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Politics 2020 (Read 143187 times)

seankenny

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#1600 Re: Politics 2020
October 25, 2021, 08:56:07 am

Edit: on per capita GDP, I was generally shocked to see it's a third higher in Denmark compared to the UK. I thought there'd be a gap but I would not have guessed it would be so big.

The U.K. is basically the Netherlands and Puglia glued together. Nine out of ten of NW Europeís poorest regions are here, and the richest.

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#1601 Re: Politics 2020
October 25, 2021, 09:15:09 am
All this debate about health was originally due to covid restrictions being brought in to save the NHS.  At the end of the day,  the  craven self interest of this government is such that its probably not going to happen before the COP,  as that might be a bit embarrassing for Boris,  and spoil all the big corporate events hes looking forward to. 

Just wait until after its over in a fortnight. 

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#1602 Re: Politics 2020
October 25, 2021, 11:15:40 am
Galpinos has said most of what I would have done so I won't rehash it.

If you google any healthcare system ranking, the UK is always up in the top few. I've no idea how these rankings are worked out, and different ones give slightly different answers. But in all of them, any system that comes above the NHS spends significantly more. That appears to be the difference. As has been remarked, you would expect the Netherlands to have better outcomes if it spends 33% more per head of population! Anyway I managed to find a link to the relevant chart from the earlier link which shows these disparities (apologies for size).

It appears to me that actually the NHS does amazingly well considering that by any comparative measure it is being run on the cheap.

The other thing I takeaway is that something has gone very, very wrong in the US. They spend twice as much as every other developed nation, and they don't even have universal healthcare, never mind universal free healthcare like we do. Which is why we would be well advised to jump onto any creeping talk of privatisation to solve NHS "issues" from this government or their outriders in the Telegraph / Times / Mail, as like Galpinos I wouldn't trust them not to go down the US route. The solution is to spend more on what we already have.


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#1603 Re: Politics 2020
October 25, 2021, 12:30:31 pm
All this debate about health was originally due to covid restrictions being brought in to save the NHS.  At the end of the day,  the  craven self interest of this government is such that its probably not going to happen before the COP,  as that might be a bit embarrassing for Boris,  and spoil all the big corporate events hes looking forward to. 

Just wait until after its over in a fortnight.

I've already heard they're expecting Glasgow to have some increase post-COP restrictions to deal with the inevitable surge in cases... Great!

Nigel

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#1604 Re: Politics 2020
October 25, 2021, 03:06:52 pm
I don't think proportion of GDP spent on healthcare is especially meaningful. The US spends close to twice as much as many European countries with some form of national healthcare, but typically with worse outcomes (e.g. life expectancy, admittedly a crude measure). Having tried to deal with the labyrinthine bureaucracy involved in US health insurance I suspect much of that extra spend has nothing to do with patient care and a lot to do with profit.

Its a bit of a tangent I know, so last mention of this, but I am still shocked at quite how much the Americans spend on healthcare! Andy, the ONS report I linked partially confirms your suspicion, in section 7 "How much is spent on healthcare governance and financing". The answer is in this chart:



The US spends £639 per capita simply adminstering their system i.e. processing insurance claims, before even doing any healthcare  That is way more than any other country - 3x more than 2nd highest spender on this. The UK spends £53, 12x less than the US. Also the other countries that spend big on this all have varying degrees of private insurance systems. Worth remembering if anyone claims that private involvement is more efficient / cheaper. Whatever its merits, its not that!

andy popp

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#1605 Re: Politics 2020
October 25, 2021, 03:25:07 pm
Thanks Nigel. My suspicions were really much more than that, but its interesting to see the actual data. The complexity and waste is truly mind-boggling. When it comes to healthcare, the market is neither more efficient nor better at serving people.
« Last Edit: October 25, 2021, 03:39:34 pm by andy popp »

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#1606 Re: Politics 2020
October 25, 2021, 03:29:14 pm
Unless they are shareholders.

Nigel

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#1607 Re: Politics 2020
October 25, 2021, 04:57:33 pm
Thanks Nigel. My suspicions were really much more than that, but its interesting to see the actual data. The complexity and waste is truly mind-boggling. When it comes to healthcare, the market is neither more efficient nor better at serving people.

