General Chat

Hardly a day passes that we do not read of some crisis in the NHS, the need for the NHS to save money, and services such as A&E units and Walk In Centres being threatened with closure or downsizing.

Today I read a report that private hospitals have been put on standby - by the Prime Minister David Cameron and the Health Secretary Jeremy Hunt, to provide thousands of beds and operations in the event of the NHS being unable to cope with an increased demand over the coming winter months.

So we cut services to save money, but if needed, we will pay money out to private hospitals for them to fill the gap left by the cuts that were made to save money - am I missing something here :-S

Only having to pay for something if and when you actually need it during the Winter months as opposed to paying for something all year round whether you need it or not sounds quite a sensible idea to me.

In an ideal world it would be nice if the NHS and other worthwhile projects could be fully funded to provide for every eventuality but that is unlikely ever to happen. Any government has only 2 ways to to raise money, taxation or borrowing. Borrowed money has to be repaid (With interest) and the current government is trying reduce the already excessive National Debt and to take the lower paid out of taxation all together. Nobody is volunteering to pay more tax so sometimes difficult decisions have to be taken especially when costs are rising and tax revenues are falling.

Unfortunately this is England not Utopia.

This national debt thing is a fallacy and is being used to support political agendas far removed from deficit reduction.

The "national debt" was first created, along with the Bank of England, as an act of legerdemain which allowed the UK government to finance ( and win ) the Napeleonic wars. At that time France had a population and an ecoomy far larger than that of the UK.

There was not the faintest chance of the debt being paid of at par though Treasury bonds such as Consoles were popular as they paid a steady 4%. Redemptions were a fraction of the face value.

In a like manner most of the Anglo Saxon governments have gone on merrily borrowing into a sinking fund ever since in order to finance whatever project was in hand be it battleships and aircraft carriers ( 1913, 2013 ) or social projects.

Controlled borrowing is an essential lever of financial governance which the Osbourne part of the coalition fails to understand as it refuses to accept Keynesian economics. The results are all around us.

The emasculation of the NHS has nothing to do with government borrowing and deficits but a lot to do with the gradual conversion of it into something that can be rolled into American health care providers such as Baxter and insurance companies. If not why are these companies contributing large sums to Tory funds ?

I am not an economist or a political historian so I bow to your knowledge on these subjects which exceeds my own.

I and possibly George OSBORNE, who after all read Modern History not Economics whilst at Oxford, obviously think somewhat differently from yourself. Speaking purely for myself I was taught to live within my means, not to borrow unless completely unavoidable. If borrowing (E.G. a mortgage) was unavoidable, to repay the loan at the earliest opportunity thus reducing its overall cost. By spending only what I could afford to spend may have meant that some of the things that I would have liked to acquire have remained on the shelf or in the showroom, to compensate I have never lost any sleep over debt.

Where George Osborne acquired his knowledge of economics I am not sure but since he has been either Shadow Chancellor or Chancellor of the Exchequer for the past 8 years I assume that he has by now at least got an idea of the basics of the subject.

Correct me if I am wrong but have not Greece and Spain got economies in even greater degrees of difficulty than that of the UK economy. Have not those 2 countries been obliged to go to the money masters in the EU to seek a loan to stave off complete economic collapse. I believe that their applications for a loan were successful but the loans came with strings attached. I cannot recall exactly what those strings were but I certainly do not remember hearing that the governments of Greece and Spain being told to apply Keynesian economics but I do recall them being told to make cuts to government expenditure .

In any case does Keynesian economics not advocate a mixed economy, predominantly private sector, but with a role for government intervention during recessions. Are those who are currently saying that the UK is no longer in recession telling the truth, deliberately lying or just making it up to get on the Tv?

The basic problem for Greece, Spain and the PIGS has been to enter into a very poorly constructed currency union. Italy has the strongest economy in Europe which is being destroyed by the €uro. Rome is on the edge of pulling out.

No amount of deficit reduction etc etc will dig them out of the hole except either (a) to leave the currency union or (b) to force Germany into accepting the mutualisation of debt. Neither (a) or (b) are short term possibilities and so some kind of slow motion wreck is pretty well inevitable. Google my mate Ambrose Pritchard Evans for more about this - he has a regular column in the Telegraph.

The idea that state economics should be run on the same lines as a thrifty German hausefrau is both naive and dangerous. It is also plain wrong.

