General Election 2015

simmo · Mar 10, 2015

Latest Tory Ad. Negative, but a great ad, in my opinion. It must sum up so many English people fears

http://www.theguardian.com/media/20...eeves-as-they-put-miliband-in-salmonds-pocket

Simster · Mar 10, 2015

Triggaaar said:
So what should they do instead?
(I don't disagree with your point)

Find a mechanism to incentivize increased funding? Also I'd like to see a cross-party steering committee implemented to address some of the issues and implement the agreed budget accordingly.

Like [MENTION=177]Brovion[/MENTION], I have anecdotal evidence of appalling management. My father was a self employed management trainer and was often asked to train NHS management. On one occasion, he was due to train 30 people over the course of the week. A grand total of SEVEN delegates turned up. When he queried this, the manager who organised it told him not to worry, he'd get his money - and as far as this manager was concerned, he had "delivered" on his target to train 30 people appropriately - regardless of the fact that 23 out of 30 delegates hadn't bothered turning up.

This sort of piss poor management costs the NHS a fortune. It's not really the fault of any party that the management in the NHS is so shockingly bad, but IMO it is the main reason that the NHS shouldn't be used as a political football. Some of the problems go far deeper than whether the Tories or Labour are in power and some cross-party co-operation wouldn't go amiss.

melias shoes · Mar 10, 2015

simmo said:
Latest Tory Ad. Negative, but a great ad, in my opinion. It must sum up so many English people fears

http://www.theguardian.com/media/20...eeves-as-they-put-miliband-in-salmonds-pocket

View attachment 63742

beorhthelm · Mar 10, 2015

Triggaaar said:
So what should they do instead?
(I don't disagree with your point)

two things - get to the root of problems and probably split up the NHS.

the former needs to be done carefully in such a way that doesn't just impose a massive cost of analysts itself. we know the problems arent strictly funding but how sub-systems interact and management. i.e. the apparent A&E crisis, which evidence suggest is caused largely by public perceptions of what A&E is for, as well as issues in GPs, social care, ambulance service, hospital care etc.

the latter is controversial, but NHS is already split between Scotland, Wales, NI and England, and at a lower level in the primary care organisations/trusts. under a national umbrella of guidance, i might make sense to split up horizontally along service lines, partially to allow better oversight and accountability and partially to allow better visibility of the interactions between services (which feeds back to the first point).

Herr Tubthumper · Mar 10, 2015

beorhthelm said:
two things - get to the root of problems and probably split up the NHS.

the former needs to be done carefully in such a way that doesn't just impose a massive cost of analysts itself. we know the problems arent strictly funding but how sub-systems interact and management. i.e. the apparent A&E crisis, which evidence suggest is caused largely by public perceptions of what A&E is for, as well as issues in GPs, social care, ambulance service, hospital care etc.

the latter is controversial, but NHS is already split between Scotland, Wales, NI and England, and at a lower level in the primary care organisations/trusts. under a national umbrella of guidance, i might make sense to split up horizontally along service lines, partially to allow better oversight and accountability and partially to allow better visibility of the interactions between services (which feeds back to the first point).

I was just thinking, it's about time the NHS had yet another reform. Here's an idea....why not just fix it once and for all?

Deleted member 22389 · Mar 10, 2015

Brovion said:
100% spot on. My wife works as an NHS nurse and has done since the mid-1980s so she's seen it all. The stories she can tell you about bureaucracy and administrative waste would make your hair curl. The Tories started the rot with their ridiculous 'internal markets' and Labour, despite having 13 years to put it right simply made things worse. Then they panicked under Brown and threw more money at it - which did nothing.

It's a bit like the England cricket team. The simplistic answer for the cricket is 'sack the manager'. The simplistic answer for the NHS is 'increase funding'. Both are far too simplistic and neither will work as they don't go to the core of the problem - the organisation. My wife says (and she's only semi-joking) that for every £100 of increased NHS expenditure that is announced only £1 will be spent on front line services and £99 on the delivery mechanism. Then for every £100 of cuts announced £99 are taken straight from front line services, because, after all, you've got to spend money on the re-organisation and the staff needed to implement the cuts.

