Can we have a constructive debate about the nearest thing we have to a national religion?

mart

James, you say Mr Hannan has "perpetuated the idea that there are only two options, the NHS or a US-style system."

Read his blog of 12 August. It's actually the system in Singapore that he refers to.

I doubt many in Britain know anything significant about how other developed countries design and provide health services.

Are there any studies comparing the various systems?

Without the facts we are not going to have any sort of informed debate.

Sally Chatterjee

I'm in full agreement with you James. It's odd that it's we're only allowed to praise the NHS and reform is something that scares people. On the other hand, seeing the level of debate in the US...

Mrs B

Exactly right. Dizzy has done an excellent post on this and the emotional response to the sacred cow that is the NHS - pointing out that it boils down to a stupid black and white discussion of "you either love the NHS or you're against it". Pathetic.

cuffleyburgers

I can't see how it would be controversial to say that whilst the principle of universal coverage has many merits, there are undoubtedly ways in which the UK system could be improved, and unnecessary cost and inefficiencies removed.

A lot of the work has I believe already been done eg by Derek Wanless, and it is to Brown's greta demerit (so no surprises there then) that having commissioned the report, as far as I know he failed to implement the recommendations.

Views of other better informed CHers plse.

I mean even Blair had some worthwhile ideas on improving the health service and was generally blocked by the then Chancellor (who, he?)

Rhoda Klapp

James, I don't always agree with you, but this time you are right.

I don't know why the NHS has to be frozen in time. Every option ought to be up for debate. I'd find the best system wherever it is (not the US, pre- or post-Obamacare) and copy it as closely as we can. I don't see why the NHS is so monolithic, nobody else at all seems to copy that. I don't know why it all has to be government-run and funded from non-hypothecated taxes.
And most of all I wish DC had the bottle to ask a few questions before throwing his support behind it.

David

"Finally, Hannan, by setting off this controversy, has hardened the Tory leadership’s resolve not to say anything remotely controversial about the NHS or think about reforming it in any way."

Another triumph for the Tory right then. Hannan's comments, particularly that the NHS is making us more ill, were hardly rational to start with, so he is to balme there.

There is just no semblance of anything apporaching a strategy from them, a recognition of Lord Hailsham's maxim that an ounce of pragmatism in power is worth an ton of ideology in opposition.

Richard

It is very depressing. If one so much as talks about the problems in the NHS in the UK they are rounded on as a heartless git, and if one suggests in the US that their insurance system is deeply flawed and those without insurance are cast aside one is a socialist.
This is how democracies die, when rational debate is no longer possible.

Verity

"instantly drowned out by emotional responses ...". Well, greedy and chippy responses anyway. Yards of ignorant, venomous verbiage about the United States - as though most of the complainers wouldn't pack up and move there on the double if suddenly offered a Green Card. I say this because surely they cannot really believe that the NHS is well run, and that it is not driven by chippiness, malice and greed.

I don't know why their empty little heads always float off to the US, when there is a system across the Channel, in France, that works very well, and is supported by tax. (Although the French system is running out of money and will inevitably have to start cutting services.)

Why is it, I wonder, that NI deductions cannot be directed to the healthcare provider of the payer's choice. And why is it, I wonder, that the NHS is so top heavy with administrators?

Nigel Bradshaw

The Tories, having looked at the Swedish experiment with "free" schools, should look at the way the Dutch health service is financed and organized.

Chris

No. We might have been able to if Hannan had kept his idiotic mouth shut.

Austin Barry

".. has hardened the Tory leadership’s resolve not to say anything remotely controversial about the NHS or think about reforming it in any way."

Or about the benefits culture or immigration or tax or education or housing or the BBC or Afghanistan or Iran etc. etc. etc.

Chuck Unsworth

Andy Burnham's references to 'Labour's NHS' are truly and deeply offensive. How does he feel about Labour's Recesssion, or Afghanistan, or Iraq, etc etc?

It's not 'Labour's' anything, is it? Or has 'Labour's Megalomania' reached the point of total ownership and domination of everything?

Chingford Man

Hannan is a free thinker, who, like Enoch before him, looks at things from first principles and follows through on his analysis. Being a prophet of the Right won't do his career any good, any more than it did Enoch's, given that politics is stuffed full of pygmies for whom original thought is anathema. (And, yes, I know that in his lifetime Enoch was pro-NHS. But the point about thinking the unthinkable still stands.)

No wonder people have so much contempt for Pretty Boy Burnham and his ilk or time-servers like Timothy Kirkhope.

