Any guesses as to what the solution will be? Privatise to save the NHS.

“The historical precedent from its 60 year history shows that in the four other times the NHS had a financial crisis the only way to get the NHS working again was to raise funding. In those four cases the funding raise was between 8% and 12%.”

Hmmmm.

And therefore this is the system (adopted by no other country) which we should continue to support??

The historical precedent from its 60 year history shows that in the four other times the NHS had a financial crisis the only way to get the NHS working again was to raise funding.

The message from that then is that maybe it is time to consider alternatives, as it has been shown that each previous “fix” simply deferred a future financial crisis rather than avoided one occurring.

If the NHS is spending more money than it has, the better question is WHY, and a better long term solution is to find out what can be done to stop that happening.

If you just throw money at it, you are simply deferring the problem for the next politician to sort out. Which makes for poor long term planning.

This is the Tory prize of privatising the NHS by the backdoor so that the public doesn’t notice until it is too late which Richard Blogger says has already happened for the PCTs.

I do not think Lansley or any of these wreckers have been stupid … their aim has been to finish off the welfare state as quickly as possible so that any other incoming government will find it impossible to reverse … why should multimillionaires worry about their potentially catastrophic economic strategy? Mrs Thatcher’s used the same strategy. Her only aims were to crush the Unions and dismantle the nationalised infrastructure, without any regard of the economy shrinking and any impact on the population.

It has been clear from the start that the GPs would not be doing the commisioning but would be employing private health companies, populated staff made redundant from the PCTs, and that the NHS would be put into straight competition with private health care providers.

Where is any sort of mandate for this! Cameron lied when he said no top down reorganisation/NHS safe in Tory hands!

Mrs Thatcher’s used the same strategy. Her only aims were to crush the Unions and dismantle the nationalised infrastructure, without any regard of the economy shrinking

The economy grew by 26% between 1979 and 1990.

5
LOL, you mean that it had nothing to do with north sea oil and the sell-offs?

CJ @ 2

And therefore this is the system (adopted by no other country) which we should continue to support??

Yes, because the only real alternative is to scrap the NHS and revert to private health care. You people despise the NHS and want to bring it down because in your culture, helping the sick is a sign of weakness, but for the majority of decent people in this Country, the health service is a sign of a civilised society.

“Yes, because the only real alternative is to scrap the NHS and revert to private health care.”

You are familiar with how things work in (civilised when I last checked) France, Germany, etc. I assume?

CJ @ 9

Yes, but we are talking about this Country. We are not going to move to the German or French models and you know that. Nor is that the ‘big prize’ for the Tories, the Tories will never rest until the whole thing is turned to rubble and the poor can then whistle for health care. We both know that, so why pretend otherwisae? You nearly brought it down last time and you will try this time too.

The Tories will starve the NHS of funds over the next three or four years, forcing it to grind to a halt.

LOL, you mean that it had nothing to do with north sea oil and the sell-offs?

Absolutely, the excellent privatisation programme was a key factor in Britain’s economic recovery of the 1980s, and was widely copied throughout the world. The inefficiencies of stae-run utilities has just been excellently demonstrated in Northern Ireland. One of Thatcher’s greatest legacies was managing to persuade the normally economically bone-headed Labour Party to recognise this fact.

“Nor is that the ‘big prize’ for the Tories, the Tories will never rest until the whole thing is turned to rubble and the poor can then whistle for health care.”

Brilliant.

Are you Sally in disguise?

@cjcjc
Clearly you don’t understand. The reasoning is that the Tories must be evil, because I’m good, and if I’m opposed to something it must therefore be evil. Therefore they actively want to cause suffering to the poor, because I see myself as good, and no-one else can be good if they think differently to me.

@6

North sea oil contributed to growth, but was not a major driver.

Privatisations mostly happened under John majors government after 1992.

There were many drivers of growth, but subsidising failing industries and nationalised businesses wasn’t one of them.

@ 12

Where does he call anything evil? He described a policy that you labelled evil. Whether said policy has anything to do with Tory intent is another matter, of course, but you seem to be reading a different post to the one written down (maybe you’re very rational and anyone who disagrees with you must be irrational?).