Sadly I endorse your point that the NHS isn't safe with either party. So if some idiot knocks on your door and says they intend to save the NHS by increasing funding and stopping cuts - shut the door in the simpleton's face.

There is certainly a lot of paper work wastage. When my wife was pregnant we went to the free classes which by the way I would have been happy to pay for. Loads of photocopied sheets, booklets which could all be put in one book and distrbuted around the country. Loads of letters with appointments, sometimes with exactly the same information on them. Mid wife turning up when we where not even expecting her, due to mix ups. We certainly get a good service, but bloody hell don't we waste a lot money doing it.

Soulman · Mar 10, 2015

Brovion said:
100% spot on. My wife works as an NHS nurse and has done since the mid-1980s so she's seen it all. The stories she can tell you about bureaucracy and administrative waste would make your hair curl. The Tories started the rot with their ridiculous 'internal markets' and Labour, despite having 13 years to put it right simply made things worse. Then they panicked under Brown and threw more money at it - which did nothing.

It's a bit like the England cricket team. The simplistic answer for the cricket is 'sack the manager'. The simplistic answer for the NHS is 'increase funding'. Both are far too simplistic and neither will work as they don't go to the core of the problem - the organisation. My wife says (and she's only semi-joking) that for every £100 of increased NHS expenditure that is announced only £1 will be spent on front line services and £99 on the delivery mechanism. Then for every £100 of cuts announced £99 are taken straight from front line services, because, after all, you've got to spend money on the re-organisation and the staff needed to implement the cuts.

Sadly I endorse your point that the NHS isn't safe with either party. So if some idiot knocks on your door and says they intend to save the NHS by increasing funding and stopping cuts - shut the door in the simpleton's face.

Good post.

Herr Tubthumper · Mar 10, 2015

bashlsdir said:
There is certainly a lot of paper work wastage. When my wife was pregnant we went to the free classes which by the way I would have been happy to pay for. Loads of photocopied sheets, booklets which could all be put in one book and distrbuted around the country. Loads of letters with appointments, sometimes with exactly the same information on them. Mid wife turning up when we where not even expecting her, due to mix ups. We certainly get a good service, but bloody hell don't we waste a lot money doing it.

In the grand scheme of things a few extra pieces of paper is hardly a big financial deal is it?

Brovion · Mar 10, 2015

Herr Tubthumper said:
In the grand scheme of things a few extra pieces of paper is hardly a big financial deal is it?

It's what it represents. The duplication of paper is the duplication of effort. I wouldn't be at all surprised if there weren't two separate teams each doing exactly the same thing and unaware of the existence of the other. That's happened before as the result of a botched re-organisation,

EDIT: And don't get me started on when the Trusts, team names and/or logos change and they have to throw away a load of perfectly good uniforms and replace them with ones with the new branding.

Simster · Mar 10, 2015

Herr Tubthumper said:
In the grand scheme of things a few extra pieces of paper is hardly a big financial deal is it?

Are you ignoring the "Mid wife turning up when we where not even expecting her, due to mix ups"? That kind of shambles is endemic in the NHS, sadly.

Westdene Seagull · Mar 10, 2015

Herr Tubthumper said:
In the grand scheme of things a few extra pieces of paper is hardly a big financial deal is it?

It's the thin edge of the wedge though. Many of the public sector organisations are heavily beaurocratic and ineffiient - the NHS, local council, DWP and HMRC are some of the worst offenders.

beorhthelm · Mar 10, 2015

Herr Tubthumper said:
I was just thinking, it's about time the NHS had yet another reform. Here's an idea....why not just fix it once and for all?

i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

Simster · Mar 10, 2015

beorhthelm said:
i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

100% agree with this.

