds do they?

The NHS system is shockingly efficient and effective in some areas and almost unbelievably inefficient and dysfunctional in other areas; including estates management, antifraud, procurement, planning, regulation and so on.  Recognising these problems and discussing potential solutions does not mean that you are plotting the down fall of the NHS; rather that you're seeking to ensure that it 'delivers'.

Now let's have a test of your lefty credentials (and no googling); who said 'it matters not if the cat is black or white; if it catches mice it is a good cat'?

webbo

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#90 Re: The end of the NHS.
July 03, 2014, 12:46:22 pm
Tom.

Sloper

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#91 Re: The end of the NHS.
July 03, 2014, 03:52:07 pm
Kitten or Jones?

webbo

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#92 Re: The end of the NHS.
July 03, 2014, 03:58:09 pm
I thought at first it was Sylvester but he was more in to birds.

GCW

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#93 Re: The end of the NHS.
August 23, 2014, 12:32:44 am
Physician Associates?  Two years training to pretend to be a doctor but you can't prescribe medication?  Yet another nail in the coffin .....

Sloper

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#94 Re: The end of the NHS.
August 23, 2014, 09:54:04 am
All the professions have been eroded by similar moves, most legal matters are now dealt with by people who aren't qualified lawyers.

It never ends well.

Andy B

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#95 Re: The end of the NHS.
August 23, 2014, 03:41:12 pm
Teaching Assistants and Learning Mentors in education.

tomtom

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#96 Re: The end of the NHS.
August 23, 2014, 04:56:09 pm
Maybe we should have something similar for MP's?

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#97 Re: The end of the NHS.
August 23, 2014, 05:21:12 pm
Let's call them SPecial ADviserS. Although SPecIal adVserS might be a suitable alternative.

Sloper

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#98 Re: The end of the NHS.
August 23, 2014, 06:03:02 pm
Politics should not be a profession, it should be something that people do as an adjunct to a profession (or trade like teaching) on a part time basis.

The 'professionalisation' of politics is one of the reasons so many of our politicians are so second rate.

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#99 Re: The end of the NHS.
August 23, 2014, 06:19:56 pm
In HE we already have Teaching Assistants as well as lecturers etc.. Though generally seen as useful as they do the grunt work allowing us to drink coffee, grow beards, climb at raven Tor and generally put the world to rights.

The doctors one is funny though - as you already have a series of differently trained health professionals from paramedics up to highly specialised nurses etc..

 

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