What glorious logic

The NHS is a efficient as it gets, except on health outcomes, and we just don’t spend enough to get them

Some of us might think that health outcomes is the measure of efficiency.

When you hear the right wing say the NHS is inefficient, it isn’t. Nobody does it better with the resources they have got. To claim otherwise is to talk nonsense.

But then what do we right wingers know? Output as a measure of efficiency? Pah! Fie to your neoliberal measurements, candidly.

25 comments on “What glorious logic

  1. This despite the fact many NHS staff frequently complain about there being too many managers and bureaucracy. Managers complaining about having to get in bank workers at high costs due to high staff sickness levels. Patients noticing staff standing around chatting rather than working. Theatres standing empty because beds are blocked by patients waiting to go into social care etc.

    That is ignoring using technology better and efficiency savings if things were optimized potentially reducing some jobs and roles.

    Of course getting agreement on what needs to change is much harder (they’ll all point the finger elsewhere but don’t want their own jobs impacted) but to claim there is nothing that needs to be done is perverse.

  2. The NHS is as efficient as it gets, except on health outcomes so if we remove the patients the NHS would run as sweet as a nut.

  3. The NHS is almost certainly more efficient than most other developed countries’ healthcare systems.

    We spend what, 8% of our GDP on healthcare? whereas the US spends some 16%.

    Healthcare, like most spending, is subject to diminishing returns. Most gains come from cheap interventions: antibiotics, statins, etc. By the time you’re spending 16% of GDP, every extra pound (or dollar) is spending on the worried well: unnecessary tests, over-prescription, etc.

    So I’d question whether raw efficiency is the right benchmark to use, given the inherit higher efficiency of low-budget systems.

  4. Andrew M – “The NHS is almost certainly more efficient than most other developed countries’ healthcare systems.”

    Define efficient.

    “We spend what, 8% of our GDP on healthcare? whereas the US spends some 16%.”

    And Singapore spends what? 4%?

    “Healthcare, like most spending, is subject to diminishing returns. Most gains come from cheap interventions: antibiotics, statins, etc.”

    Which is to say most health benefits come from engineers (thank you Joseph Bazalgette!) and an odd Scotsman who didn’t convey his ideas very well to a perfectly normal Australian. Doctors don’t actually do much for anyone.

    “By the time you’re spending 16% of GDP, every extra pound (or dollar) is spending on the worried well: unnecessary tests, over-prescription, etc.”

    And yet the US has better cancer outcomes. Every extra penny spent on health care produces a better outcome. Just not much of one. Doctors don’t actually do that much for people.

  5. “Managers complaining about having to get in bank workers at high costs due to high staff sickness levels.”

    The amusing thing about this is most bank workers are full and part time NHS staff doing extra work. They are so worried about NHS under funding that they demand a higher rate to do more work.

    Of course, you could argue it’s the agencies that enable this that are creaming off the money. Except that the biggest agency is NHS Professionals Limited, whose significant controller is “The Secretary Of State For Health”.

  6. “And yet the US has better cancer outcomes.”

    Am not an expert on this, but don’t differences in times when cancers are detected (eg differences in screening) change reported survival times and rates even in the absence of any health benefit? (Extreme case by way of example – an essentially untreatable cancer will seem to have a higher survival time if detected earlier. Or a growth that was never going to pose a threat to health will bump up survival rates if detected and removed.)

    So I’m never quite sure what to make of cancer statistics from different health systems.

    How well does life expectancy work as a very raw measure, provided we understand – as smfs says – that is about more than the health service and is affected by sanitation, health education, national diet and lifestyle? Even there, different countries seem to treat newborns differently – there seems to be some variation in what counts as a stillbirth, if I recall correctly. “Life expectancy at age one”, perhaps, maybe combined with a separate but very sceptical glance at infant mortality figures?

  7. You get a certain stripe of Americans congratulating me on the NHS, to which I usually reply that all of my jobs in the last two decades offer subsidised private health insurance and suggest they ask why 🙂

  8. Health outcomes measure effectiveness. (Financial) efficiency is what you get per how much you pay.

  9. MBE

    “there seems to be some variation in what counts as a stillbirth”

    Indeed. A large part of the ‘amazing Cuban healthcare’ is down to how long after a live birth do they still count subsequent mortality as a ‘stillbirth’. Three months, I believe.

    Germany pulls the same trick.

    It goes to show that, where the statistics of health outcomes are concerned, people are often, unwittingly, comparing apples with oranges.

  10. Nobody does it better with the resources?

    So all those people who campaigned and worked hard to set up hospices were kidding themselves?
    I go to my local hospice a few times a year (they run other clinics from the rooms), its a very nice place.

