22 thoughts on “Reforming the NHS in one short column”
Chris
Yep, in the UK for various reasons those supporting nationalisation don’t like competition and tend to combine nationalism with monopoly because unions …
German GPs , Swedish schools show the example of state provision with market based competition. No idea if there is a decent source of such.
I did once long ago try and launch a study on looking at the competition or its various lower levels of substitution (benchmarking etc) as drivers of innovation but didn’t get very far.
Chris
sorry that should have been ‘drivers of innovation and productivity in the public sector’
Jim
How does competition between State owned hospitals improve outcomes if the State owned hospitals can’t go bust? If there is no consequences to being sh*t why would they improve?
Andrew Again
Anecdote, but it proves the point. I need a follow on CT scan. The NHS will send me an appointment time without caring about my schedule. In Singapore I would queue up at a scanning facility which publishes its schedule to doctors who can book me in the same day. I know this as I’ve done it. Results sent electronically to the doctor AND given to the patient as well, easing getting a second opinion. I can be done inside 24 hours as I can go back to the referring doctor who will have set up a time for me to come back knowing I’ll be back inside 24 hours. Treatment inside 36 hours if lucky but inside a week if not.
Here I got a call yesterday morning from registrar, I’m waiting for the scan appointment. I will then wait for a (different?) registrar to call me. Then I’ll wait to get booked in for treatment, again at a time convenient for the health service. For this “envy of the world” I am paying a fortune in tax and I’m paying for others to get the service for free as well.
Our economics service today put out a note saying UK NHS performance could account for a drop in GDP given the number of unhealthy workers.
Chris
@Jim – in some models (no idea about Singapore) state funded entities can go bust but even without that transparency and choice – especially if it leads to improved salaries in the better organisations – drives behaviours. More often the lower attainer gets ‘taken over’ by a better organisation to avoid the whole going bust idea.
bloke in spain
Prepare to have your UK bank accounts closed, Tim. You’ve just written high heresy. or is it blasphemy? Steve’d know about religions.
Tim Worstall
Yeah, it is going to upset damn near everyone. Markets without capitalism annoys the capitalists, reform of the NHS everyone else. No wonder no one sends me those porpaganda cheques everyone else seems to get.
ZT
The USA health care system works very well- IF YOU HAVE ENOUGH INSURANCE. I too can get same-day CRT and MRI scans, with no out-of-pocket charges. But I pay about $12,000 per year in insurance premiums. Most people can’t (or don’t want to) pay this much.
They have completely overhauled the ‘NHS’ here over a couple of years and to my surprise it works brilliantly!
We used to have a State Health System which was utter shyte and a brilliant Private Healthcare System.
Now you register with a GP who gets a bunce for each patient seen. I can literally walk into the surgery at any time and be seen without an appointment and a minimal wait.
If the GP refers you or you need additional treatment you can go to any outlet you choose to receive it – including the previously private hospitals.
The whole thing is held together with a brilliant IT system which allows the doctor/specialist to see all your records on-line including X-Rays, MRI Scans, etc. The patient has access to it too.
There is obviously tax involved but patients also contribute.
As an example: I fractured my ankle on the 2nd of June. Was taken straight to the GP who charged €3 and referred me for X-Rays which were added to my computer record.
Was driven to the radiologist, walked (hobbled) straight in and had 3 X-Rays (€10). Was immediately given the disc and result (fracture) so called my GP who referred me to the Orthopaedic Surgeon.
Drove straight there, hobbled in and was put in a cast and given meds (€6).
Drove to the Pharmacy and picked up my prescription (all done on-line) which cost €3 (€1 for each item).
The whole thing was under two hours…
I’m not sure if it is sustainable but it is excellent and doesn’t cost 45% of Government spending…
Jim
NHS hospitals are never going to compete with anyone. They’ll just go on being same the pay and pension for their employees and f*ck the patient machines as they are today. All safe in the knowledge no-one can be sacked or made redundant, no-one can have their pay reduced, and if they face a shortfall in revenue because they’ve pissed off enough people in their locality they’ll just get bailed out by the taxpayer, again. Not least because the unions would never agree to splitting the NHS up into separate entities for pay and conditions purposes.