A state which always spends 6d in the pound less than it raises in taxes is heading for deflation and ruin. Look under the carpet at Germany - there is a nasty crawly mess under the flagstones of insolvent regional banks, an insolvent mittelstand and a first rate energy crisis amongst other problems. I doubt if Micawber economics has any room for the creation of trillions of govt debt which kept the UK from tanking during the recent financial meltdown for instance.

Osbourne is in the grip of a manic belief in Say's Law. Nothing can change that except losing the next election which is inevitable. There are many signs that the the govt is looking to lock the UK into long term deals which will be very hard for a Labour govt to unpick e,g, selling off the only profitable railway ( the East Coast main line ) , the evil nuclear power deal with EDF and very possibly fracking deals and more free schools. They have something radical hatching for NHS finance too though whether it can hatch between now and Jun 2015 is uncertain. There is already quite enough trouble with IDS' alienware.

Try this as a basic reference for monetary policy by Paul Einzig:
http://books.google.co.uk/books/about/Monetary_Policy.html?id=PESTnQEACAAJ&redir_esc=y

No, Osbourne hasn't read it but every senior number cruncher at Gt George St and the BofE has in their undergraduate days.They are running around like mad March hares.

Mark Carney has very different ideas about deficit finance to those of Geo Osbourne. There will be a crunch between now and the next election when the rather resistable force of Osbourne's housing bubble runs into the immovable object of BofE interest rate rises. Ouch.

Here is a handy financial gadget
http://www.check.co.uk/hp-12c-financial-programmable-calculator.html?gclid=CK3N7r3g3LoCFfMdtAod7mYASg
I have a real one but there is a FREE emulation app for Android.

good luck

Back to the NHS and how we got to where we are today - Well you had the hospitals, you had the matrons responsible for nurses and auxiliary staff, you had the senior consultants each responsible for their area of expertise and you had the hospital administrator responsible for the day to day running of things except those areas that were the responsibility of the matron or senior consultants - you did not have countless numbers of individuals running round with clipboards under their arms trying to look busy.

That was until Ernest Roy Griffiths (later to become Sir Ernest Roy Griffiths) came on the scene when he was asked in 1983 by Margaret Thatcher and Norman Fowler her Secretary of State for Social Services, to produce a report on the management of the NHS. At that time he was a director and deputy chairman of the supermarket chain Sainsbury's, he went on to become Deputy Chairman of the NHS Management Board and also an adviser to the government on the NHS, for his services to the NHS he received a knighthood in 1985

The report he published led to Margaret Thatcher introducing what became known as "the internal market" into the NHS, at the time some suggested the NHS would now be run like a supermarket, this was because he allegedly joked that - it took a grocer to teach a grocer's daughter the difference between price and cost.

The introduction of the internal market in the NHS changed the priority from meeting the needs of patient to making hospitals more cost effective and productive by making trusts compete with each other for patients. It is worth noting that admin costs in the NHS in 1979 were about 6% of their overall budget and after the introduction of the internal market they doubled to around 12% of their overall budget.

Margaret Thatcher resigned in 1990 and was succeeded by John Major, he to was a supporter of the internal market and continued with his predecessor's reforms, albeit at a slightly slower pace, due to the fear of losing votes in the forthcoming general election. He won the 1991 general election and the changes to the NHS once again gathered pace.

In 1997 John Major lost the general election and New Labour swept into power and Tony Blair became Prime Minister dashing any conservative ideological dreams of privatising the NHS.

New Labour under Tony Blair introduced a controversial 10 year plan to re-organise the NHS, more nurses, more doctors, more hospitals using the controversial PFI funding, NHS Trusts, and despite his earlier opposition to private companies being involved in the NHS, there were many provisions in his 10 year plan to allow private companies to get involved.

After interference by 5 prime Ministers and some 13 Secretary of States for Health, over a period of 30 years, each with their own agenda of reforms, is it any wonder how the NHS is facing the crises it faces today.

In my opinion, Margaret Thatcher, John Major, Tony Blair, Gordon Brown, and David Cameron - have all played a role in bringing about the crises in the NHS, and all they can say is, it's not our fault for where the NHS finds itself today - it's all their fault, they should all hang their heads in shame.

At some point in time I do not know when, politicians have to revisit the original 1948 principles of the NHS and use those to build a cross party consensus to produce an NHS, free at the point of contact, which can provide treatment for all UK citizens who have a genuine medical condition.