The sad fact is that if you want complete freedom to argue something controversial, it is increasingly difficult to do so within the UK political system when the hacks are scared of any genuine debate.

We need leaders not followers. Good on you, Daniel.

Richard Simmons

Absolutely right.

It is depressing that Cameron and his team are not looking at the best examples in the world of universal state supported health care and bringing that best back home.

Instead we are stuck with this dreary 'NHS versus USA' debate - comparing two of the Western world's worst health care 'systems'.

Can't the Speccie do an analysis (look at France, Belgiium, Singapore and Australia for starters) and produce a constructive way forward?

Between them I am sure James, Peter and Fraser could produce something worthwhile and move this debate to where it ought to be.

Ian C

Hannan said the right thing about how an NHS would not be culturally suitable for the USA. But he played bad UK politics in denigrating the NHS explicitly.

He has previously made a very coherent case for alternatives to the way the NHS delivers healthcare in the UK - independent providers paid for by the state and voluntary top-up, per many continental countries - but he denigrated the 'holy of holies', so putting back his advancing reputation as someone who can express himself with clarity. He will recover, but he has not made life easier for either Cameron or himself in the meantime by not making the distinction between health delivery mechanisms and the principle of a ‘free at the point of delivery’ (but inevitably rationed) healthcare service.

He should follow up and make these distinctions clear. It is an opportunity to kick start the debate we all need and many want. Cameron is naturally scared of it at this time and can’t be seen to be initiating it in terms other than those he has used on Twitter. But the opportunity is presented by Obama’s inept attempts to reform the US system. It would be very easy to start by saying that the discussion is categorically not about whether the NHS has a future, because its principle of free at point of delivery has long been inviolable, unlike in the USA where he got clumsily sucked into the debate.

Moozer

Hannan was foolish to appear on Fox News. If he wants a credible, intelligent debate then surely there is some other outlet? I know Fox News adores him and they have probably raised his profile amongst the GOP one hundred fold. But appearing on such a station just cheapens his argument.

Steve.W

“One wonders whether we will ever be able to have a rational debate about the merits of the NHS”

So long as the Prime Minister is a twit the answer to that must be no.

35 words, so that's OK.

TrevorsDen

Hannan gained wide notoriety re his speech attacking Brown at the EU parliament and so Labour will relish attacking him.

But you are right Mr Forsyth - Hannan has only succeeded in polarising an argument which needs rational analysis. The NHS can do without even more politicising.
It shows him to be stupid not clever. One hopes he might learn but somehow I doubt it - all of a sudden I see a man who only likes the sound of his own voice.

I said at the time his attack on Brown was written up too big (it was an open goal after all) - now he has only succeeded in narrowing conservative options on the NHS.

Ed Hoskins BDS (London) MA (Cantab) RIBA

I posted this comment earlier in response to the NHS isn't free http://www.spectator.co.uk/coffeehouse/5261858/the-nhs-isnt-free.thtml

but I can see no harm in repeating it here

Why the health service works in France

It is of great sadness to me that political dogma manages to blank out any consideration that methods and experience from elsewhere could ever be applicable in the UK.

This is particularly so in the NHS, where the dogma that the government has to be directly responsible from taxation for the supply of health care have been inbuilt for so long. This combined with “free at the point of use” is particularly damaging. (What is even more amazing is the fact that so little in the NHS is actually free at the point of use, prescription charges, dental costs (if available at all on the NHS) and the endemic rationing, which itself translates into huge costs for the individual patient.)

So why are things so different here in France. These are my simple conclusions:

A. The system is run on an insurance basis based on income supported by the state but with no direct participation by the state. the insurers are themselves competitive amongst themselves. The system has state protection for the low paid, the chronically ill, pensioners, children, etc. Top up insurance can be purchased out-with the system to cover the balance not paid for within the system. The insurance organisation reports on all transactions and produces an annual account for each of its clients showing the premiums paid and the amounts disbursed on behalf of the insured so it is abundantly clear the actual costs of health services.

B. “Free at the point of use” in the UK is a fallacy and only encourages people to use UK medical services unnecessarily and to regard the access to such services as being as of right. The public perception of that “right” may even be one of the causes of violence towards hospital staff in the UK A+E departments.