Out of interest Andy, in the US itself, when discussing domestic healthcare and its various tweaks, is there a widespread recognition by everyone (politicians / media / man in the street) that they spend twice as much as all other countries, for a worse service? Or is this somehow "hidden" / not widely known?

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#1608 Re: Politics 2020
October 25, 2021, 05:36:23 pm
Which is why we would be well advised to jump onto any creeping talk of privatisation to solve NHS "issues" from this government or their outriders in the Telegraph / Times / Mail, as like Galpinos I wouldn't trust them not to go down the US route. The solution is to spend more on what we already have.

Although I am not a fan of private healthcare having worked in a private hospital in Malaysia, the NHS needs some sort of reform.
Spending more money on what we have will be a huge waste. There is a lot of wastage in the NHS in some places and it's hugely inefficient in many ways, although in others it does remarkably well. I think that private involvement in some places might be a benefit especially the things that it does badly, such as resourcing.

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#1609 Re: Politics 2020
October 26, 2021, 09:39:57 am

Edit: on per capita GDP, I was generally shocked to see it's a third higher in Denmark compared to the UK. I thought there'd be a gap but I would not have guessed it would be so big.

The U.K. is basically the Netherlands and Puglia glued together. Nine out of ten of NW Europeís poorest regions are here, and the richest.

This stats seems to come up pretty often but I'm not sure it really indicates what people seem to think and tends to lead to somewhat simplistic and exaggerated conclusions.

Appears in this sort of article though the link to the original data doesn't seem to work:  https://inequalitybriefing.org/graphics/briefing_43_UK_regions_poorest_North_Europe.pdf

It does appear that some of the starkest results may be related to the difference in region sizes selected, full fact looks at this in some detail, https://fullfact.org/economy/does-uk-have-poorest-regions-northern-europe/

If you look at larger regions then it would appear that the UK looks pretty similar to France, poorer and more economically divided than Germany or smaller, richer Northern European countries such as Denmark, Belgium, Austria etc but significantly less divided than e.g. Italy or Spain.

https://en.wikipedia.org/wiki/List_of_OECD_regions_by_GDP_(PPP)_per_capita,  splits UK into 12 regions and France into 13 (excluding overseas territories).

UK has 1 very rich region (London), another over 45k (South East) then 5 between 35k to 50k, and other 5 between 30k and 35k.

France has 1 very rich region (Ille-de-France), then 5 between 35k and 40k and 8 between 30k and 35k.  Interestingly Scotland, East, North West and South West are richer than all but 3 French territories.

The figures for Italy are quite different and show why the Netherland / Puglia comparison doesn't really work for the UK while it does have a strong element of truth for Italy.  Italy is split into 21 regions (so somewhat smaller region size), 2 regions have GDP over 50k, another 9 over 40k, only 3 regions between 30k and 40k and 7 regions (basically the whole of Southern Italy plus Sardinia) between 20k and 30k (3 of which are below 25k)

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#1610 Re: Politics 2020
October 26, 2021, 10:12:50 pm
Although I am not a fan of private healthcare having worked in a private hospital in Malaysia, the NHS needs some sort of reform.
Spending more money on what we have will be a huge waste. There is a lot of wastage in the NHS in some places and it's hugely inefficient in many ways, although in others it does remarkably well. I think that private involvement in some places might be a benefit especially the things that it does badly, such as resourcing.

Maybe so, not having worked in healthcare I really couldn't comment on the details of procurement.

However, looking briefly at more country-by-country data it looks like we could employ a load more doctors and nurses, on the assumption that the NHS is competent at hiring staff?! And increase numbers of beds, imaging machines. Relative to other OECD countries we are quite a way down the pecking order on everything e.g. fewer MRI machines per head than Turkey, less than half as many nurses per head than Norway, 3x fewer beds per head than Germany.

It would cost money but none of these things should waste anything as I understand we are known to be short of them all anyway? Links below if anyone's interested, quite illuminating:

https://data.oecd.org/healthres/doctors.htm#indicator-chart
https://data.oecd.org/healthres/nurses.htm#indicator-chart
https://data.oecd.org/healtheqt/hospital-beds.htm
https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm#indicator-chart

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#1611 Re: Politics 2020
October 26, 2021, 10:39:13 pm
Although I am not a fan of private healthcare having worked in a private hospital in Malaysia, the NHS needs some sort of reform.
Spending more money on what we have will be a huge waste. There is a lot of wastage in the NHS in some places and it's hugely inefficient in many ways, although in others it does remarkably well. I think that private involvement in some places might be a benefit especially the things that it does badly, such as resourcing.

