Summary of May Debate on the NHS
Our panel of three "experts" (who claimed they weren't expert but if over 100 years of experience in healthcare doesn't make them experts, I don't know what does!) did a great job of pulling in a good crowd of about 20.
Michael Thorn, Mike Naylor and Dr. Andrew Nelson, introduced themselves and their topic with some controversial and provocative themes.
The NHS is the largest state employer in Europe, and eats about £60 billion per year of taxpayers' money. Dr. Nelson had brought with him a heavyweight prop - a huge tome listing the many thousands of drugs available for doctors to prescribe. He drew a contrast between the immediate post-war period - when the average doctor's bag contained a few all-purpose drugs and "a doctor's role was to bring people into the world and to ease their passing from it" - and today, when the huge variety of drugs and procedures has led to the growth of a vast army of nurses, administrators, managers and consultants around the doctors.
The NHS was portrayed as a "bottomless pit", with ever-increasing lists of treatments provided free at the point of use. IVF and forms of cosmetic surgery, for example, are sometimes provided for "free". Patients (or customers!) have unrealistic expectations from the NHS.
Bureaucracy - "the British disease"?
The BBC employs 27,000 people - more than all 4 of the US networks! The MoD employs more civil servants than soldiers! In keeping with this "British disease", the NHS employs a vast army of non-medical staff. Addenbrookes in Cambridge employs 2.68 non-medical staff for every patient, compared to 1.24 in a typical French hospital of a similar size.
Someone asked, if the medical staff know what needs to be done (a phrase often used), why has the profession been so quiet?!
Free for All?
"Neither the public nor doctors themselves appreciate the real cost of drugs and treatments".
The public does not appreciate the NHS and this leads to abuse of the system, and wastefulness. The fact that the NHS is "free at the point of use" sounds like a good idea, but it was never intended to be that way, even by Beveridge.
"Whilst most people will accept that when their car goes wrong, they need to shell out £500 on a new exhaust system, they don't think it is acceptable to pay out when their own health goes wrong".
Successive governments have set the public's expectations far too high. What is more, the NHS in combination with social services, encourages people to sit back and take life for granted in general.
Doctors also don't appreciate the cost of the treatments and drugs they are prescribing. In the absence of fund-holding at practice level, doctors don't appreciate the cost of brand-name drugs versus generic drugs, or the relative cost of basic and common treatments such as hip replacements.
Procurement has been "notoriously bad" in the NHS.
Fund-holding is a good idea, but in addition there should be doctors trained in medical economics and the business side of medicine, as a specific discipline. Otherwise, there is a risk that doctors get steam-rollered by the business managers.
Party Politics and the NHS
Are we too short-termist about the NHS? Should the NHS be a non-party, consensus issue, with a longer term strategy and vision which is agreed by all parties?
Politicians in general are terrified to criticise the NHS or propose cutting it down.
About one in ten British employees work for the NHS, so to criticise is to lose votes. (Gordon Brown's philosophy was described as "The more people are on your payroll, the more voters you have"!).
If privatisation is a dirty word for politicians to use, there are a few other suggestions about how it might work to take the NHS "out of politics". For instance, the BBC is managed by Charter, the rail industry is regulated, the Bank of England is independent. Perhaps, like for the pensions issue, an independent report should be commissioned (like the Adair Turner report), which might stand a chance of being independent of the political parties.
This sounds like a good idea, but in practice is likely to be impossible. Governments need to be involved in order to set the priorities for expenditure.
Until David Cameron, there was significant disagreement about how much should be spent, as a baseline, on the NHS. Several present were disappointed with David Cameron's policy statements on the NHS, suggesting that the status quo would prevail in terms of expenditure. He should be thinking more radically, and should not be afraid of accusations of "Tory Cuts". (Perhaps the Tories should embrace and adopt the phrase "Tory Cuts" and turn it to our advantage?).
Government's role should be to prioritise and define exactly what should be provided for "free". There needs to be some prioritisation, and so the NHS will not ever be entirely separate from politics.
Get Better Soon?
So is the NHS getting better, with all of Labour's extra investment? The consensus was almost certainly no. There was much anger and frustration at the incidence of MRSA ("are we going backwards in time?!"), the fact that bed occupancy of about 100% leaves the system unlikely to be able to cope with an epidemic such as Avian Flu, and the incompetence with which doctors' pay was calculated.
Big is Beautiful?
Perhaps the NHS should be split up geographically or by specialism, to make it easier to manage, more flexible and leaner. Its current size makes it difficult to manage change. However a geographical split would be difficult because of major equipment such as CAT scanners which need to be centralised and utilised almost 100%. Also splitting the NHS by geography would lead to inconsistency and arbitrage (travelling for treatments).
La Solution Francaise?
Much reference was made to the French health system (number one in the world, according to a survey 7 years ago, when Britain came 34th in the world).
"We have a conceit in this country that our health service is the best in the world, but it's not - we have a lot to learn from other systems".
The French system is one in which 75% of any medical bill is paid by the equivalent of National Insurance, but provision is not totally free. Waiting lists are almost unheard of.
Closing Words
So what did we agree upon? I think we agreed that doctors should be trained in economics. There should be more fund-holding. There should be fewer bureaucrats. Government should prioritise NHS funding more carefully (and very possibly cut it down). Total privatisation may be a step too far, but an increasing mix of private and public provision seemed to be the consensus. The rest is up for grabs.