C. Here the modest fee 20 payable to the GP, most of which reimbursed later, is a disincentive to time wasters and malingerers, even in country of hypochondriacs. It is amazing how effective the cash flow consequences of having to pay the doctor his 20 fee, even though it can be claimed back later, is in making sure that patients really need to be there. Of course anyone with a noted chronic condition or socially disadvantaged will be reimbursed 100% and if he has a Carte Vitale the GP is credited automatically without money changing hands. The GP's or consultants charged fees are his income and he like other health professionals are in overt competition with each other.

D. The Pharmacist will provide over the counter advice and drugs for almost any common aliment. He will also provide prescription drugs (un-reimbursed) if needed at his discretion. Thus the load on the GP is much reduced.

E. All the providers in the system, the GPs, consultants, diagnostic labs, district nurses, etc. are self-employed private contractors within the system. They normally work at proscribed fee scales.

F. The contractors in the system choose their mode of working from the point of view of their own businesses, within those fee scales. This results in the outcomes most of which would be remarkable in the UK except in the costly private sector:

• The GP has no secretary and no appointment system. Turn up when you need and wait perhaps 20 minutes on a busy day.
• GP’s are not paid by a capitation fee based on patient numbers but on their actual patient appointments. And only recently a system of affiliating patients to GP’s has been introduced, before that it was totally open to the choice of the patient on any particular occasion
• The patient also has the choice of which consultant to see but the GP will always recommend the one he considers suitable.
• The GP will also be happy to make home visits: the reimbursed charge is rather more.
• The dentist has no dental nurse and runs the practice single handed. A large proportion of his fees are reimbursed to the patient.
• The busy cardiology practice with three consultants has just one administrative assistant.
• The district nurse will turn up at on the doorstep to take a blood sample at 7.00 am in the morning for a fee of 6.35 (reimbursed).
• The consultant dermatologist answers his own phone and makes his own appointments without any need for administrative help.
• As well as doing major surgery, the consultant orthopedic surgeon does his own splint work on the spot.
• Etc. etc.
Thus the administrative load created by centralised control and rationing of consultants and hospital appointments does not exist.

G. As separate private contractors, all health professionals work as if “their time was their money”. This difference was emphasized on the recent Gerry Robertson programme when an NHS consultant clearly stated, that this was the difference was between his work in the NHS and his outside private practice. Most UK hospital consultants are already private contractors as well as being well-paid part-time government employees.

H. There is a real emphasis on preventative medicine and prompt treatment is considered to be economically worthwhile. Thus certainly in my experience waiting lists just do not exist.

I. There is an abundance of medically qualified people in the system and indeed there is a degree of competition between them. According to OECD figures, there are almost twice as many medically qualified professionals per head of population as in the UK health service

J. The medics run the hospitals and other facilities not the government or the administrators. They see the benefit of having an absolute minimum of administrative overheads. Those that exist are mainly involved with the ensuing that the Insurance organisations are charged correctly. This also means that there are no artificial limits placed on maximising the use of expensive capital equipment and the hospital installations.

K. Also, crucially, as the government is not supplying the service, the state does not own the product of the service nor most importantly the patients medical records.
Patients have bought the service either directly at the proscribed rates or via their insurance and they are therefore the owners of the results. Responsibility for the ownership of such records is reasonably unloaded on to the patient. This eliminates another whole swathe of administrative costs. And as there is no government duty of care with regard to patient records, there is no need / apparent obligation / or demand to create an expensive nationwide database of everyone’s medical records.

I believe that it is only in very few chronic cases that longstanding records are essential for treatment.

Any minimal useful information (such as the fact that I am diabetic, allergies, blood type, etc.) is retained on the chip of my Carte Vitale. The Carte Vitale is a type of credit card with a chip, that is used to organise the data required for my insurer to pay the sums necessary to the whichever part of the health system I have used. The card can be updated automatically with any changed circumstances when visiting the pharmacy. This seems to be a truly efficient use of Information Technology as applied to the health service.

Along with a pragmatic hands-on approach to consultant referral and appointment making, the need for a failing £20 billion government organised Health IT project collating everyone’s medical records is eliminated at a stroke.

And here a much simpler IT system works and it has been working for decades.

The Nation’s Health not the National Health Service should be the priority of government.

I certainly I believe that health outcomes for a similar percentage expenditure of GDP are much better here than in the UK.

The NHS is certainly not the only way of organizing it and the clear evidence is just across the channel.

Dave B

I seem to recall hearing the french system being described as the 'least bad' european system.

Simon

This is exactly why its a 2nd/3rd term issue! There wont even be a 1st term if you lot were to get your way and Dave pledges to cut health spending. Welcome back to planet earth boys.

