Willy, there’s a solution here

Last Thursday, my wife was readmitted to hospital nearly two years after her first admission for treatment for acute lymphoblastic leukemia. She is very ill, but the nursing, always humane and in sufficient numbers two years ago, is reduced to a heroic but hard-pressed minimum. She has been left untended for hours at a stretch, reduced to tearful desperation at her neglect. The NHS, allegedly a “protected” public service, is beginning to show the signs of five years of real spending cumulatively not matching the growth of health need. Between 2010 and 2015, health spending grew at the slowest (0.7% a year) over a five-year period since the NHS’s foundation. As the Health Foundation observed last week, continuation of these trends is impossible: health spending must rise, funded if necessary by raising the standard rate of income tax.

The first is the overall economic point. Something that “requires” an ever growing budget in real terms, one that requires that ever growing budget to increase faster than the size of the economy itself, cannot be allowed to continue to do so. For if we do let it run on then it will swallow the entire economy at some future point. We must therefore change the way that we organise said activity. In order to raise productivity: thus we can continue to increase the amount of the good and or service that is offered while not having to increase the resources devoted to doing so.

And the only way we’ve really got of improving productivity is the use of markets. No, not the full blown American health care system, just the use of providers competing in markets, with government financing. And we do even know that this works. NHS England has had some of this for a decade or more, NHS Wales and NHS Scotland have not. And NHS England has been getting more productive more quickly than NHS Wales and or NHS Scotland. We do actually know that this works.

Good, so that’s what we must do then.

And as to the personal, yes of course it is tragic for you and your wife. And yet the two of you are multimillionaires from that buy to let empire. And further you alone are making of the order of £200k a a year (Master of an Oxbridge college, main columnist in a national newspaper? Book sales? Yup, you are). And yet you are calling that people on the minimum wage should pay more income tax in order to care for your wife in her hour of need?

Umm, no, sorry , not buying it.

You dip into your savings and hire a nursing assistant. That’s what you’re complaining about, not nursing itself, but basic care and attention. And your wife doesn’t need that at all hours of the day so the hire can help out with the other patients at times as well perhaps. You know, given that you’re one of the noblesse of our modern age, how about showing some of that oblige?

One more thing:

Equally, there was no point in holding the 40% stake in Eurostar, forecast to generate more than £700m in dividends over the next decade and a good payback for £3bn of public investment. Thus it was sold for £757m in March, the government concerned to get the sale through before the general election. You could only proclaim a £2.25bn loss on the public balance sheet and the surrender of £700m of dividends as a “fantastic deal for UK taxpayers”, as Osborne did, if you see zero value in public activity.

Or possibly if you understand the concept of discounting to net present value……

26 thoughts on “Willy, there’s a solution here”

  1. The NHS, allegedly a “protected” public service, is beginning to show the signs of five years of real spending cumulatively not matching the growth of health need.

    Has it ever? Did it happen in that mysterious period before “five years ago”? Can it ever?

  2. Will Hutton and his wife can go fuck themselves. Do they honestly think that in 2 years, with inflation-busting rises in NHS spending that this was the result, rather than now finding that they once went into a well-managed bit and are now finding themselves in a shittily-managed bit?

    The problem with the NHS is always that no-one fixes the shittily-managed bits of it. There’s some good bits, but if I had to put one of my parents into an NHS hospital, I’d be trying to check they were OK as often as possible.

  3. Good piece Tim–

    Apart from:

    “And the only way we’ve really got of improving productivity is the use of markets. No, not the full blown American health care system, just the use of providers competing in markets, with government financing.”

    The US system in no way even resembles a free market. It is rotten with state meddling. Why then pander to deceitful leftist biases by talking as if it is?

    Is this –like the climate change nonsense–another of your blind spots?

  4. No, I’m aware of the failures of the US system. Just didn’t want to go into them here. Singapore is probably the best model.

  5. I was having this discussion with my Mother just the other day. We came to the conclusion that faith in ‘the NHS’ is just that, faith. No amount of fact, or failure of its standards or even it causing mass deaths seems shake the faith, not among the committed anyway. We also concluded that there was no way of reforming the NHS until it has collapsed to such a degree that even the most fanatical NHS adherents begin to question their faith.

    This article is interesting, because one of the ‘great and the good’ has experienced the NHS in the raw, as experienced by the masses, and not liked what he has seen. Of course he’s drawn the wrong conclusions, but its the first step on his personal road to Damascus.

    Sadly thats all we can wait for – more death, misery and suffering caused by the NHS before we are ‘allowed’ to reform it into something suitable for a first world economy. And as ever it the Left that is the cause of this evil, as socialism ever is.

  6. What makes me laugh is the concept that the mighty NHS can be plunged into ruin since May.

    The socialist hand has been on the tiller of the NHS since its inception more often than not.

