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Saturday, 10 October 2015


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Spending per capita on the NHS has increased over recent years, and still the service gets worse, and goes into deficit spending.

The NHS blames the ageing population and the immigrants putting "pressure" on services.

But the immigrants are young and supply huge amounts of labour to the NHS while taking less than average themselves being younger, without immigrants the ageing population problem would be much worse.

Without immigration and the EU to hold down spending, Britain will quickly become hell on earth.


Well, perhaps this could be an outlet for your desire to become a political activist! You could mount a campaign to make people pay upfront in cash for their varicose veins stripping etc. You would be well ahead of the curve with that.

Once you learn why hospitals are replacing ward nurses, sisters and matrons with administrative officers, HR executives and bed managers, all of whom seem to have less medical knowledge than can be found on the back of an Elastoplast box yet have salaries many times more than their trained predecessors, you may understand why the NHS is in the state it is. But then the official policy is that hospitals don't need nurses. They need expensive administrators and managers. It is 'owed' hundreds of thousands, if not millions, of Pounds from medical tourists, yet doesn't seem to have a way of recouping that money. When the Outlaw (that's like an in-law, only she was wanted), was injured in America, she was taken to a hospital, given pain relief and then asked, "How are you going to pay for this?". Fortunately, she had insurance but if not, all they would have done was to give her more pain relief and discharge her. Why can't hospitals in the UK employ someone to do this? The job would pay for itself many times over. It would also stop, or recoup the cost, the Nigerian millionaire's wife flying to London, giving birth, and then flying home again because Nigerian hospitals are shit holes. It would also stop the American woman flying to UK, suffering from appendicitis and reporting in to A & E as the flight cost was cheaper than the operation in the US. Until our political masters lose their right to private and immediate health care, nothing will change except the standards will continue to fall for the general public and the debt will get higher.

Spot on Penseivat,
When I was a contract driver for the NHS, I got into some interesting discussions with managers. One of them admitted that NHS departments were about 100% overstaffed and said that it could bin half of them without any reduction in the quality of service. It goes without saying though the union bruvvers would fight tooth and nail to prevent anything like that from taking place.

I meant the management in NHS departments

Having been abroad for many years until recent and having sampled healthcare in all of them I can attest the NHS is decidedly not the envy of the world. It is from my observation the most dysfunctional and badly organised even Trinidad with it's limited resources has given me better service.

The best I found to be is the French one. The reason being that it's provision and funding is done in a way that ensures the medical staffs puts patience needs before their own you cannot say that about the NHS. It also ensures a degree of personal responsibility with it's partial funding through insurance top up schemes. Of course you can say then it is not free which is true for the reasonably well off and then it is not overly burdensome for them. For the poorest it can be as the government pays the insurance top in part or in full depending on individual circumstances.

The first thing I noted when I visited a UK GP surgery on my return from abroad was the number of administration staff swanning about the place. Then a notice caught my eye that told me that I was only allowed 10 minutes of the doctors time and I could only bring to the doctors attention one ailment even if I had more than one. I was flabbergasted in all my visits to doctors abroad that method of healthcare had never been applied to me or any other patience I knew. The doctors took along as it takes, were thorough in their examination and made sure all my needs were dealt with.

So far I have had disagreements with 5 doctors at the surgery perhaps pointing out that they are lazy incompetents was not a good idea. Pointing out that in France GP surgeries do not have receptionists and if they do they are part time or any administration staff at all did seem to offend. I could not stop myself from adding that nurses do not work out of GP surgeries or that you do not have to attend a hospital for many tests you go to a laboratory of choice and receive the results not in weeks but within 24 hours.

There is considerably more I could tell you about the failings of the NHS and how other healthcare systems are many times better I think I have rambled on long enough I know.

I had a blood test this week, on Tuesday. The results arrived on Wednesday afternoon, the doctor rang me up to discuss them and I picked up a copy on Thursday. Of course, as Mr Duff kindly pointed out, I do live in the arse-end of the UK.

By the way Lawrence. The other day you claimed that 11% of NHS staff were migrants. According to the ONS 10% of the UK population are immigrants or the children of immigrants.

NHS-PBIN-sounds like some of our entitlement agencies here in the declining US-where's my A. They are so "ponzied" graft ridden, money wasting and yet untouchable. To suggest any reform to stop this is heresy. To defend the continuation as is of one of these monstrosities is to be considered principled.

BOE: "By the way Lawrence. The other day you claimed that 11% of NHS staff were migrants. According to the ONS 10% of the UK population are immigrants or the children of immigrants."