So you just get another ‘reform’ of the NHS that costs a fortune, and achieves nothing.
If you’re going to do anything, give people the cost of NHS treatment to add to their own money to spend in the private sector. Need a hip replacement, go private and the NHS has to pay whatever a hip op costs them towards the cost. Get as many people as possible used to the idea of a) going private and b) paying for and managing their own care. Then when 50%+ of people have done this, you might just be able to reform the NHS a bit, because you’ll have fatally weakened its hold on people’s psyches.
“the same DC Thompson papers …”: I don’t know whether you are referring to The Beano or The Dandy.
philip
Those neutron bombs which were supposed to vaporise everyone but leave the buildings standing. Did any test get done to see if it worked in real life?
I say, give it a go.
bloke in spain
Jim’s right. The core purpose of the NHS is to provide an income for those employed by it. Healthcare is an accidental by-product. It would probably be cheaper in the long run to just continue paying NHS staff. And then pay for a separate private health system. At least that would limit the cost of the NHS to what it is now plus inflation. You’d remove the incentive for it to grow. Or, at least, you’d remove the pressure to continually spend more in real terms for a declining service.
I’m fascinated to know how Cyprus managed their change. It require death squads? I can’t imagine anything else would incentivise change in the NHS.
Some of my best friends
Could there be a reason why Singapore does this best, other than the genius of its politicians? Could it be that having a large non-resident working population which goes away when it gets old improves the economics?
The NHS is desperately in need of admin which works. But if you want realistic comparisons, looks at somewhat similar countries.
Paul, Somerset
The NHS does have one big incentive – to grow the waiting lists. That way the NHS gets more money. The last thing you’d want to do if you worked for the NHS is cure patients. If you did too much of that, the waiting lists would shrink and the taxpayer wouldn’t hand over so much money.
I’m fascinated to know how Cyprus managed their change. It require death squads? I can’t imagine anything else would incentivise change in the NHS.
They announced it, put the IT in place and flicked the switch!
Expats like me who were paying for Private Health Insurance and enjoying excellent care and short waiting times got to cancel their policies and save €€€€€€€€€s…
The general public got to stop queuing at the General Hospitals and use the Private Hospitals and consultants instead.
It is quite incredible what they have managed to do to be honest.
Ljh
Most NHS staff see themselves as ministering angels not servants of the people. Any reform requires that their income be directly dependent on how much service they provide not how diverse and smug they are..
MC
@Some of my best friends – Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%).
Jim
“Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%).”
I bet they aren’t as unhealthy as the UK is. How many land whales do you see zooming about on mobility scooters?
Perhaps we should ban mobility scooters. Then there might be an incentive for those on the edge of needing one to lose weight and improve their health rather than continue sitting on their arse and stuffing their faces.
Some of my best friends
” Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%)”
That’s the proportion of citizens over 65. The “non-resident” population is excluded from those statistics. So Singapore is entirely dissimilar.
MC
I bet they aren’t as unhealthy as the UK
Probably not, but that wasn’t the point being made. You might also argue that Singapore isn’t an appallingly-run dump, so should not be compared with the UK.
Incidentally, non-Chinese Singaporeans tend to be as porky as Brits.
Of course, the suggestion that the NHS is shit because British people are fat is entirely specious. Just another attempt to shift blame away from the useless cunts running it. Being fat is indeed bad, for fat people. The idea that they are swallowing up (boom boom) cash that would otherwise be used to make the NHS run like clockwork is bollocks on stilts.
Addolff
MC, indeed, and the tossers also grizzle about the costs to our NHS of alkies and smokers, conveniently ignoring the fact that alkies and smokers contribute circa £24 Bn a year in taxes, technically covering the costs of treating ALL cancer patients, ALL diabetics and ALL of said fatties.