Maybe so, not having worked in healthcare I really couldn't comment on the details of procurement.

However, looking briefly at more country-by-country data it looks like we could employ a load more doctors and nurses, on the assumption that the NHS is competent at hiring staff?! And increase numbers of beds, imaging machines. Relative to other OECD countries we are quite a way down the pecking order on everything e.g. fewer MRI machines per head than Turkey, less than half as many nurses per head than Norway, 3x fewer beds per head than Germany.

It would cost money but none of these things should waste anything as I understand we are known to be short of them all anyway? Links below if anyone's interested, quite illuminating:

https://data.oecd.org/healthres/doctors.htm#indicator-chart
https://data.oecd.org/healthres/nurses.htm#indicator-chart
https://data.oecd.org/healtheqt/hospital-beds.htm
https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm#indicator-chart


On many of the things,  its not just how many you have,  it's that ours are old and years behind what some other countries have. 
On beds its not really beds at all,  you can have them anywhere,  (like the vast nightingale  hospitals) this word always really refers to the staff to look after them.

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#1612 Re: Politics 2020
October 27, 2021, 07:49:44 am
Although I am not a fan of private healthcare having worked in a private hospital in Malaysia, the NHS needs some sort of reform.
Spending more money on what we have will be a huge waste. There is a lot of wastage in the NHS in some places and it's hugely inefficient in many ways, although in others it does remarkably well. I think that private involvement in some places might be a benefit especially the things that it does badly, such as resourcing.

Maybe so, not having worked in healthcare I really couldn't comment on the details of procurement.

However, looking briefly at more country-by-country data it looks like we could employ a load more doctors and nurses, on the assumption that the NHS is competent at hiring staff?! And increase numbers of beds, imaging machines. Relative to other OECD countries we are quite a way down the pecking order on everything e.g. fewer MRI machines per head than Turkey, less than half as many nurses per head than Norway, 3x fewer beds per head than Germany.

It would cost money but none of these things should waste anything as I understand we are known to be short of them all anyway? Links below if anyone's interested, quite illuminating:

https://data.oecd.org/healthres/doctors.htm#indicator-chart
https://data.oecd.org/healthres/nurses.htm#indicator-chart
https://data.oecd.org/healtheqt/hospital-beds.htm
https://data.oecd.org/healtheqt/magnetic-resonance-imaging-mri-units.htm#indicator-chart

I canít imagine encouraging my children to seek careers in medicine.
From my peripheral knowledge of the culture and compared to my military background, I have the impression that the life of a junior doctor (in particular) is one of relentless misery and bullying (victim of), whilst experiencing stupid and harmful working hours and conditions, with ever declining respect and opportunity at the end of a very very long training tunnel.
Listening to tales from relatives that have been or are going through that mill, it generally sounds like a self flagellating exercise, and thatís speaking as someone who likes to live in a hole in the ground for days on end and works four month stretches at sea, with no rest days and rather high levels of responsibility.

I canít imagine recruiting or retention being that great.

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#1613 Re: Politics 2020
October 27, 2021, 08:26:30 am
Am I wrong to think the biggest difficulty the UK healthcare system faces is that it has to treat the average UK person? In that the average UK person is really fucking unhealthy. And requires more healthcare compared to the average European.
Or is that an inaccurate assumption on my part fuelled by anecdote and bemusement at how we've seemingly become a nation of fat useless bastards, and not backed up by stats?

Using Matt's naval narrative, paying for more buckets to bail out leaky ships is perhaps not as wise a long-term approach as investing in ships that leak less (good health).

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#1614 Re: Politics 2020
October 27, 2021, 08:34:14 am
Am I wrong to think the biggest difficulty the UK healthcare system faces is that it has to treat the average UK person? In that the average UK person is really fucking unhealthy. ?


In my experience that's pretty accurate.  But not the only problem.  I'm extremely dubious that trying to Google comparative statistics would help either. Overall though,  if people looked after themselves slightly better there would be fewer problems.  Unfortunately,  the PM is dead set against sugar taxes, and campaigned against Jamie Oliver when he tried to make school meals healthier. 