11% of the NHS staff are immigrants, quite right: -

11% of the population are immigrants, quite right: -

So even if the overall figures above were the thing to go by exclusively, that means that immigrants contribute as much in work for the NHS pro-rata as their population.

In other words, Richard's ludicrous "we've only got one glass of water to share between two families, or, immigrants are putting undue pressure on the NHS" arguments are rubbish. It's break even.

But if you look inside the figures (see first link above), you'll find that 14% of all clinically trained staff are immigrants, and 26% of all doctors are immigrants!

So as I've been saying, the immigrants wipe all the old folks dribbly bottoms, do the injection, operations, and actual healthcare, and the home grown public sector class push email from their inboxes to their outboxes, PR, admin, marketing, and "management".



You're making the mistake of thinking you know how to run a hospital, or even the whole NHS, and attempting to engage on that basis.

I remember listening to people blahing on about how to run the car industry, trains, coal mining, steel manufacturing, Telco, gas, electricity, water distribution, even computer manufacturing, in the 1970's. Where the factories should be, what coal miners should be paid, how many wheels the cars should have, etc.

Today the 1970's saloon bar bore with a diploma in business studies from a third rate poly who thinks he / she can run an industry has been replaced by the blog bore of the same ilk.

The politicians encourage a "national debate" on how to run things, and for the great unwashed to think their ideas are worthy when they should be ignored. Politicians flatter us into believing our cranky ideas are great, and they stand for election on the basis of them. This is not for our benefit, but so the politicians can accrue a public sector empire that will continue to vote for them and more public sector forever after. Which public sector voter ever voted to reduce the public sector?

Since we stopped having a "national debate" about how to run those 1970's public sector industries and privatized them, the rotten ones that cost us a fortune have thankfully disappeared, and the worthwhile ones are run without a national "debate-of-idiot-bores".

Rather, 65,000,000 people choose not with their gobby mouths and cranky ideas the least idiotic of the dumb-arse politicains to run those industries, but rather with their hard earned cash. They vote with their hard earned cash, and choose their cars, energy, transport, iThingies, items made of steel, individually instead.

Until we do that completely and totally with the NHS and state education, those last two public sector dinosaurs will continue to degrade and abuse us.

Not one of the political parties offers us that. They all tell us they're listening to our stupid ideas, flatter us to get our votes, with no expectation that they will actually improve the productivity, value for money, or quality of those industries - but with the certain expectation that they will expand their clientalist public sector power base.


The NHS was supposed to do the basics now they pay for vanity mistakes like the damage done to women who wanted bigger tits and lips to please the man. And as new drugs are invented at great expense the bill gets bigger. It is a bottomless pit but the taxpayer thinks it can go on and on without actually paying more tax,

I am not claiming I can run a hospital or even the NHS. I thought I was merely pointing out what I perceived to be a retrograde step in the running of, at least, one hospital where my wife and two of her friends (all specialist trained RGNs - they used to be called SRNs back in the day) worked. They all agreed that management levels had increased while employed nursing staff decreased (with expensive agency nurses filling shortfalls in staff). Two members of my darts team also work at that hospital, one a porter and one a doctor, and my posting was based on their views as well as my own knowledge. I can't build a car, but I know some makes are crap; I can't manage a football team but I can tell where some teams are going wrong. Similarly, I can't run the NHS but I have opinions of how it can be improved. My comments and suggestions are those of a layman, but even so, are possibly worth considering.

I'll take the bait, David. "Obamacare" is not the system he wanted, only the system he could get politically. The US hasn't had a "private" system in many years. It has been a hodgepodge of Tricare, Medicare, Medicaid, government supported clinics, subsidized insurance companies, and laws that don't allow hospitals to turn away patients from emergency rooms, which happen to be the most expensive points of service. Before Obamacare we had over 50 million people with no access to healthcare, and hospitals literally put uninsured people in taxi cabs to drop them off in slums to die or seek help elsewhere. Even then the cost of "private" insurance was skyrocketing. In short, the system had become completely unsustainable.

The ACA (the real name of Obamacare) is probably a step toward something like a Swiss system in which semi-private insurance companies are strictly controlled by the government. According to a report from the Commonwealth Fund "The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014." The cost of care has seen the smallest increases since the 1960's.

Depending on the politics, though, we might still end up with a system similar to Canada's, which is rated almost as highly as France's by the WHO. The Canadians complain about their system every 10 years or so because advancing technology both in machinery and drugs puts pressure on the system to raise taxes. Eventually it's hashed out and things run smoothly again for a while. I have many friends in Canada and they're happy with their system on the whole. I haven't heard any complain about the government inserting expensive bureaucrats, though. If true that is certainly a problem for you.