Yep, in the UK for various reasons those supporting nationalisation don’t like competition and tend to combine nationalism with monopoly because unions …
German GPs , Swedish schools show the example of state provision with market based competition. No idea if there is a decent source of such.
I did once long ago try and launch a study on looking at the competition or its various lower levels of substitution (benchmarking etc) as drivers of innovation but didn’t get very far.
sorry that should have been ‘drivers of innovation and productivity in the public sector’
How does competition between State owned hospitals improve outcomes if the State owned hospitals can’t go bust? If there is no consequences to being sh*t why would they improve?
Anecdote, but it proves the point. I need a follow on CT scan. The NHS will send me an appointment time without caring about my schedule. In Singapore I would queue up at a scanning facility which publishes its schedule to doctors who can book me in the same day. I know this as I’ve done it. Results sent electronically to the doctor AND given to the patient as well, easing getting a second opinion. I can be done inside 24 hours as I can go back to the referring doctor who will have set up a time for me to come back knowing I’ll be back inside 24 hours. Treatment inside 36 hours if lucky but inside a week if not.
Here I got a call yesterday morning from registrar, I’m waiting for the scan appointment. I will then wait for a (different?) registrar to call me. Then I’ll wait to get booked in for treatment, again at a time convenient for the health service. For this “envy of the world” I am paying a fortune in tax and I’m paying for others to get the service for free as well.
Our economics service today put out a note saying UK NHS performance could account for a drop in GDP given the number of unhealthy workers.
@Jim – in some models (no idea about Singapore) state funded entities can go bust but even without that transparency and choice – especially if it leads to improved salaries in the better organisations – drives behaviours. More often the lower attainer gets ‘taken over’ by a better organisation to avoid the whole going bust idea.
Prepare to have your UK bank accounts closed, Tim. You’ve just written high heresy. or is it blasphemy? Steve’d know about religions.
Yeah, it is going to upset damn near everyone. Markets without capitalism annoys the capitalists, reform of the NHS everyone else. No wonder no one sends me those porpaganda cheques everyone else seems to get.
The USA health care system works very well- IF YOU HAVE ENOUGH INSURANCE. I too can get same-day CRT and MRI scans, with no out-of-pocket charges. But I pay about $12,000 per year in insurance premiums. Most people can’t (or don’t want to) pay this much.
They have completely overhauled the ‘NHS’ here over a couple of years and to my surprise it works brilliantly!
We used to have a State Health System which was utter shyte and a brilliant Private Healthcare System.
Now you register with a GP who gets a bunce for each patient seen. I can literally walk into the surgery at any time and be seen without an appointment and a minimal wait.
If the GP refers you or you need additional treatment you can go to any outlet you choose to receive it – including the previously private hospitals.
The whole thing is held together with a brilliant IT system which allows the doctor/specialist to see all your records on-line including X-Rays, MRI Scans, etc. The patient has access to it too.
There is obviously tax involved but patients also contribute.
As an example: I fractured my ankle on the 2nd of June. Was taken straight to the GP who charged €3 and referred me for X-Rays which were added to my computer record.
Was driven to the radiologist, walked (hobbled) straight in and had 3 X-Rays (€10). Was immediately given the disc and result (fracture) so called my GP who referred me to the Orthopaedic Surgeon.
Drove straight there, hobbled in and was put in a cast and given meds (€6).
Drove to the Pharmacy and picked up my prescription (all done on-line) which cost €3 (€1 for each item).
The whole thing was under two hours…
I’m not sure if it is sustainable but it is excellent and doesn’t cost 45% of Government spending…
NHS hospitals are never going to compete with anyone. They’ll just go on being same the pay and pension for their employees and f*ck the patient machines as they are today. All safe in the knowledge no-one can be sacked or made redundant, no-one can have their pay reduced, and if they face a shortfall in revenue because they’ve pissed off enough people in their locality they’ll just get bailed out by the taxpayer, again. Not least because the unions would never agree to splitting the NHS up into separate entities for pay and conditions purposes.