O, and I wonder if the cost of health services compared above includes the 37bn that our government wasted on test and trace
« Last Edit: October 27, 2021, 09:00:28 am by TobyD »

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#1615 Re: Politics 2020
October 27, 2021, 08:37:19 am
...

I canít imagine recruiting or retention being that great.

Speaking as someone who has quit a job as allied health professional neither can I.

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#1616 Re: Politics 2020
October 27, 2021, 08:58:31 am
Am I wrong to think the biggest difficulty the UK healthcare system faces is that it has to treat the average UK person? In that the average UK person is really fucking unhealthy.
I’d imagine it’s a factor. But doesn’t get away from the chronic underinvestment compared to other countries that Nigel has linked to upthread.

Quote
Using Matt's naval narrative, paying for more buckets to bail out leaky ships is perhaps not as wise a long-term approach as investing in ships that leak less (good health).
But what’s contributing to poor health in the UK? What would you invest in? That is such a massive topic, but you’d have to look at reducing levels of poverty to begin with, as that is intrinsically linked with poor health.

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#1617 Re: Politics 2020
October 27, 2021, 09:41:19 am
Am I wrong to think the biggest difficulty the UK healthcare system faces is that it has to treat the average UK person? In that the average UK person is really fucking unhealthy.
Iíd imagine itís a factor. But doesnít get away from the chronic underinvestment compared to other countries that Nigel has linked to upthread.

Quote
Using Matt's naval narrative, paying for more buckets to bail out leaky ships is perhaps not as wise a long-term approach as investing in ships that leak less (good health).
But whatís contributing to poor health in the UK? What would you invest in? That is such a massive topic, but youíd have to look at reducing levels of poverty to begin with, as that is intrinsically linked with poor health.

Don't want to be that guy again but how much evidence is there that UK is significantly unhealthy compared to other European countries?  Life expectancy figures for Western Europe are remarkably similar really, between 80.6 (Germany) and 83 (Switzerland) with UK at the lower end (81) but ahead of, among others, Germany, Denmark and Belgium.   Figures on healthy life expectancy are a bit more difficult to find and it's not clear how accurate they are but a quick look again shows UK in the bottom half but not any way a significant outlier.   ​

Yes we are amoung the worst for being overweight/obese but it does feel like there is a bit of trope on here to blame a lot problems on fat people not looking after themselves.   I'm sure we do have issues with health inequalities in the UK , a lot of those linked to financial inequality and division but it has to be overly simplistic to blame all the problems of the NHS on that.

It could be argued that the NHS provides good value service given the lower level of UK spending on health compared to  lots of similar countries and I think it is often pretty effective particularly for acute and emergency care.  But the payback for that low spending/investment (and arguably other issues around organisation etc) includes often slow and frustrating service, big gaps in areas like chronic conditions, mental health etc and some pretty difficult working conditions for a lot of the staff.




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#1618 Re: Politics 2020
October 27, 2021, 09:50:59 am
I don't know what the stats are for the UK, but I was listening to something last night that said that in the US in the 70s there were 8 administrators for every healthcare provider on average. Now there are 1800 and that healthcare should be renamed sick care.   

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#1619 Re: Politics 2020
October 27, 2021, 10:07:44 am
 Re population health.

I don't think that looking at a UK life expectancy figure will tell you a lot.
It's about quality of life, and both are extremely unequal around the UK.
People who live to 80, but with COPD for the last 20 years of that, are a) putting a huge burden on the health service b) not having a good time with COPD. It's one of the most underestimated conditions, sufferers are frequently too breathless to eat properly, wash properly etc let alone do any exercise.

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#1620 Re: Politics 2020
October 27, 2021, 10:34:34 am
Re population health.

I don't think that looking at a UK life expectancy figure will tell you a lot.
It's about quality of life, and both are extremely unequal around the UK.
People who live to 80, but with COPD for the last 20 years of that, are a) putting a huge burden on the health service b) not having a good time with COPD. It's one of the most underestimated conditions, sufferers are frequently too breathless to eat properly, wash properly etc let alone do any exercise.

Possibly, but it doesn't tell you that we're significantly worse than other similar countries.

