UK NHS: Government proposed changes from July 2024

Yes that’s true. But usually management changes are done under a banner of cost cutting. If one healthcare service were radically to decide that cost cutting shouldn’t be priority and that saving lives should be the money could flow into actual healthcare and not be endlessly messed about with by managers who are middlemen numerous and paid a lot on the basis that they will save money via their talents for making efficiencies.

But the problem with that is that the efficiencies that could be made are very limited and yet still somehow decades into this fad, not yet realised.

For example staff are going off sick constantly and dropping out of work forces yet managers in healthcare in general do not get upgrades to ventilation or air purifiers or staff and patients in N95s etc, they just let them go sick which is inefficient. But it does prevent proactive money spending. See also certain healthcare departments going without funding, because the budget can’t be found, then patients deteriorate into more serious illnesses and require other departments to spend 10,20,40…. times more to treat and maybe still lose their lives. I just don’t think that ‘efficiency’ means anything at all under these political conditions.

If a government is averse to public funding for public services, for countries that embraced neoliberalism for the last few decades this is the case, then the calls for efficiency are a useful sufficiently non specific sort of positive rallying cry, surely one cannot object to efficiency?
Yet that means one thing very pointedly, like a big drop down banner at a political rally;
WE ARE NOT PROMISING PUBLIC RESOURCES SUFFICIENT TO MEET THE POPULATIONS REQUIREMENTS. Like it’s completely unthinkable that the amount of money it would take could or should be spent on alleviating suffering and saving lives. Of course the small print banner which is rarely seen would necessarily say, ‘so therefore some of you will have to suffer your lives away and die of the treatable conditions we feel it prudent and efficient to draw the line and say no more no more.’

So it’s true I agree healthcare is incredibly inefficient in terms of delivering health and safety and life enhancing life saving care. But healthcare can’t be left to capitalism and capitalists and state supporters of capital interests and still represent an efficient vehicle for care and treatment. Because money is going to be price gouged out of the system at every opportunity. The drug prices paid, the insufficient PPE because that’s where the ideology the politics is or the body or hospital didn’t find capacity for it in the low budget for health and safety, whatever. There it’s a money wasting inefficient system from the perspective where you’re not a corporate entity benefiting.

People who value most of all efficiency, in the sense of rapid delivery of all the expensive resources straight to the doctors and, on to their patients at speed couldn’t get or keep a high level management position. It’s not possible. Because to achieve and maintain such a career they would necessarily have to prioritise protecting the budget.
Under the logic of capitalism that means the immediate budget not the fall out that’s coming down the line following all the budget protecting corner cutting. That’s literally not your business.

When politicians and healthcare bodies talk about ‘efficiency’ it’s never separated from cost cutting, for a reason. It’s not a good sign. That why I think it has to come down to money first efficiency second. Survival first.

 

I hope you're alright. That sounds very worrying.

 

Are you advocating for a privatised system over the NHS?

 

I paid to have the best surgeon do it on the same Thursday.

 

Absolutely not. A private system drives all the wrong motives and ends up costing five times as much as needed. The only sensible answer is a communal 'National Insurance' that is adequately resourced. The only mistake Bevan made was to think that it would save money by making people healthier. Healthy people end up costing far more in old age care. The reason for having the system is that it is the only sensible way to get universal health care at a reasonable price. Maybe even then the Labour movement was led astray by bogus economic arguments.

 

Yes.[elderly people cost money to treat & that’s fine]
I think it certainly was.[Maybe that calculation was more accurate when considering how poor public health was when most people struggled to afford any healthcare? In any case the foundational idea, the framing of money saving has haunted the NHS ever since. In conflict with its slogans about cradle to grave care. Making accessing care for many people difficult or impossible.]


[=Edits, to say what was being referred to]

 

Glad it's done and dusted and that you're OK!

 

What do you think about the scope of preventive health measures to help matters? That's part of the proposed strategy, though I don't know if specifics have been made public.