So you just get another ‘reform’ of the NHS that costs a fortune, and achieves nothing.
If you’re going to do anything, give people the cost of NHS treatment to add to their own money to spend in the private sector. Need a hip replacement, go private and the NHS has to pay whatever a hip op costs them towards the cost. Get as many people as possible used to the idea of a) going private and b) paying for and managing their own care. Then when 50%+ of people have done this, you might just be able to reform the NHS a bit, because you’ll have fatally weakened its hold on people’s psyches.
Even the the war criminal has worked this out.
https://www.telegraph.co.uk/news/2023/07/05/nhs-reforms-patients-pay-speed-up-access-tony-blair/
“the same DC Thompson papers …”: I don’t know whether you are referring to The Beano or The Dandy.
Those neutron bombs which were supposed to vaporise everyone but leave the buildings standing. Did any test get done to see if it worked in real life?
I say, give it a go.
Jim’s right. The core purpose of the NHS is to provide an income for those employed by it. Healthcare is an accidental by-product. It would probably be cheaper in the long run to just continue paying NHS staff. And then pay for a separate private health system. At least that would limit the cost of the NHS to what it is now plus inflation. You’d remove the incentive for it to grow. Or, at least, you’d remove the pressure to continually spend more in real terms for a declining service.
I’m fascinated to know how Cyprus managed their change. It require death squads? I can’t imagine anything else would incentivise change in the NHS.
Could there be a reason why Singapore does this best, other than the genius of its politicians? Could it be that having a large non-resident working population which goes away when it gets old improves the economics?
The NHS is desperately in need of admin which works. But if you want realistic comparisons, looks at somewhat similar countries.
The NHS does have one big incentive – to grow the waiting lists. That way the NHS gets more money. The last thing you’d want to do if you worked for the NHS is cure patients. If you did too much of that, the waiting lists would shrink and the taxpayer wouldn’t hand over so much money.
I’m fascinated to know how Cyprus managed their change. It require death squads? I can’t imagine anything else would incentivise change in the NHS.
They announced it, put the IT in place and flicked the switch!
Expats like me who were paying for Private Health Insurance and enjoying excellent care and short waiting times got to cancel their policies and save €€€€€€€€€s…
The general public got to stop queuing at the General Hospitals and use the Private Hospitals and consultants instead.
It is quite incredible what they have managed to do to be honest.
Most NHS staff see themselves as ministering angels not servants of the people. Any reform requires that their income be directly dependent on how much service they provide not how diverse and smug they are..
@Some of my best friends – Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%).
“Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%).”
I bet they aren’t as unhealthy as the UK is. How many land whales do you see zooming about on mobility scooters?
Perhaps we should ban mobility scooters. Then there might be an incentive for those on the edge of needing one to lose weight and improve their health rather than continue sitting on their arse and stuffing their faces.
” Singapore is entirely similar in terms of the age of the population. The proportion of over 65s there (18.4% of the population) is almost exactly the same as in the UK (18.6%)”
That’s the proportion of citizens over 65. The “non-resident” population is excluded from those statistics. So Singapore is entirely dissimilar.
I bet they aren’t as unhealthy as the UK
Probably not, but that wasn’t the point being made. You might also argue that Singapore isn’t an appallingly-run dump, so should not be compared with the UK.
Incidentally, non-Chinese Singaporeans tend to be as porky as Brits.
Of course, the suggestion that the NHS is shit because British people are fat is entirely specious. Just another attempt to shift blame away from the useless cunts running it. Being fat is indeed bad, for fat people. The idea that they are swallowing up (boom boom) cash that would otherwise be used to make the NHS run like clockwork is bollocks on stilts.
MC, indeed, and the tossers also grizzle about the costs to our NHS of alkies and smokers, conveniently ignoring the fact that alkies and smokers contribute circa £24 Bn a year in taxes, technically covering the costs of treating ALL cancer patients, ALL diabetics and ALL of said fatties.