    The fact that it is shit is really down to that.

    And as for there being too many patients…

    Going to St Thomas’ in Westminster every day for a month is a bit of an eye opener. Sitting in Bloods one day I realised that none of my fellow patients were talking English. Not one of the thirty odd other people there.

    And more than one cab driver taking me there from Charing Cross regaled me with tales of people grasping tatty bits of paper on which was written “Doctor So and so, St Thomas Hospital”. These were used because verbal instructions were not achievable.

  7. It is the National and not international bit of the NHS that is giving the problem.
    If the borders of the country are not secure and we do not know how many people is in the country, how can we draw up a realistic budget for the NHS? That is mission impossible.
    The effect of serving all comers means that we need a magic porridge pot to fund the NHS.

  8. I like Jim’s point about someone meeting the real NHS for the first time. I was a fan of the NHS too until I worked in the procurement part of it for a year. I ran frameworks purchasing specialist bits and pieces for PCT’s. I trimmed 12m quid off their spend for the next 5 years, and the management were more worried that I’d pissed off suppliers by asking them to justify above inflation price rises than pleased I’d saved money.

    The problem isn’t the budget, it’s how it’s being used.

  9. “not the full blown American health care system”: the idea that the American system is “the use of markets” is as daft as anything written by that turd Hutton.

    Are the NHS and the American system are the alpha and omega of how not to do it.

  10. Funny how the buzzword “sustainable” never seems to be applied to government.

    The greenies hector us to consume less, but never hector the government to consume less.

  11. Much as I like the idea, I can’t see the NHS allowing scab labour private nursing assistants to sully their perfect producer capture environs.

  12. All that money and he still wont go private? “Fuck my wife… fuck the poor people who need the NHS… I’ll stick to my bullshit principles”

  13. Even if he hires one from exactly the same temp agency the hospital uses.

    It’s the principle of the thing, you see!

  14. Tim – an excellent piece. And you skewer Woolly Willy perfectly.

    John Miller
    And not only the patients. I once attended UCLH, after referral from my local consultant in Suffolk. The UCLH receptionist, whose English was barely comprehensible, asked me if Suffolk was in north London.

  15. Ted S – if there was an upvote for comments, I’d use it. Governments and Greens think that ‘sustainable’ is for other people.

  16. ” The Conservatives’ choice is driven by a refusal to see any merit in public activity: in their worldview, the point of life and the purpose of civilisation is to celebrate and protect the private individual, the private firm and private property. The state should be as small as possible.”

    When that happens please tell me and I’ll come home in a jiffy.

  17. Dongguan Zhang: it says a lot about Will that he says that as if it’s a bad thing. He just let’s it hang there as if it’s self evidently awful, and dares you to disagree.

  18. “until it has collapsed to such a degree that even the most fanatical NHS adherents begin to question their faith.”

    That won’t happen: the response will always be that it failed only because it never had enough funding, similar to “true communism/socialism has never been tried”.

  19. @Dongguan John

    Not a good idea to go private with ALL or other malignancy with complications. Private hospitals not usually set up with the right kit or rooms (e.g. +ve pressure isolation) or knowledge of protocols.

    When haematological malignancy patients get sick, they get sick very quickly and you want an experienced registrar seeing them very quickly with adequate ICU support.

  20. The NHS, allegedly a “protected” public service, is beginning to show the signs of five years of real spending cumulatively not matching the growth of health need.

    I’m actually quite astonished by this sentence. “TORY NHS CUTS!” is such an article of faith on the Left that it’s quite shocking to see one of them who’s looked at the actual figures and can’t bring himself to tell the usual lie. And of course it’s a right bugger for the impact of his writing. Can’t see anyone shouting “END REAL SPENDING CUMULATIVELEY NOT MATCHING THE GROWTH OF HEALTH NEED!” on a march any time soon.

    Between 2010 and 2015, health spending grew at the slowest (0.7% a year) over a five-year period since the NHS’s foundation.

    Now, that’s bollocks. TORY NHS CUTS are a lie, but NHS cuts aren’t. Callaghan cut the budget, didn’t he? Or is Hutton picking his five-year periods very carefully?

  21. I’ve been referring to it as the National “Health” “Service” for years. Recently tried to get treatment in London with my Northern Irish address and discovered I need to be putting the “National” bit in quotes too.

  22. “TORY NHS CUTS are a lie, but NHS cuts aren’t. Callaghan cut the budget, didn’t he? Or is Hutton picking his five-year periods very carefully?”

    Also incidentally agreeing that Mrs T obviously didn’t ‘cut the NHS’ either.

  23. I think Hutton should keep his wife out of it.

    I also think that if Singapore is the best model of what you want for the UK, what you want is unlikely to be a good idea. Because if Singapore’s approach could be made to work in a country more like the UK, it already would have been.

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