Brovion · Mar 10, 2015

beorhthelm said:
i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

That is exactly right. When the NHS was founded hospitals did little more than take out you appendix or deliver your baby. If your kidneys, liver or heart packed up - you died. If you got cancer - you died. Diseases like AIDS (and all the expensive treatments) didn't even exist. Plus there was full employment and most people worked in tough jobs and promptly keeled over a few years into retirement and probably didn't even get back in care and pensions what they'd paid in via NI. Yet even then the original model couldn't be sustained and amid a lot of recriminations prescription charges were bought in.

It needs someone with a bit of vision to plan where we go in the next 50 years.Using it as a political football doesn't help.

West Hoathly Seagull · Mar 10, 2015

beorhthelm said:
i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

Simster said:
100% agree with this.

I am wondering whether part of the problem is actually the "N" in NHS. The problem with tackling this is that the idea that you can have whatever you need done free at the point of delivery whether you're in Camborne or Carlilse, Newcastle or Newhaven is completely ingrained into the public psyche in this country. At university, I did an element of Welfare Studies as part of my Politics degree, which included the history of the NHS. Apparently before it was formed, there was a debate in the Labour Party as to whether the NHS would come under County Councils or Whitehall. Right-leaning Ministers such as Herbert Morrison and Stafford Cripps wanted the former, while Tony Benn and Nye Bevan on the Left insisted it should be a truly national service, and won out. Perhaps in the aftermath of the war this was a good thing, but is such a vast organisation appropriate to the 21st century? I despaired when Andrew Lansley carried out his top-down reorgansiation. Primary Care Trusts more or less mirrored top-level local authorities. I would have devolved PCTs in this way; a missed opportunity in my view. It will be interesting to see how George Osborne's experiment of devolving Health in Greater Manchester goes. It might be a model that works. "Postcode lottery", people will scream if such changes were brought in on a wider scale. I would counter that we are just about the only country in Europe that tries to organise health services on a national level. Herr Tubthumper can confirm this or contradict me, but I'm sure Health is run by the Lander in Germany, not the Federal Government. It might also force people to vote in County Council elections, rather than continuing with the dire 30% or whatever it is turnout.

Secondly, we need to ask ourselves what we can afford. Can we really afford to provide treatment free, or do we need to move to a social insurance system as on the Continent? In France, I think one is compelled to belong to a mutuelle, which both individual and employer contribute to and this pays back (most of) the cost of doctors' visits and operations. I think Germany and certainly the Nordic countries have a similar arrangement. Other than the UK, I think Spain is the only country with free healthcare at the point of delivery, but again it is delivered by the regions rather than the national government.

Of course, all the problems that other posters have mentioned still apply, but the two areas I have mentioned above are rarely discussed.

Herr Tubthumper · Mar 10, 2015

West Hoathly Seagull said:
I am wondering whether part of the problem is actually the "N" in NHS. The problem with tackling this is that the idea that you can have whatever you need done free at the point of delivery whether you're in Camborne or Carlilse, Newcastle or Newhaven is completely ingrained into the public psyche in this country. At university, I did an element of Welfare Studies as part of my Politics degree, which included the history of the NHS. Apparently before it was formed, there was a debate in the Labour Party as to whether the NHS would come under County Councils or Whitehall. Right-leaning Ministers such as Herbert Morrison and Stafford Cripps wanted the former, while Tony Benn and Nye Bevan on the Left insisted it should be a truly national service, and won out. Perhaps in the aftermath of the war this was a good thing, but is such a vast organisation appropriate to the 21st century? I despaired when Andrew Lansley carried out his top-down reorgansiation. Primary Care Trusts more or less mirrored top-level local authorities. I would have devolved PCTs in this way; a missed opportunity in my view. It will be interesting to see how George Osborne's experiment of devolving Health in Greater Manchester goes. It might be a model that works. "Postcode lottery", people will scream if such changes were brought in on a wider scale. I would counter that we are just about the only country in Europe that tries to organise health services on a national level. Herr Tubthumper can confirm this or contradict me, but I'm sure Health is run by the Lander in Germany, not the Federal Government. It might also force people to vote in County Council elections, rather than continuing with the dire 30% or whatever it is turnout.