My GP surgery is in a highly populated area and very busy. The reception area has an automated check in although the receptionist who deals with prescriptions and local chemists has to book people in who cannot work the simple automated system. I went along for my three monthy jab yesterday and was also given the flu jab. The nurses were working on 5 min appointments. It was a case of hello and cheerio and they had to record all details on the PC.
We only have x ammount of nurses and doctors serving us so I am afraid the personal touch and a chat is just not possible.
So do let tens of thousands of refugees in and totally fuck up the system.

To satisfy rules inflicted from on high, our GP surgery has the usual "sorry, try for your urgent appointment by ringing our engaged line at precisely 0830 tomorrow". They also have the "ten minutes, one affliction and you're out" notices. The first time we visited the no-nonsense old-school doctor said " I'm here for you; we'll take as long as it takes."

One of my favourite sports elsewhere is asking questions; they're not set up for it and it throws their day completely. "Your cholesterol is 5.4" "Ah, what is it normally?" No answer. My rheumatologist is great fun as she expects to do the talking and expects me to listen...

We've found, too, that small hospitals treat you better than large, which must be a reflection on the system as a hole. (Notatypo)

It is all the fault of the new untermensch. -The elderly.
They get ill. No wonder things are glueing up.
The Liverpool path thing , rationing of health treatment are all too inefficient.
Sooner or later there will be assisted demise. Thus leaving things for the young. They dont bother the NHS.

£2000 per person, per annum. That's what the NHS costs us. Not the working population, but each and every man jack of us, from cradle to grave, every year.

Now imagine giving £2000 pppa to every citizen in Britain. Not cash that could be spent down the pub, but social buying power in the form of a voucher or credit.

Then take the supposed service level of the NHS - the drugs, treatments, operations, procedures, maximum waiting times - and offer it to the market. The whole globalized market. Because I don't give a shit whether a Canadian, a Swiss, a Somali, an Indian, or an African serves me, so long as I can choose the best value for money in the world. Throw the doors open to the world's healthcare providers and let them compete for my custom.

And write into the Service Level Agreement that the price must be the same for everyone, irrespective of age, pre-existing infirmity, or any other criteria. Let the actuaries and the bankers do their magic to produce a price.

And free the doctors and nurses to go work for the best employers, in surgeries and hospitals that they choose.

And notice, at no point have I said anything about how to run a hospital of a healthcare service. Because I don't know, neither do you, and neither does anyone until the competition is running, and we discover the competent ones bubbling to the top of the market.

And then systematically break up any monopolies that arise when the successful ones get too big to fail.

And that's it. Whether it's health, education, car manufacturing, coal mining, ...

But it won't be done while we think we know how to run an industry, and politicians tell us we're right, and we vote them in to run it using our designs. And so the degradation and abuse never ends.


I'll take the bait Lawrence. If the "glass of water" analogy is such a crap analogy, why are there now shortages in school places, medical services and above all houses? Might it have anything to do with the fact that there has been an unprecedented growth in population due to immigration without a corresponding rise in the development of the necessary infrastructure to support them?
I also note that you haven't answered any of the points made by various people on this forum concerning the cultural clashes and loss of national cohesion that the huge numbers coming in are causing.

This is getting a bit off track though. Returning to the subject, a big part of the NHS problem - which I have observed first-hand - is that they are chronically over managed and that this has been at the expense of providing adequate front line services such as nursing staff. I would listen with great interest to anything you had to say on that.

Lawrence's speciality is suggesting solutions to our problems that are not going to happen. He knows that, we know that. It's all just hot air.

"I would listen with great interest to anything you had to say on that (chronic over management and nursing shortages in the NHS)."

Richard, please, you've missed my point yet again.

As soon as I respond to that question, and propose some management and nursing shortage fix to the NHS, I've fallen for the politician's trap. He smiles and rubs his hands together with glee, and invites me to vote for him or one of his mates with the closest fit to whatever cranky designs I might have made.

And so the NHS perpetuates and grows, designed by idiots and run by even dumber politicians. The degradation and abuse seemingly eternal.

The people who know how to run a hospital or a health service are not known to us in advance, and in fact, not knowable in advance. Their voices are drowned out with the 65,000,000 million others who think they know.

As Church and / or Turing proved for Turing machines, you can't tell whether the Turing machine will stop or go to infinity without running it; no parallel analytical contraption exists to predict the answer - will it stop or regress to infinity - in advance. Only running the Turing machine will yield the answer.