 

Preventive health measures are long overdue of course. But they don't cost anything so they have nothing to do with making the NHS work. And they will mean healthcare costs more in the long term because when people will live longer they cost more to look after in old age. So the economic argument is backwards, as it was for Bevan.

The preventive health measures we need are chiefly reducing obesity, smoking and alcohol use. Reducing obesity is just a matter of introducing laws that discourage people from buying crisps and coke. Laws cost nothing. Smoking is easily dealt with by making the manufacture and sale of tobacco products illegal, as should have been done fifty years ago. Reducing alcohol consumption is probably best dealt with with tax and restriction on advertising. None of it costs anything. Tax revenue would go down for tobacco but you deal with that by increasing income tax a bit. Income tax is absurdly low. That is the real problem because if you offload tax on to consumer spending you force people to waste money on unhealthy things. Even Plato understood the problem - the problem of democracy that elected governments will always try to reduce income tax.

 

Well if true to form that’ll mean lecturing poor people over their undesirable behaviours, and ‘a carrot and stick’ approach that is all stick. But mostly it’ll just be blaming the different economic situation on fat people, and conflating being fat with doing no exercise, because you know. Maybe a plan to ban people who eat biscuits or smoke cigarettes from using the NHS. Maybe a ‘free’ smart watch that tells the government whether you do enough excise to qualify for healthcare.

 

Do they, though? Don't they add years in good health rather than just dragging out the poor health?

 

I’m of the opinion it’s not relevant to humanity if it cost more or less. That we so readily talk like it’s reasonable to care about the abstract concept that is ‘the economy’ over actual living people is an absolute tragedy.

I did read somewhere that people dying is actually very costly for the economy though so there’s that.

 

Probably not. In general obese people manage pretty well until they are in their sixties and then they get heart attacks and strokes. Smokers used to have dreadful emphysema but with better nutrition and less air pollution these days they just discover they have inoperable lung cancer aged 54. Alcoholics have a great time until they get liver failure or prostate cancer.

If you take away these problems you have people living to 90+ and at least half of those will cost £60-120,000 a year in care fees for about ten years. They will also have major health costs for rodent ulcers, recurrent episodes of infection, injections for macular degeneration and so on.

 

And of course 90 year olds in care homes don't buy a lot of computer hardware, fast cars, mobile phones, international flights to boost tax inflow.

 

I am glad that you have had your surgery done with the best chance of a good outcome. I hope you continue to be well.
Do you mind if I ask what " on the same Thursday" refers to? Was it immediately after diagnosis or on the same Thursday that it would have been done if you were a NHS patient?
I ask because, as a NHS patient , one cannot choose one's surgeon. I recently had an NHS procedure done by a trainee not very successfully. I know training is necessary but ....who honestly wants to be trained on? It didn't relieve the pain as planned and affects me considerably. It needs doing again but the NHS wait to see the Consultant is about a year.

 

What I think most people are also unaware of is the symbiosis between the insurance companies and the private clinics. Insurance companies actually want people to go to private clinics and claim rather than go to government hospitals. The more claims there are the more the premiums are justified. The bigger the business. Backhanders get paid between commercial organisations. Lawyers testify in favour of their chums.

The situation is the same in vet medicine and has become completely absurd, with huge fees for MRI scans for cats and dogs supporting lavish vet centres.

 

Tsk Tsk. Failing at Vimes economic wisdom.

Although looking at the dumbass ways the enormous costs of health issues medicine miserably fails at and what is done to address them, this is entirely expected. They keep 'counting' the cost-benefits of things that have zero benefits. This is not a sane system. In fact they somehow keep expecting that the costs should go down. Despite doing everything to make them go up. It's quite an insane system, actually. Entirely governed by the next budget and with zero consideration that reducing expenses out of one pocket but increasing them in another doesn't work well when it's the same pair of pants.

 

Major plan to cut waiting lists will see millions receive faster diagnosis and treatment
LINK

 

Amazing to see an NHS advert for itself with all the glowing testimonials they can find and none of the ones that point out that we will not see millions receive faster diagnosis and treatment.

Or at least not the right diagnosis and treatment.