I and others have just spent about 10 minutes driving round a multi-storey Hospital car park hoping to be able to park, all to no avail because there isn't enough spaces, it was my day off and thought I would have my hearing aid fixed, instead I have to take time off work for which I don't get paid and set out at silly o'clock (again) tomorrow in the hope of getting a parking space.
This is not the first time it has happened.
But as long as the " Managers" get their bonuses.............

The NHS back in 1979 was a very simplistic organisation run as OFITG says by a hierarchy of sisters, matrons and senior doctors who had graduated to the title of plain "Mr.".

All well and good but the delivery was also simplistic with far too many ancient buildings, nurses still largely thinking along Florence Nightingale lines and doctors practising medicine as a family fiefdom. The last thing anybody worried about was the delivery of modern let alone state of the art health care for the people paying for it, whether they wanted the NHS or not.

And so the NHS got the shake up needed, a lot more professionalism, a lot more money and overall the UK found itself with quite a good health service

Like a lot of nice-to-have things a quite good health service costs lots of money, the more so for a continuously growing and aging population which refuses to keep fit or abandon such things as smoking, getting wrecked at the weekend, junk food and sugar.

Up until the crash the NHS was just about squaring the circle. Now it has no chance - even if Lansley's empire wanted to expand spending it cannot.

Returning the NHS to imagined halcyon days of matron in charge and amateur management is not going to happen.

The most basic reason of all why the NHS is coming apart at the edges is that it exists. Nowhere else in the world is there any attempt to run such a large organisation as a homogenous entity. It cannot be done.

Sure there are sticking plaster attempts - internal market, trusts and now doctors commissioning units ... No matter it is just a different way of looking at the same camel.

Somehow it will have to be broken up into more manageable units. There are several ways this can be done and are being debated right now behind tightly closed doors.

Another basic problem is the financial model which may have been fine in 1948 but no longer works. The present free-at-the-point-of-use system will have to be replaced by an insurance based system as anywhere else in the world. If not the choice will between a fading NHS increasingly abandoned by the better off or costs that would sink any government budget.

The other root problem of the NHS is political. There is no particular reason why the state in providing health care, education and so on should also own the facilities used and employ the workforce. That it chooses to do so is a throwback to Victorian public works programs and socialism as expressed in post ww2 Britain.

Like most things that need fixing the original architects are best placed to deliver a changed health service for a very much changed country.

Sorry but I have to say this and it may upset some but it is my opinion.
The clue is in the name NATIONAL HEALTH SERVICE. Not for cosmetic surgery, IVF or foreigners coming because it is free. It is for people of this nation who need life saving surgery and medication to keep or stay healthy.

Sorry Zzzzz but the NHS is being privatised already at a rate of knots.
PIck up this on BBC Radio i|Player

BBC R4 8pm 12 Nov 2013 File On 4 A Healthy Market

Dreadful.

It's about time the private hospitals help the NHS - and they shouldn't get a 'bonus' for doing it - it should be considered a form of compensation.

People get private health insurance - that runs out, or the private hospital botches a job - and the NHS has to take over :-|
In the process, genuine NHS patients are pushed further back on the waiting list..

For people that pay for private health insurance it is good that they have the benefit of being seen earlier by consultants etc. But ,and it is a big but, many of these consultants are already employed by the NHS and I think that it is unfair that their private patients get priority over others when it comes to treatment.

Many of my immediate family have these insurances and for non-emergency situations they are excellent.

For emergency treatment I do not think there is anything that can surpass the NHS despite all the bad press it gets.

Indeed Joeva, I worked at a private hospital in the TSSU department, the surgeons etc considered it overtime to work there and one of them was looking after my brother in an NHS hospital.
I do feel very strongly that cosmetic surgery, IVF etc should not be done on the NHS as it is not life threatening, beds would be available and if so those that needed it stand more chance of getting it, others should go private, it would also sort out how badly they " needed" the surgery.

I agree that the NHS spends considerable amounts of money providing treatments for issues which are not medical conditions that threaten peoples ability to lead a normal healthy life and it was never designed to provide these.

I also think that a considerable amount of money is wasted on treating self inflicted problems from boozy nights out, the NHS is not there to provide a comfortable bed for someone to sober up. The cost to the NHS of treating those who cannot hold their drink is astronomical - especially at weekends, whatever happened to the old fashioned charge of drunk and disorderly where you spent the night in a police cell.

Hardly a new story, this has been happening for donkeys years. But now it is a political story to shock our Middle Englanders again.