Since competitions and markets are isomorphic to neural networks, which in turn are Turing machines, there's no knowing who, with what idea or design, will win the prize and stop the competition by becoming a monopoly - the hospital and healthcare solution that ends up being so chosen it defeats all the others and stops the competition. The only way to find out is to run the competition.


"Lawrence's speciality is suggesting solutions to our problems that are not going to happen. He knows that, we know that. It's all just hot air."

I wonder.

Remember how Blair persuaded the masses he wasn't a socialist. The "third way" was different, new, he opined. They believed him. Then Blair took the public sector from one third of the economy to half of the economy and crashed us into a cliff face.

Well there is a chance that Cameron, and the peeps behind him, are using the same trick but in our favour.

The great unwashed need persuading he's no longer the "nasty party", while behind the scenes he shrinks the public sector as a proportion of the economy back to nearer a third than a half. So far so good.

Then suddenly, we get an announcement. The PHS. The "Personal Health Service". Free at the point of service, tailored to your needs, cradle to grave, pre-existing infirmities covered. If you're Mum and Dad with two kids, that's £8,ooo per annum of healthcare added to your living wage.

Choose any healthcare provider that meets the NHS service level (treatments, drugs, maximum waiting times, etc.), duly regulated by the state. Change your mind every month if you're not satisfied with a service provider, because the contracts are monthly.

And if you choose a service provider that can do the service level for less than £2,000, then you keep the change and can spend it on tailored healthcare. A new pair of tits, longer winky, gym membership, whatever.

An Uber for healthcare.

Which takes us rather nicely back to where we started.


You got quoted on samizdata!!!

Yes, I saw all these hits coming in this evening. Samizdata - what an honour - and I told them so!

Let me get this right Lawrence...
Correct me if I'm wrong but it seems that what you are saying is that taking remedial action to correct over management and nursing shortages in the NHS is not advisable because to do so would be to fall into some politician's trap. OK then, what would you advise?

Also, I think you should clarify what you mean when you say that the people who know how to run a hospital or health service are not known to us in advance. Perhaps I am being missing something here, but I would have thought that the rigorous interview of candidates with a proven record in management is a pretty good way of ensuring that suitable personnel are appointed to managerial positions.

One thing that I think that we can both agree on is that the NHS has become a gigantic sacred cow and anyone in power who introduces measures to improve it will be met with howls of protest even if those measures are demonstrably correct.

I'm astonished that you all are envious of Obamacare. No one here is happy with it. It's a huge step backwards. Everything -- premiums, co-pays, ESPECIALLY deductibles -- are all more expensive now, and absolutely nothing has changed in the actual service.

The only people buying insurance on the exchanges are people who either lost their insurance through their employer because the penalty was cheaper than paying for insurance, or people who manage to find a plan that is cheaper than the tax penalty (which means that they don't actually get any healthcare, because the deductible is $6000.)

And all of this -- useless insurance for the old price, or the same insurance for a much higher price -- has only gotten us from 14 million uninsured... to 11 million uninsured. For $250 billion a year just in overhead, not actual care. We could have just bought private policies for those 3 million that got insurance, and not f-ed up the whole healthcare industry in the process.

Phelps, welcome to D&N. Alas, I have never understood 'Obamacare' but given where it originated from I can well believe it is an A1 cock-up! But of course, it will act as a stepping stone for some red-in-tooth-and-claw socialism later on.

Richard - SoD has already said what should be done and on this occasion he is spectacularly correct.

We need to end the idea of health providers being run by the state because the state is incapable of running anything, anything at all, efficiently.

If 80% of the money currently splurged on politically and exediency driven spending in the NHS was instead made available to people to buy their own medical insurance, and health providers (eg hospitals, clinics, surgeries etc) were private businesses, and I like the idea of many of them being cooperatives, but competing to provide excellent care at the lowest cost then I can quite safely guarantee that there would be a 20% reduction in health care costs, and a very significant improvement in outcomes and patient satisfaction.

In every situation where market solutions have been tried they lead tohuge improvements, and in the NHS the potential to improve is vast.

Your obsession with management numbers is misguided because reform cannot be delivered from the top down, by politicans (who have brought it to its current pass) and without giving rein to vast innovation.

Cuffley, my obsession is not with management numbers, but budget. What is being paid to keep excess managers in employment is diverting funds from front line services where they are desperately needed - and we are talking about serious amounts of money.

As it happens, I agree with you completely regarding the State's ability to run anything. To be frank, it couldn't even run a bath. What I genuinely don't know is how any necessary improvements can be introduced without some group or other raising hell for political purposes - which is exactly what would happen if anyone tried to introduce the eminently sensible measures that you have just suggested.

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