    Or how about GP surgeries, private these past couple of decades. I had to wait 3 days for an appointment a few weeks back, pretty rare to wait so long. Its like the bad old days when GPs were employed by the NHS.
    Commonly same day or next day appointments, the village surgery has around 12 doctors and we have another surgery (same owner) next village along linked to both receptions so if cannot get a quick appointment at one can get appointment at the other (another several doctors there).

    30 years ago when seeing an NHS GP I used to wait 3 or 4 days commonly.

  11. All comparisons seem at least a little arbitrary, % of GDP in particular.

    The fact is, the NHS does a great many things in a chronically inefficient way. Get some health care workers in a room in private, and they’ll tell you amazing stories.

    There seem to be two main drivers:

    1) Whiners are incentivised in budget discussions.
    2) Constant restructuring from the centre, and the imposition of pretend markets

  12. ‘Some of us might think that health outcomes is the measure of efficiency.’

    That is effectiveness. Effectiveness and efficiency -the two words are not interchangeable.

    Efficiency is maximum output for minimum input.

    Effectiveness can be achieved without efficiency. Twenty doctors and fifty nurses per patient would be very effective, but efficient?

    As a student of economics you should know that Mr W.

  13. Surely Spud is old enough to need some non urgent tinkering with his ageing body, something inconvenient but not life threatening ? Then get him onto a waiting list for non urgent investigations then non urgent intervention. Let him experience the glorious National Health Soviet up close, over weeks, then months, then years and see if he loses the will to live.

  14. The NHS is as efficient as it gets … When you hear the right wing say the NHS is inefficient, it isn’t.

    This is actually quite funny.

    Just about anyone inside the NHS will tell you that those statements are complete and utter bollocks.

    But what amuses me is that his wife (ex-wife?) is / was a GP… Didn’t they ever talk..:)

  15. PF: But what amuses me is that his wife (ex-wife?) is / was a GP… Didn’t they ever talk..:)

    I’m sure that they had plenty to disagree about profoundly which is why her time was declared to be up.

    This is the reason I imagine that his family outings to pinacles of efficiency in Bavaria and elsewhere do not include his erstwhile spouse.

  16. “This is the reason I imagine that his family outings to pinacles of efficiency in Bavaria and elsewhere do not include his erstwhile spouse.”

    Mrs M: I want to go somewhere sunny and relaxing
    Mr M: And I want to go to look at steam trains
    Mrs M: But we always do that
    Mr M: I offered Dachau a while ago
    Mrs M: It’s not exactly relaxing
    Mr M: Or you could have come to look at the waders feeding in the Wash.
    Mrs M: I fear we have drifted apart
    Mr M: Right thinking people tend to agree with me

  17. I’m probably doing the ex Mrs Murphy an injustice but I picture someone like Alan Partridge’s assistant, Lynn.

  18. Tweet from HarrisTax. Anyone know any more?

    Interesting that Tax Justice can’t afford the rich. Mind you who can. Perhaps they should ask Margaret Hodge’s offshore trustees to repeat their bailout of Tax Research.

  19. Ljh
    Indeed. I’d favour repeated prostate biopsies (anal route), without anaesthetic….Such fun!

  20. UK is touted as a “nation of animal lovers”

    Owners are happy to pay for private treatment for their pets and no huge campaign for a NVS.

    At the same time, we’re told people won’t pay for their own treatment.

    Doesn’t make sense – implies Mr & Mrs will pay for Fido to be treated, but would let their child die rather than pay for treatment.

  21. Andrew M:

    “The NHS is almost certainly more efficient than most other developed countries’ healthcare systems.”

    Not buying that. Percentage GDP spent on healthcare is an extremely crude measure. And nationalisation never works well.

    Moreover, in rural England, I find it takes me a week to see a GP, while I can see one in 3 hours in rural Spain – or 10 minutes in rural Greece. The Spaniard is better equipped than his UK equivalent; the Greek is as well equipped as a UK GP, but his buildings are crumbling.

  22. It vexes me as an engineer to see the term efficiency bandied around by people who seem not to understand it. Efficiency equals quantity of desired output over quantity of input; anyone trying to decouple efficiency from output is barking. So, to John B’s point, if you have zero effectiveness, you have zero efficiency and low effectiveness with gigapounds of input is a pretty good indicator of low efficiency.

    However, even as I type this I note the word desired before output. Most of the time engine noise is waste, not desired output, but some people detune an engine slightly because a certain roar is part of their desired output. To most sensible people, the desired output of a health system is summed up by health outcomes. If, however, the engine noise of committee meetings, employment for union members and political dividend from being seen to care about the national religion is your desired outcome then yes, it might be deemed efficient.

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