Healthy life expectancy:

https://ec.europa.eu/eurostat/statistics-explained/index.php?title=File:Life_expectancy_and_healthy_life_years_of_people_aged_65_years,_by_sex,_2018_(years)_AE2020.png

Given the variations in the data I'm not sure how consistent/accurate this is, but in the end it's not clear to me that UK is massively different to other European countries.  The developed world has made big strides in keeping people alive longer,  maybe not so much in keeping people healthy longer?

UK may be slightly different to other European countries but do we really believe that we're exceptionally bad in this way?  If we're not careful don't we just end up as the opposite side of the coin to classic rightwing GB (English?) exceptionalism.

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#1621 Re: Politics 2020
October 27, 2021, 10:52:04 am
Re population health.

I don't think that looking at a UK life expectancy figure will tell you a lot.
It's about quality of life, and both are extremely unequal around the UK.
People who live to 80, but with COPD for the last 20 years of that, are a) putting a huge burden on the health service b) not having a good time with COPD. It's one of the most underestimated conditions, sufferers are frequently too breathless to eat properly, wash properly etc let alone do any exercise.

Possibly, but it doesn't tell you that we're significantly worse than other similar countries.

Healthy life expectancy:

https://ec.europa.eu/eurostat/statistics-explained/index.php?title=File:Life_expectancy_and_healthy_life_years_of_people_aged_65_years,_by_sex,_2018_(years)_AE2020.png

Given the variations in the data I'm not sure how consistent/accurate this is, but in the end it's not clear to me that UK is massively different to other European countries.  The developed world has made big strides in keeping people alive longer,  maybe not so much in keeping people healthy longer?

UK may be slightly different to other European countries but do we really believe that we're exceptionally bad in this way?  If we're not careful don't we just end up as the opposite side of the coin to classic rightwing GB (English?) exceptionalism.

Theres absolutely no way I'm looking for statistics on this, but something like a comparison of annual hospital admissions due to an acute exacerbation of copd would be a measure of some sort. 
For a lot of people,  the advances in longevity,  as you suggest have not been matched by an advance in quality of life.  Modern medicine, in many cases, seems to have achieved maintaining suffering for longer more than anything else.  Having said that though, if you work in healthcare,  you don't tend to see the people who are enjoying their lives in later lives,  and I've certainly met many people in their 90s who are having a great time. 

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#1622 Re: Politics 2020
October 27, 2021, 11:00:35 am

Yes we are amoung the worst for being overweight/obese but it does feel like there is a bit of trope on here to blame a lot problems on fat people not looking after themselves.   

I was going to suggest late onset diabetes as a measure of people sitting on the couch eating ready meals but was very surprised to find out we seem to be among the lower end for this in Europe...

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#1623 Re: Politics 2020
October 27, 2021, 11:00:46 am
I realise it's very lazy to post this idle thought without a link, but here goes.
I don't deny that there's been chronic underinvestment in the NHS for years, and that it is fraught with problems.

But, my experiences with it have all been very positive - from routine GP stuff to trauma care (that was admittedly less positive but, ultimately, I dropped in on Sheffield Northern with very little warning and the titanium they gave me still seems to be doing the job 10+ years later) to childbirth stuff. I also remember that there was a report that came out a few years ago describing the NHS as one of the best healthcare in Europe and the world. Can anyone remember which report this was and why it is no longer relevant?

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#1624 Re: Politics 2020
October 27, 2021, 11:09:12 am
What IanP said. UK COPD rates are on the high side compared with EU countries but this is just one condition. Overall, UK longterm disability rates are in the middle of the range amongst European countries. 



It is a similar story for longevity, health-related quality of life, perceived quality of life and so on. The UK is usually somewhere in the middle compared with other European countries for societal health measures (obviously these data conceal huge variations between Kensington and Merthyr).

Back to the US healthcare system. I don't even think its that good even if you have infinite money. The legal, financial and cultural background mean that unnecessary highly invasive procedures are rife. Very frequently, the best medical option is to do nothing, and that often includes investigations. That's hard when you've got $millions of scanners and surgical teams at the ready.

An anecdote: In around 2007 I took a lad to the Hi-Desert Medical Centre (Joshua Tree) with a suspected broken hip after he'd fallen soloing. We had to wait an agonising 6 hours in casualty before he was seen by a doctor and got proper pain control. Far worse than any of numerous UK experiences.






 

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