Michael Thorn, Mike Naylor and Dr. Andrew Nelson, introduced themselves and their topic with some controversial and provocative themes.
The NHS is the largest state employer in Europe, and eats about £60 billion per year of taxpayers' money. Dr. Nelson had brought with him a heavyweight prop - a huge tome listing the many thousands of drugs available for doctors to prescribe. He drew a contrast between the immediate post-war period - when the average doctor's bag contained a few all-purpose drugs and "a doctor's role was to bring people into the world and to ease their passing from it" - and today, when the huge variety of drugs and procedures has led to the growth of a vast army of nurses, administrators, managers and consultants around the doctors.
The NHS was portrayed as a "bottomless pit", with ever-increasing lists of treatments provided free at the point of use. IVF and forms of cosmetic surgery, for example, are sometimes provided for "free". Patients (or customers!) have unrealistic expectations from the NHS.
Bureaucracy - "the British disease"?
The BBC employs 27,000 people - more than all 4 of the US networks! The MoD employs more civil servants than soldiers! In keeping with this "British disease", the NHS employs a vast army of non-medical staff. Addenbrookes in Cambridge employs 2.68 non-medical staff for every patient, compared to 1.24 in a typical French hospital of a similar size.
Someone asked, if the medical staff know what needs to be done (a phrase often used), why has the profession been so quiet?!
Free for All?
"Neither the public nor doctors themselves appreciate the real cost of drugs and treatments".
The public does not appreciate the NHS and this leads to abuse of the system, and wastefulness. The fact that the NHS is "free at the point of use" sounds like a good idea, but it was never intended to be that way, even by Beveridge.
"Whilst most people will accept that when their car goes wrong, they need to shell out £500 on a new exhaust system, they don't think it is acceptable to pay out when their own health goes wrong".
Successive governments have set the public's expectations far too high. What is more, the NHS in combination with social services, encourages people to sit back and take life for granted in general.
Doctors also don't appreciate the cost of the treatments and drugs they are prescribing. In the absence of fund-holding at practice level, doctors don't appreciate the cost of brand-name drugs versus generic drugs, or the relative cost of basic and common treatments such as hip replacements.
Procurement has been "notoriously bad" in the NHS.
Fund-holding is a good idea, but in addition there should be doctors trained in medical economics and the business side of medicine, as a specific discipline. Otherwise, there is a risk that doctors get steam-rollered by the business managers.
Party Politics and the NHS
Are we too short-termist about the NHS? Should the NHS be a non-party, consensus issue, with a longer term strategy and vision which is agreed by all parties?
Politicians in general are terrified to criticise the NHS or propose cutting it down.
About one in ten British employees work for the NHS, so to criticise is to lose votes. (Gordon Brown's philosophy was described as "The more people are on your payroll, the more voters you have"!).
If privatisation is a dirty word for politicians to use, there are a few other suggestions about how it might work to take the NHS "out of politics". For instance, the BBC is managed by Charter, the rail industry is regulated, the Bank of England is independent. Perhaps, like for the pensions issue, an independent report should be commissioned (like the Adair Turner report), which might stand a chance of being independent of the political parties.
This sounds like a good idea, but in practice is likely to be impossible. Governments need to be involved in order to set the priorities for expenditure.
Until David Cameron, there was significant disagreement about how much should be spent, as a baseline, on the NHS. Several present were disappointed with David Cameron's policy statements on the NHS, suggesting that the status quo would prevail in terms of expenditure. He should be thinking more radically, and should not be afraid of accusations of "Tory Cuts". (Perhaps the Tories should embrace and adopt the phrase "Tory Cuts" and turn it to our advantage?).
Government's role should be to prioritise and define exactly what should be provided for "free". There needs to be some prioritisation, and so the NHS will not ever be entirely separate from politics.
Get Better Soon?
So is the NHS getting better, with all of Labour's extra investment? The consensus was almost certainly no. There was much anger and frustration at the incidence of MRSA ("are we going backwards in time?!"), the fact that bed occupancy of about 100% leaves the system unlikely to be able to cope with an epidemic such as Avian Flu, and the incompetence with which doctors' pay was calculated.
Big is Beautiful?
Perhaps the NHS should be split up geographically or by specialism, to make it easier to manage, more flexible and leaner. Its current size makes it difficult to manage change. However a geographical split would be difficult because of major equipment such as CAT scanners which need to be centralised and utilised almost 100%. Also splitting the NHS by geography would lead to inconsistency and arbitrage (travelling for treatments).
La Solution Francaise?
Much reference was made to the French health system (number one in the world, according to a survey 7 years ago, when Britain came 34th in the world).
"We have a conceit in this country that our health service is the best in the world, but it's not - we have a lot to learn from other systems".
The French system is one in which 75% of any medical bill is paid by the equivalent of National Insurance, but provision is not totally free. Waiting lists are almost unheard of.
Closing Words
So what did we agree upon? I think we agreed that doctors should be trained in economics. There should be more fund-holding. There should be fewer bureaucrats. Government should prioritise NHS funding more carefully (and very possibly cut it down). Total privatisation may be a step too far, but an increasing mix of private and public provision seemed to be the consensus. The rest is up for grabs.
posted by Helen at 3:53 PM
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