Err, yes Bob, this is the point

Why reforms are destroying the essence of the NHS

The NHS will be unrecognisable in 10 years\’ time, says Bob Hudson, if the current bill succeeds – which it looks likely to do

This is the aim and contention. The contention is that the NHS needs to be changed, the aim is to change it.

To change it from a centrally planned, in fact one of the last relics of near-Stalinist planning, system where government finances and provides health care into a system whereby government finances health care and we have a mixed environment of suppliers, some government, some charitable, some mutually owned and some no doubt private for profit.

Now maybe you think that\’s a bad idea and maybe you think it\’s a good one. I think it\’s a good one, as do the people putting the plan into place. For the simple reason that what is regularly regarded as the best health care system in the world, the French one, operates in this new manner: government financing and a multiplicity of suppliers and a multiplicity of forms of supplier.

The structure of the best health care system in the world. Worth copying really.

But whether you think this is  good idea or not is one thing. Expressing surprise that the NHS will be changed is another. Because this is actually the point: to change the NHS.

9 comments on “Err, yes Bob, this is the point

  1. Is the French system really the best, and by what metric? I was under the impression that the Singapore and Swiss systems fared best in terms of value-for-money, with the Swiss version being more socially acceptable to Europeans.

  2. One major problem in the nhs, apart from Nurse training, is that they are not capable of proper purchasing management. Heaven forfend we should need more mangers, but private companies in the main do buy in an appropriate manner to get best value.

  3. Heaven forfend we should need more mangers, but private companies in the main do buy in an appropriate manner to get best value.

    Oil companies operating in Nigeria and complying with local content regulations not being in the main.

  4. Oil companies operating in Nigeria and complying with local content regulations not being in the main.

    I thought that the most effective, if not the most moral, way of squaring this circle was to bribe the State Governor enough that you didn’t have to comply with the regulations?

  5. “The NHS will be unrecognisable in 10 years’ time”

    You mean patients won’t have to crap in their beds because the nurses can’t be bothered to help them?

    Shocking. What would Bevan say?

  6. Tim, a few days ago you told us that the proper measure of cancer care was mortality rates (not improvements in them) and that “Even though the NHS has been getting better at curing cancer it’s still bad at doing so”. Well, according to the paper you referred to, and averaging the rates for men and women (which is crude, but not unfair), in the most recent common data the cancer mortality rate for 15-74 year olds in England & Wales was 2565 per million people. In France it was 2667.

    So by your own preferred measure, the NHS is better than the world’s best system.

    Tim adds: “Tim, a few days ago you told us that the proper measure of cancer care was mortality rates (not improvements in them)”

    No, actually, I didn’t. What I said was that claiming that the NHS is “better” by looking at improvement rates rather than absolute rates is incorrect. You can say that faster improvement rates means that it is improving faster, sure, but if you want to claim “best”, which is an absolute statement, then you must look at absolute numbers. I was correcting the error made by those claiming that improvement rates = absolute rates.

    And no, sorry, mortality rates for cancer aren’t the defining measure either. For a start we need to know what the underlying incidence is. To make numbers up entirely, a medical system that manages to cure a high cancer incidence rate is better than a medical system that fails to cure a low cancer incidence rate. (A high incidence might show all sorts of other problems of course, from genetics to environmental pollution, but that’s not the health care system).

    The best measure I can think of (and delighted to be corrected) is mortality amenable to health care. A measure that the NHS used to be shite on and is now merely bad to not very good.

  7. Do I hear the rumble of moving goalposts?

    The leading proponents of amenable mortality statistics see them as giving warning indicators of where improvements may be available, rather than general methods for comparing healthcare between countries. But as it happens, both Nolte & McKee and Tobias & Yeh have France only very slightly better than the UK on amenable cancer mortality – if the UK is sitting somewhere between “bad” and “not very good” then so is France.

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