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As a Brit using the NHS I can only add that I trust, and expect, every government to make the NHS worse whilst they talk of how marvellous it is. I would reall

As a Brit using the NHS I can only add that I trust, and expect, every government to make the NHS worse whilst they talk of how marvellous it is. I would really like it given to an independent cross-party body, or the civil service, to try distance it from politics and The Treasury. I'd like to see legislation to heavily penalise drug companies seeking 20,000% price increases and the like. Both sides fiddle with it, trivially and constantly. They will even fiddle when they have won a second term or reorganised ministers - because what they themselves thought 4 years ago must have been stupid and should be immediately changed, or something. Much of the waste is from badly thought through political fiddling, remnants of previous fiddling, and public-private partnerships stupidly chosen during a time of lowest borrowing in British history. Neither side is honest about it however.

sgt101 9y ago
Imagine how well an NHS organised as it was in 1948 would function in today's world. Although there is no doubt that it could be better managed setting it in aspic will kill it surer than a nail in the back of the head. The NHS will face massive challenges in the next 30 years from demographic pressure on demand and staff, technology change and citizen behaviour and expectation. Radical "fiddling" is going to be needed to keep it alive. This is 100's bn pounds - it's the core of UK politics and it should be - we are a democracy.
- oldcynic 9y ago
  Who's suggesting it be set in aspic? That would be idiotic. I'd trust an independent body, with cross-party oversight, rather more to make changes, and choices, most suited to the service and populace than most politicians. There might even be some opportunity to think long term rather than just having the next election in mind.
  - dageshi 9y ago
    I wouldn't. Any time that independent body fucked up or did a bad job, they'd simply claim they didn't get enough money from the government to do the job. Whether that was the truth or not. The "cross party" oversight would then take positions according to their party priorities, if in power blame the independent body for doing a bad job, if not in power blame the government for not giving them enough money. Unless of course that independent body had separate tax raising powers for just the NHS? In which case I can't see how they can't be elected as they have the power of taxation. You can't get politics out of the NHS, it spends too much money raised by taxation.
    - oldcynic 9y ago
      I think it's axiomatic that every human endeavour is flawed. It's pretty clear NICE works rather well and is now accepted by both political sides and the profession. Let's start there. In terms of funding the NHS spends a smaller proportion of GDP than most developed nations. If we can nail defence and overseas development as x% of GDP, why not also for the NHS? Perhaps consider increasing to the average EU spend?
      - DanBC 9y ago
        For one example of politicians chosing to ignore NICE look at the Cancer Drugs Fund. The CDF makes available cutting edge new technology to people dying from cancer. These meds are very expensive. They often fail the NICE appraisals. The CDF pays for the meds. We know that these meds often don't work at all, and sometimes cause harm, and are fantastically expensive. https://www.theguardian.com/science/2017/apr/28/cancer-drugs-fund-condemned-as-expensive-and-ineffective https://www.theguardian.com/science/2017/apr/28/cancer-drugs...
    - pjc50 9y ago
      I suppose the TV license system is very close to an independent body with "tax" raising powers (including the ability to jail people for non-payment). No longer quite so popular.
      - DanBC 9y ago
        Strictly speaking you can't go to jail for non-payment of tv licence. You'd get a fine, and go to jail for not paying the fine. You're right that people get a criminal conviction for non-payment of the licence fee, and that's a bit worrying when it happens to so many people.
- gaius 9y ago