JONNY

Obviously, reading some of these comments, there are a whole load of Tories whose dearest wish would be to renage on the NHS.
Lose the next Election for certain.
And grudgingly put Brown/Mandelson back in power for another 5 years.
Jut so they can have a go at Cameron.
How very very masochistic.

Rob

Constructive, rational debate? Like what rent a mouth Hannan was doing? There was nothing constructive about what he was saying.

Dirty Euro

The WHO rankings are how to compare the systems.

HJ

Well, we're not going to have a constructive debate, are we?

Andy Burnham (Health Secretary) has (according to the BBC) just attacked Dan Hannan as "unpatriotic" for criticizing the NHS and, inevitably (and tediously) said that his words were an "insult" to the 1.4m NHS workers.

This is about the level of debate we can expect between the parties. Apparently, to criticise the near-monopoly employer that 1.4m medical staff work in is "unpatriotic" and "an insult" to those staff. Has he considered that some, at least, of those staff might agree with Dan Hannan and prefer that there was an alternative system and employer?

http://news.bbc.co.uk/1/hi/uk_politics/8200817.stm

Incidentally, I can explain to Verity why the NHS is so top-heavy with administrators. In the 'old' days of the NHS, the medical staff's attitude (and what happened) was "just give us the money and leave us alone". The result was that the NHS was orientated towards their needs and preferences and not those of its users (and taxpayers). Even New Labour recognised this, but as they are ideologically in favour of a government funded and run system and against one where the patient wields spending power, they needed some other way of forcing the staff to perform. Hence the target culture and the bureaucracy needed to enforce it. Of course, this has been a disaster (partly because the bureaucrats are also a producer interest group) - the cure nearly as bad as the disease - but this is fundamentally the reason.

The logic that the provider must be made directly answerable to the user through the funding method, and that this can only happen when there is choice, completely escapes them

maisie

Verity "Well, greedy and chippy responses anyway."

Though is that a surprise given the level of debate from Fox News, who after all, have provoked this reaction?

Andy Leeds

Trouble with all of this is, quite simply, that Daniel Hannan is quite right in what he said. The NHS does not work and never has, nor ever will. The sooner we all realize this and begin to look at a better way of organising healthcare the better for us all. In The Times yesterday was one glaring statistic: 5 year survival rates from testicular cancer are 90+% in the USA and 50% here. It is, I believe similar in other areas. So lets stop all this silly crap that the NHS is wonderful. Try telling that to all those 40% who have died of cancer who had they lived in the USA would probably be alive 5 years on. It is a disgrace.

Verity

Rhoda K - Several posters, including me, have recommended adopting the French system wholesale. And I would add, get some French people in at the top to run it.

PS - Daniel Hannan for Leader of the Tories. We'd walk the next election.

Minnie Ovens

Thank you, Mr Forsyth for an extremely lucid precis of the situation.
I do still come down heavily on Mr Hannan's side. He has been promoting an alternative system for sometime and it seems interesting.
In fact Mr Hannan seems to have more balls, executional intelligence and leadership ability than any Tory MP's!
Mr Cameron has not been forced into an "either,or" situation. It just seems that he cannot be bothered about making improvement to a good but outrageously expensive system.
But then Mr Cameron seems to like to pose without having any opinions or policies of his own.
The last thing we need is to elect the Conservatives by default.
If you look at The Spectator or The Times correspondence you will find a fund of experience driven ideas from a very intelligent, activated audience.
But why bother with these when you can spend quality time moaning about your meagre stipend.

Verity

Jonny - I don't know what "renage on the NHS" means, even if renege were spelled correctly.

However, many of us think that Cameron for five years would spell the end of our country. Many of us want the Tories to lose the next election in order to get rid of Cameron. Labour cannot stagger on for more than 18 months or two years into a new term, they're already on their knees, and a Vote of No Confidence called by the new Tory leader would triumph.

drakes drum

What this argument has shown in vivid technicolour is the shallowness of one, David Cameron.

Hannan was only saying what he had written, with Douglas Carswell, in The Plan. Hannan believes, as I do, that the Singapore Health System would deliver fairer and cost effective health provision.

Is The NHS a sacred cow which is above criticism?

Of course it is. It is a Socialist State within a capitalist system..think on that.

Cameron just insults everyone's intelligence, and shows what little he has, by denigrating one of the few thinkers in the Tory Party.

Cameron is just a man with few idea's. Wanting power for powers sake and the Tories have got themselves a major problem.