Secondly, we need to ask ourselves what we can afford. Can we really afford to provide treatment free, or do we need to move to a social insurance system as on the Continent? In France, I think one is compelled to belong to a mutuelle, which both individual and employer contribute to and this pays back (most of) the cost of doctors' visits and operations. I think Germany and certainly the Nordic countries have a similar arrangement. Other than the UK, I think Spain is the only country with free healthcare at the point of delivery, but again it is delivered by the regions rather than the national government.

Of course, all the problems that other posters have mentioned still apply, but the two areas I have mentioned above are rarely discussed.

Good question. As I understand it everyone, in effect, has health insurance. Some is state provided and some private but both operate in a similar way as UK private health insurance ie you get ill and your insurance covers you for the care. The state insurance and any payments are dealt with at the lander level but I am pretty sure you can go anywhere in the country to get your care.

I think this is what happens anyway. I'll ask around to get a definitive answer.

Mileoakman · Mar 10, 2015

Secondly, we need to ask ourselves what we can afford. Can we really afford to provide treatment free, or do we need to move to a social insurance system

I thought thats what we had. Treatment isn't free, its paid for out of NI and other taxes

Brighton Mod · Mar 10, 2015

beorhthelm said:
i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

Totally correct in your view that the NHS should be de politicised, it serves no one any good for it to be used in a national debate when the difference in the political perspective is about giving or with holding finance from it. It will definately need to change and I feel that a seperate levy should be made on individuals and business to pay for it. Instead of our NI money being spread over many areas there needs to be a direct conduit from tax payer to the NHS, It is the envy of most of the world but it has to be paid for and if there was more transparency for the payments then we could see that this service was adequately funded. But keep the politicians away from it!!!!!

simmo · Mar 10, 2015

beorhthelm said:
i know, a fair point. but its struggling because its doing far more than originally designed 60 years ago and will not cope with the next 50 years. a complete overhaul, not simple reform, is the only way i see it will still be functional in a couple of generation's time. it would need cross party support and NHS be a de-politicised zone for it to happen.

Absolutely. There needs to be a serious discussion about the NHS that should cross all party political lines. So much has changed demographically since it's inception and now it is an incredible (financial) burden on the state. As the average age that people die (probably increased around c20 years since 1946) and costs of medicines etc will only go up this will only get more so making it really untenable going forward. You can just look at pie charts of all govt spending to see how each year more and more of the slice of the pie is taken for health.

I will make a suggestion, how about a very long term reduction of the mass populations reliance on the NHS. Let me elaborate, all those people that have already paid some of their salary e.g NI/Tax etc now can use the NHS "free" but people whom start paying NI/tax at a certain date (let us say for example 1st Jan 2016) now must pay a premium for a (non NHS) health care insurance policy out of their salary (but get a refund of any of their portion of the income tax that would have been used for the NHS)....over a long time those that pay for the health insurance policy (say 18 year olds now) will get older and those that rely on the NHS would naturally die off, thus decreasing the overall cost any future government would pay for it. I can see there are a huge number of issues with this that need ironing out (what about the unemployed, you would probably need to make it compulsory for working 18 year olds to purchase a policy, what about caveats in the private health care insurance etc) however, it would stop people coming from abroad and using the NHS (for free) without paying any UK NI/Tax prior to this. Please take it as an attempt at a "cross party" suggestion for a long term solution to funding for health care in our country (which truly is an elephant in the room that needs serious addressing). It is not necessary to tell me how great the NHS is and fall into party political rhetoric.

Brighton Mod · Mar 10, 2015

Mileoakman said:
Secondly, we need to ask ourselves what we can afford. Can we really afford to provide treatment free, or do we need to move to a social insurance system

I thought thats what we had. Treatment isn't free, its paid for out of NI and other taxes

I think the politically designed 'free at the point of delivery' is fantasctic and self serving of politicians. If this statement were true, then my flights abroad are free at the point of delivery, my seat at the Amex is free at the point of delivery as is any parcel that I receive at home as these have been paid for previously. The NHS is not free in any respect and continual reference by politicans to this needs to stop are it is deliberately inaccurate.

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