  Aneurin Bevan believed that the cost of the NHS would reduce over time as the population got healthier. The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? No progress will be made, by either party, until someone stands up and does this.
  - pbhjpbhj 9y ago
    You can't put a figure on it. The system interfaces with every area of life, and with capitalism. Western Capitalism says the amount spent on healthcare should grow until all available money becomes profit for the Capitalists. Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia because it mines the metals that make the earphones used in mp3 players by students training to be teachers, to encourage them to teach more sport to children so that when those children grow up they'll need less heart bypass surgery. Meanwhile the Siberian mine leads to contaminants in the ocean that cause excess cost to all health regimes around the world ... Health encompasses all parts of life, it needs selfless, holistic, planet-wide approach. You could spend £150 Trillion in health and still find more areas of spending to address.
    - justinmk 9y ago
      > Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia In other words, central planning doesn't work[1]. NHS was a "special case" that tends towards the general case, as is the tendency of all untouchable mandates. [1] https://en.wikipedia.org/wiki/Economic_calculation_problem https://en.wikipedia.org/wiki/Economic_calculation_problem
      - DanBC 9y ago
        The NHS (in England) hasn't been centrally planned for some time now. That's what CCGs are for. Also, a bunch of stuff (drug and alcohol services, weight loss, smoking cessation, suicide prevention, sexual health, etc etc) isn't even NHS any more, and is part of Public Health which is part of local authorities.
- pbhjpbhj 9y ago
  Yes, but that doesn't mean we should plan the NHS according to the political whims of a party who only look to the next 4 years, and a person who is usually inexperienced in the field and likely to be replaced in the next reshuffle in 12 months time. What's the Tory's stated public position for their 30 year goals and what immediate and mid-term changes have they made in order to achieve that? Fiddling is _not_ needed. Planned, careful, forward looking, evidence based change (that's not focused on shifting funds towards private profit) is certainly required.) It's just like education, every new minister (usually entirely new to the field) dicks around changing stuff because they want to justify their pay and because not changing it might seem like someone else had a good idea and that apparently is complete anathema to our current politicians.
- DanBC 9y ago
  Sure, but pretty much everyone (even current Conservative party) agrees the Lansley reforms (The Health and Social Care Act) were a fucking mess and are currently causing problems.
- rmc 9y ago
  When it was set up in the 1940s, it was claimed to be impossibly expensive, and would bankrupt the nation.
cstross 9y ago
I'd like to see a long-term outcomes-based comparison between NHS England and the Scottish NHS, frankly. The Scottish NHS is a fully devolved issue and has been diverging from the English system for most of a decade now, with a greater emphasis on preventative healthcare and screening programs (not to mention free prescriptions for all). In another couple of years we may even have some hard statistical data on what practices work best!
- AlphaSite 9y ago
  Scottish NHS also has funding issues, so who knows whats going to happen.
- tim333 9y ago
  I believe they did a study and outcomes were better in England. I'll try google it.
DanBC 9y ago
> I would really like it given to an independent cross-party body, or the civil service, to try distance it from politics and The Treasury. They did that. The governmental bit (in England) is the Department for Health and Social Care. NHS England is the qango that runs the NHS in England. They provide money to CCGs to commission most services. NHS England directly commissions some (so called "tier 4" services) - eg inpatient mental health services for children; medium and high secure mental health services; etc. I genuinely have no idea what happens in Wales, Scotland, or NI. Health is devolved and they run their systems independently.