I cannot believe that rational people have backed this man as a leader. He is a coward and his actions towards Hannan have proved that.

Verity

Yes, Maisie, but were it not for Fox News, the Americans would be stuck with what is, in effect, the BBC with commercials - albeit with better looking people.

dorothy wilson

James you are absolutely right. Unfortunately, there seem to be a number of subjects on which it is near possible to have a serious and rational debate. The NHS is one of them, immigration is another. Add "equal opportunities", diversity and political correctness in general and you have a pretty poisonous - and even dangerous - mix.

Kevyn Bodman

Rhoda,early on, has written the comment I would have.

Ed Hoskins,thank you.

As for Dan Hannan, thank heavens for a politician who says what he thinks, and clearly so we know what he thinks.
True he is not doing his political career any good, but every credit to him for his clarity and honesty.Would that we had more like him, on all sides too.Lucid,cogent and honest.
Compare and contrast: Hannan/Burnham.
Hannan/Mandelson.
Hannan/Duncan.

Simon Stephenson

I wonder why there are so many people who seem unaware that politics is principally about continuous assessment and re-assessment of the allocation of scarce resources? Why there is so little acceptance that the idea of a resource-consuming leviathan such as the NHS being absolved of the need to participate in this process is absurd, not to put too fine a point on it?

Could it be related to the popularly-held belief that public expenditure is funded from a bottomless well of money, that commitments in one area are pain-free everywhere else, and that therefore reduction of provision in emotional areas are always heartless and unnecessary?

Wake up! Every pound that's wasted perpetuating the totemic but irrational policy of "free at the point of use" could, and should, be applied to providing more needed services elsewhere. Believing this does not make us "anti-NHS" any more than questioning George Bush's action in Iraq makes us "pro-terrorist".

Verity

I agree with Hannan on the Singapore health care system, but they do tend to get things right in Singapore. It's all in the willingness to invest the time in planning in minute detail. This is why their public transportation system is also superb.

Re Daniel Hannan himself, Kevyn Bodman styles him "Lucid,cogent and honest." Beyond dispute.

Hysteria

depressing that Hannan is now being accused of being unpatriotic.....

David

"We need leaders not followers"

Good leaders need goo judgement though. There is no point in having a leader if they are going to lead you off a cliff.

"but were it not for Fox News"

But nothing. If I want an alternative, I want one that is decent, reliable and does a good job. I'm not going to defend a channel that spews lies simply because "it's an alternbative"

"Many of us want the Tories to lose the next election in order to get rid of Cameron"

You may want to go back to losing election after election, I don't. In 2005, we ran on a dog whistle platform. Despite Labour being deeply unpopular, having been utterly discredited due to lying to take us to war, we still lost.

Cameron has taken the party to within sight of the winning post for the first time since 1994. Yet people like you want to throw it away because he doesn't match your narrow minded definition of a Conservative. I've got news for you - the Conservative party is a broad church, with members holding a wide range of views, and Cameron represents quite a lot of those who stuck with the party, working for its success even when it was headed off into a direction which they did not completely agree with.

porkbelly

The whole Cameron/Hannan brouhaha underscores the depressing fact that absolutely nothing of substance would change under a Conservative government...those whining that Hannan will somehow cost his party the election by allowing himself to speak honestly should reflect on how meaningless the next election will be in real terms.

JONNY

'Labour cannot stagger on for more than 18 months or two years into a new term, they're already on their knees, and a Vote of No Confidence called by the new Tory leader would triumph.'

Have you ever considered writing political fiction, Verity?
This submission certainly shows creative fertility. Though perhaps for a first try, it stretches the reader's credibility a bit too far (even for a novel).

However who knows - might we be looking at the new Michael Dobbs?

Max Kaye

Roger Helmer (MEP) gave a good radio interview today (I think on R4) supportive of [the gist of] Hannan's comments.

It's high time that the holy cow that is the NHS undergoes root and branch reform.

Hysteria

p'raps the best we can hope for is DC arranges a review of HOW the money is spent, whilst promising to keep the total amount protected...?

Anne Wotana Kaye

A serious observation. On TV, an American used the horrible condition of British teeth as a reason for not having a health service like Britain. "Has anyone seen the teeth these Brits have?" he cried in desperation. Whatever we think about him, Lord Mandelson must be true Nu Labour. Despite his mainly manicured appearance,m he has a mouthful of nasty discoloured, misformed teeth. Ugh!