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In fact, I would argue that for all its possible faults (which all systems have) the fundamental problem with the NHS is not in how it is structured or in its p

In fact, I would argue that for all its possible faults (which all systems have) the fundamental problem with the NHS is not in how it is structured or in its processes. Rather, it boils down to funding. Nothing else. Just that. The one feature that the NHS has proven time and time again is that it is one of the most cost-efficient healthcare systems in the World, and given that it is working suboptimally that is a clear sign that the NHS needs a significantly greater (and stable and dependable in the long-term) financial investment. Once that is sorted, all other further changes and optimisations that may be needed can be worked on. But debating how the NHS needs to be reformed today is arguing on the helm of the Titanic on how to improve its unsinkability while it sails merrily towards an iceberg.

origin_path 4y ago
NHS funding increases constantly over time, often by massive amounts. The NHS is currently not merely suboptimal. You could have argued that before Team Expert came along in 2020 but not now. It's totally collapsed. There are now people routinely dying whilst waiting to be seen in A&E let alone the massive backlog for cancer. By any metric the NHS in 2022 has completely ceased to function properly. There seem to be a lot of British people in denial of this fact. The NHS is dead. The only reason it still exists at all is because it isn't a company so the usual safety systems like bankruptcy can't force a reset. Note that other countries which spend comparable amounts don't have this problem. I'm lucky enough to have left the UK a long time ago and lines in a party of Europe where the healthcare system is easy more privatised and less controlled by the government. Things here are normal, good even and I can get seen by a gp or specialist more or less immediately.
- Mordisquitos 4y ago
  Still, merely "more vs. less" privatisation is not the determinant factor. Case in point, I currently live in Spain where universal healthcare is fully public as is the NHS(*), and over time decentralised and became fully devolved to each of the 17 autonomous communities (almost federal states in all but technicalities). In general, from a user's perspective, Spanish healthcare tends to work better than the NHS in many regards, albeit with less flexibility at the GP level and more of a hassle when moving between regions. Anecdotally, from the experience of Spanish friends having lived in countries with a more or less public-private model (Belgium, Germany, Ireland) have expressed that the systems there are generally worse, and miss the Spanish healthcare system. However, different regional governmens have made a greater or lesser move towards covert privatisation via externalisation, and while the two that have done it the most (Catalonia and Madrid) are generally the worst performers, there is little correlation otherwise. The Basque Country, Navarre, Asturias and Aragon are all top performers, yet the first two have privatised significantly while the latter two have kept the system more fully public. On the other hand, Andalusia with very little privatisation is together with Madrid and Catalonia as one of the worse. And yet, when compared by investment, the pattern becomes much more clear. Madrid, Catalonia and Andalusia have some of the lowest healthcare investment per capita. The Basque Country, Navarre, Asturias are some of the greatest investers—Aragon not so much, but still on the top end of the scale. (*) As a digression, due to historical differences in how each system evolved, they are not quite the same. Spanish healthcare evolved from Social Security, and thus used to require being either employed, officially on unemployment, or being a dependant of someone in either circumstance (now it's more lenient). Also, all doctors involved are state employees. The NHS on the other hand evolved as a right of all legal residents of the UK, and GPs surgeries are almost always private businesses that are adscribed to the NHS.
scrlk 4y ago
That makes sense - we should find if there are any limits to the existing system after spending is increased to match Western European nations (~11% of GDP [0]). (my gut instinct says that we have hit those limits: if the NHS was a good model, you would expect another country to copy it) If the healthcare outcomes don't resemble what other systems can provide with the same level of funding, there needs to be a serious discussion as to whether the NHS model is fit for purpose for today. [0] https://www.oecd-ilibrary.org/sites/e26f669c-en/index.html?itemId=/content/component/e26f669c-en https://www.oecd-ilibrary.org/sites/e26f669c-en/index.html?i...
onlyrealcuzzo 4y ago
Isn't the problem with the NHS that you don't have enough doctors? Money can solve that, but it isn't the only option.
midasuni 4y ago
Look at g7 health funding by gdp for the last 40 years. The U.K. has been 10% lower than the rest (and about 1/3 - 1/2 of the US) for 40 years, Tory, labour, coalition, doesn’t matter.

origin_path 4y ago

NHS funding increases constantly over time, often by massive amounts. The NHS is currently not merely suboptimal. You could have argued that before Team Expert came along in 2020 but not now. It's totally collapsed. There are now people routinely dying whilst waiting to be seen in A&E let alone the massive backlog for cancer. By any metric the NHS in 2022 has completely ceased to function properly. There seem to be a lot of British people in denial of this fact. The NHS is dead. The only reason it still exists at all is because it isn't a company so the usual safety systems like bankruptcy can't force a reset. Note that other countries which spend comparable amounts don't have this problem. I'm lucky enough to have left the UK a long time ago and lines in a party of Europe where the healthcare system is easy more privatised and less controlled by the government. Things here are normal, good even and I can get seen by a gp or specialist more or less immediately.

Mordisquitos 4y ago
Still, merely "more vs. less" privatisation is not the determinant factor. Case in point, I currently live in Spain where universal healthcare is fully public as is the NHS(*), and over time decentralised and became fully devolved to each of the 17 autonomous communities (almost federal states in all but technicalities). In general, from a user's perspective, Spanish healthcare tends to work better than the NHS in many regards, albeit with less flexibility at the GP level and more of a hassle when moving between regions. Anecdotally, from the experience of Spanish friends having lived in countries with a more or less public-private model (Belgium, Germany, Ireland) have expressed that the systems there are generally worse, and miss the Spanish healthcare system. However, different regional governmens have made a greater or lesser move towards covert privatisation via externalisation, and while the two that have done it the most (Catalonia and Madrid) are generally the worst performers, there is little correlation otherwise. The Basque Country, Navarre, Asturias and Aragon are all top performers, yet the first two have privatised significantly while the latter two have kept the system more fully public. On the other hand, Andalusia with very little privatisation is together with Madrid and Catalonia as one of the worse. And yet, when compared by investment, the pattern becomes much more clear. Madrid, Catalonia and Andalusia have some of the lowest healthcare investment per capita. The Basque Country, Navarre, Asturias are some of the greatest investers—Aragon not so much, but still on the top end of the scale. (*) As a digression, due to historical differences in how each system evolved, they are not quite the same. Spanish healthcare evolved from Social Security, and thus used to require being either employed, officially on unemployment, or being a dependant of someone in either circumstance (now it's more lenient). Also, all doctors involved are state employees. The NHS on the other hand evolved as a right of all legal residents of the UK, and GPs surgeries are almost always private businesses that are adscribed to the NHS.

scrlk 4y ago

That makes sense - we should find if there are any limits to the existing system after spending is increased to match Western European nations (~11% of GDP [0]). (my gut instinct says that we have hit those limits: if the NHS was a good model, you would expect another country to copy it) If the healthcare outcomes don't resemble what other systems can provide with the same level of funding, there needs to be a serious discussion as to whether the NHS model is fit for purpose for today. [0] https://www.oecd-ilibrary.org/sites/e26f669c-en/index.html?itemId=/content/component/e26f669c-en https://www.oecd-ilibrary.org/sites/e26f669c-en/index.html?i...

onlyrealcuzzo 4y ago

Isn't the problem with the NHS that you don't have enough doctors? Money can solve that, but it isn't the only option.

midasuni 4y ago

Look at g7 health funding by gdp for the last 40 years. The U.K. has been 10% lower than the rest (and about 1/3 - 1/2 of the US) for 40 years, Tory, labour, coalition, doesn’t matter.