sgt101 9y ago

Imagine how well an NHS organised as it was in 1948 would function in today's world. Although there is no doubt that it could be better managed setting it in aspic will kill it surer than a nail in the back of the head. The NHS will face massive challenges in the next 30 years from demographic pressure on demand and staff, technology change and citizen behaviour and expectation. Radical "fiddling" is going to be needed to keep it alive. This is 100's bn pounds - it's the core of UK politics and it should be - we are a democracy.

oldcynic 9y ago
Who's suggesting it be set in aspic? That would be idiotic. I'd trust an independent body, with cross-party oversight, rather more to make changes, and choices, most suited to the service and populace than most politicians. There might even be some opportunity to think long term rather than just having the next election in mind.
- dageshi 9y ago
  I wouldn't. Any time that independent body fucked up or did a bad job, they'd simply claim they didn't get enough money from the government to do the job. Whether that was the truth or not. The "cross party" oversight would then take positions according to their party priorities, if in power blame the independent body for doing a bad job, if not in power blame the government for not giving them enough money. Unless of course that independent body had separate tax raising powers for just the NHS? In which case I can't see how they can't be elected as they have the power of taxation. You can't get politics out of the NHS, it spends too much money raised by taxation.
  - oldcynic 9y ago
    I think it's axiomatic that every human endeavour is flawed. It's pretty clear NICE works rather well and is now accepted by both political sides and the profession. Let's start there. In terms of funding the NHS spends a smaller proportion of GDP than most developed nations. If we can nail defence and overseas development as x% of GDP, why not also for the NHS? Perhaps consider increasing to the average EU spend?
    - DanBC 9y ago
      For one example of politicians chosing to ignore NICE look at the Cancer Drugs Fund. The CDF makes available cutting edge new technology to people dying from cancer. These meds are very expensive. They often fail the NICE appraisals. The CDF pays for the meds. We know that these meds often don't work at all, and sometimes cause harm, and are fantastically expensive. https://www.theguardian.com/science/2017/apr/28/cancer-drugs-fund-condemned-as-expensive-and-ineffective https://www.theguardian.com/science/2017/apr/28/cancer-drugs...
  - pjc50 9y ago
    I suppose the TV license system is very close to an independent body with "tax" raising powers (including the ability to jail people for non-payment). No longer quite so popular.
    - DanBC 9y ago
      Strictly speaking you can't go to jail for non-payment of tv licence. You'd get a fine, and go to jail for not paying the fine. You're right that people get a criminal conviction for non-payment of the licence fee, and that's a bit worrying when it happens to so many people.
gaius 9y ago
Aneurin Bevan believed that the cost of the NHS would reduce over time as the population got healthier. The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? No progress will be made, by either party, until someone stands up and does this.
- pbhjpbhj 9y ago
  You can't put a figure on it. The system interfaces with every area of life, and with capitalism. Western Capitalism says the amount spent on healthcare should grow until all available money becomes profit for the Capitalists. Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia because it mines the metals that make the earphones used in mp3 players by students training to be teachers, to encourage them to teach more sport to children so that when those children grow up they'll need less heart bypass surgery. Meanwhile the Siberian mine leads to contaminants in the ocean that cause excess cost to all health regimes around the world ... Health encompasses all parts of life, it needs selfless, holistic, planet-wide approach. You could spend £150 Trillion in health and still find more areas of spending to address.
  - justinmk 9y ago
    > Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia In other words, central planning doesn't work[1]. NHS was a "special case" that tends towards the general case, as is the tendency of all untouchable mandates. [1] https://en.wikipedia.org/wiki/Economic_calculation_problem https://en.wikipedia.org/wiki/Economic_calculation_problem
    - DanBC 9y ago
      The NHS (in England) hasn't been centrally planned for some time now. That's what CCGs are for. Also, a bunch of stuff (drug and alcohol services, weight loss, smoking cessation, suicide prevention, sexual health, etc etc) isn't even NHS any more, and is part of Public Health which is part of local authorities.
pbhjpbhj 9y ago
Yes, but that doesn't mean we should plan the NHS according to the political whims of a party who only look to the next 4 years, and a person who is usually inexperienced in the field and likely to be replaced in the next reshuffle in 12 months time. What's the Tory's stated public position for their 30 year goals and what immediate and mid-term changes have they made in order to achieve that? Fiddling is _not_ needed. Planned, careful, forward looking, evidence based change (that's not focused on shifting funds towards private profit) is certainly required.) It's just like education, every new minister (usually entirely new to the field) dicks around changing stuff because they want to justify their pay and because not changing it might seem like someone else had a good idea and that apparently is complete anathema to our current politicians.
DanBC 9y ago
Sure, but pretty much everyone (even current Conservative party) agrees the Lansley reforms (The Health and Social Care Act) were a fucking mess and are currently causing problems.
rmc 9y ago
When it was set up in the 1940s, it was claimed to be impossibly expensive, and would bankrupt the nation.

cstross 9y ago

I'd like to see a long-term outcomes-based comparison between NHS England and the Scottish NHS, frankly. The Scottish NHS is a fully devolved issue and has been diverging from the English system for most of a decade now, with a greater emphasis on preventative healthcare and screening programs (not to mention free prescriptions for all). In another couple of years we may even have some hard statistical data on what practices work best!

AlphaSite 9y ago
Scottish NHS also has funding issues, so who knows whats going to happen.
tim333 9y ago
I believe they did a study and outcomes were better in England. I'll try google it.

DanBC 9y ago

> I would really like it given to an independent cross-party body, or the civil service, to try distance it from politics and The Treasury. They did that. The governmental bit (in England) is the Department for Health and Social Care. NHS England is the qango that runs the NHS in England. They provide money to CCGs to commission most services. NHS England directly commissions some (so called "tier 4" services) - eg inpatient mental health services for children; medium and high secure mental health services; etc. I genuinely have no idea what happens in Wales, Scotland, or NI. Health is devolved and they run their systems independently.