A healthy policy development

Simon

Just a minute for the last year or so the heffer house blog has been arguing that Dave's health policy should be to announce spending cutsin the health budget before the election. No mention was ever made of how this election winning strategy might go down with the electorate of course. So if this post is a sign that the blog is reconnecting with planet earth then it is to be "hugely welcomed"

2trueblue

For those who have retired are you going to give us our shares back and then we can have a choice?

The whole system has lost credibility because it is so abused. We used to have to take our medical card when signing on with a GP or dentist. This ensured you got service and proved you belonged to the system.

There is huge waste and lack of accountability in the system. Those at the frontline provide a good service but the top seems to have layers and layers of people who have a different agenda.
It is imperative that the vulnerable are protected. Those at the top should have to 'keep their hand in' by accompanying their staff on the frontline, to keep them in touch with what the service is all about, and the standards practiced. Often they are too removed from the coalface and the practicality of the end product delivery. Some are just beuracrats who have no expertise or indepth knowledge in the field they work.

The amount of money wasted on the benefit side through fraud should have more paractical initiatives tried to combat abuse. When you work you have to turn up at a specific place etc to get paid. I do not understend a system whereby money is paid without the person having to turn up. People do not even have to be in the country! The system is so complicated and it is often the vulnerable that suffer whilst the 'wily' work the system. If it were simplified then surely we would all benefit. We have technology now that should be used to this end.

John Bowman

The staff already own the NHS which is why it is a product driven - here's what we are prepared to offer, take it or leave it - rather than a market driven - this is what the user needs and wants - service.

It, like any enterprise which offers a product or service, needs to be profit motivated so there is a culture based on reward and merit and not just length of service, job demarkation and minimum effort.

Verity

Adopt the very successful, and excellent, French or Singapore systems and get a team of Froggies or Singaporeans over to set it up and run it for the first five years. Success guaranteed.

Forlornehope

It is true that the French get, marginally, better outcomes than the NHS. It is also true that they spend between 30% and 50% more to get them (it depends on how you do the sums). For all its faults, if you look at the data (strange idea) you find that relating outcomes to expenditure the NHS does pretty well. Could it be better, of course, does it stand comparison with other countries, very much so. The relative efficiency of the NHS may be a result of its good performance on primary care, as shown in the recent Commonwealth Fund study, http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx.

For comprehensive data, the most recent World Health Organisation data can be found here:

http://www.who.int/whosis/whostat/2009/en/index.html

The real stand out numbers, of course, are for the USA, which spends about twice as much as the NHS for pretty lousy results. Given where we are, and the undoubted opportunities of improved efficiency, it makes absolute sense to ring fence the NHS but to expect it to do a lot more with what it gets.

Snowman

The NHS stands for nothing, but a smaller size replica of the communist systems of yesteryear. The latter imploded, and the idea of wholesale nationalisation got thankfully trashed. It’s only a matter of time that the NHS follows into the dustbin of man’s follies, too. The monopolistic monstrosity may have served its purpose when the masses were poor, and unaccustomed to get anything for free, well ‘free at the point of delivery’ anyway, the costs hidden from the public view. It was the ‘need’ of the people that the early days NHS served. In a rights-overflowing Britain, it’s the ‘wants’ it has satisfy. Sadly for those who support the NHS, there’s a limit to ‘needs’, ‘wants’ have the ability of expanding to infinity and beyond.

The high-tech sector and the NHS were born roughly at the same time. The first transistor, the predecessor of the sophisticated mutli-gate ICs of today that are at the core of every electronic ‘box’ appeared at the end of the 40s, as did the legislation for the publicly funded health delivery service. Both sectors are a mix of hardware and software. Since their inception, the high-tech sector, purely market driven, has delivered a range of products and services at a cost to the users that enable even the poorest in the society to benefit from them, e.g. every homeless man in London owns a mobile. The NHS, on the other hand, owned by every one of us and run by Government appointed bureaucrats has moved from one crisis to another, devours more than £1,500 per each man, woman and child, and still cannot get rid itself of waiting lists that often stretch beyond the life expectancy of the sick.

Dr Blue

http://www.hsj.co.uk/news/policy/nhs-managers-to-back-labour-as-job-fears-focus-their-minds/5008054.article

Looks like NHS managers know who butters their bread. Maybe Andrew lansley's policies have more going for them than I realised.

The managers poll does rather show the Labour client vote in action doesn't it?

And the doctors who actually deliver the service are deserting Labour even more than the general population as shown in this poll in Pulse http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4124254&c=2

2trueblue

My son moved to France 2yrs ago with his French wife who was 6mths pregnant. They were asked for e2,000. when my daughter-in-law registered at their chosen hospital. When our grandson was born the bill was e500 and that had to be paid before they left the hospital. The e2,000 was not repaid for 22mths.
When our grandson was 14mths old he had an accident and at each visit to the ospital we had to pay for the visit and for the dressings etc. that we collected from the pharmacy. The familys card had not come through at that time, (16mths after they had moved) and until it did they paid for their treatment. Eventually their card came through and they were refunded the major portion of the money.
That is our experience of the French system.
The treatment was excellent, but it certainlly was not free at the point of delivery. You have to have the relevant documents to get treatment.

John Bowman

"Outcomes" - which focus on severe conditions such as cancer, or heart disease, is just one criterion to judge cost and effectiveness of a health system. The majority of users do not experience "outcomes" they just want to get a good service and see a doctor without having to give reasons to the receptionist and 10 to 14 days notice.

Besides, "outcomes" depend on a number of factors apart from actual treatment,cultural and social for example which might affect how soon people present with a complaint or how good people are at taking medicines.

French system: it is not free at the point of delivery, the State only reimburses up to 70% of drugs/treatment. Private top-up insurance may be bought and is tax deductible. Those on low incomes get 100% reimbursement and those with chronic conditions get 100% on the particular condition. A large part of the provision is private charging the fee rates agreed with the State.

French healthcare costs more because of over-prescribing by doctors and overuse by patients many of whom seek multiple consultations for the same problem. Recent rules have been introduced to reduce these factors.

it is a puzzle why son of 2trueblue had those problems. Form E111 should have covered at least 80% of costs prior to enrolment in the French system and had he arrived in France with Form E106, and gone to the local office of l'Assurance Maladie to register, he would have received an "Attestation" which would have served until his Carte Vitale arrived - normally quickly.

Verity

John Bowman - Yes, over-prescribing, if you can call it that - I prefer to say over-medicating - is a problem because some patients go from doctor to doctor with the same problem, getting different prescriptions. And then the poor doctor gets a visit from a government officer when he didn't even know the patient had already received medical advice from others. It's a loophole I am sure they are working on closing.

It's a very good system, though.

2trueblue

They has moved from UK to Ireland and then to France. If you are late in applying for forms you do not get them.