14 – it’s hard to read this:

the Tories will never rest until the whole thing is turned to rubble and the poor can then whistle for health care. We both know that, so why pretend otherwisae

other than as a belief that Tories are fundamentally bad people, devoted to the destruction of the poor. It’s a failing on both sides of the political divide (though, as PJ O’Rourke says, the left tends to believe the right is evil; the right tends to believe the left is stupid) not to listen to Don Corleone. Never hate your enemies, it clouds your judgement.

He takes the attitude that the financial problems are the problems of Primary Care Trusts (PCTs), NHS trusts, Foundation Trusts and GPs: he gives them money and if they generate a deficit that is their problem. (Of course, it is not their problem, it is our (patients’) problem)

The obvious solution here is to give the NHS more money when they generate a deficit because they will then realise, at last, that they are in fact attached to a drip that contains MAGIC MONEY.

And then they won’t have to worry about what they spend next year because, when they realise they are spending too much, they will remember about the MAGIC MONEY.

And of course this country is so prosperous that we have an unlimited supplies of MAGIC MONEY. and only stupid people don’t realise that MAGIC MONEY is actually made out of paper. If we run out all we have to do is print some more.

Tory knobheads.

@ Pagar

You are quite right…money does literally grow on trees.

But seriously, it is a massive problem that NHS beaurocrats have no incentive whatsoever to make savings or control costs, and often quite the opposite. Cutting NHS spending back to 2006 levels (in real terms) is not going to mean the destruction of the NHS, going to deny the so-called poor medical care and wouldn’t even affect patient care if productivity had managed to improve at all, rather than falling.

That people (Left wingers) say it is is pure hyperbole, much in the same way arguing in the face of reality that any cut is uneccesary or that we can grow our way out of the deficit is of the same mould – that of bullsh1t. An ounce of hubris, and facing reality, as Darling did (he who said that the country would face the biggest spending cuts ever shoud Labour win before he was shouted down by Brown/Balls) would be welcome from the Left. It woudl at least make for more mature debate.

I think we should all take note of the promises of the trolls that the NHS will be saved by these necessary reforms. Let’s look into the LC archive in a year and see who’s prophesies have been most accurate.

I seem to have solicited a series of responses that say that the only solution is to move to a (largely) private system like they have in France or Germany. May I shatter your illusions by bringing in some facts?

The OECD gives the following expenditure (% GDP, 2008)

Germany 10.5%
France 11.2%
UK 8.7%

If you want a German or French system then you will also have to accept German or French levels of spending. That means spending an extra £22bn or £30bn more, that is, throw more money at it. As I mentioned, the NHS is expected to spend less, so I am afraid your dreams of a private French or German system will never happen.

I have put a graph on my blog of the changes in funding over the lifetime of the NHS. There are a couple of things to note:

1) The NHS has never sustained flat funding or a cut in funding for more than one year at a time
2) When there has been flat funding or a cut, the funding in subsequent years has increased, sometimes quite sharply

Lansley is suggesting that there will be flat funding (if you believe that “efficiency savings” is not a cut) or a 4% cut (if you are sensible and realise that “efficiency savings” is a real cut) for every year for four years. This has never been done before. In the past when a cut has been made the effect has been so serious that the government has had to throw money at the service to mitigate the damage the cut caused. Isn’t it better to avoid that situation? And before the usual suspects say that if you need to increase funding every year then there must be something wrong with the service, bear in mind that every healthcare system has annual increases in funding. No other healthcare system can sustain the sorts of cuts that Lansley is suggesting. And no other healthcare system can sustain such cuts along side a re-organisation of the scale Lansley is suggesting.

Lansley’s vanity re-organisation will make the financial crisis worse. He has shown over the last 8 months that he is not capable of running the service on a tight budget (something that is clearly difficult to do) – one third of PCTs are in deficit! He will clearly push the NHS into a catastrophic state with his mind focussed on a re-organisation that is neither needed and no one voted for.

17. Tyler

Cutting NHS spending back to 2006 levels (in real terms) is not going to mean the destruction of the NHS, going to deny the so-called poor medical care and wouldn’t even affect patient care if productivity had managed to improve at all, rather than falling.

What evidence do you have about that?

Cutting the 2010 funding level back to 2006 levels means a 20%-25% cut. How can you say that such a large cut will not affect care? Any commercial organisation taking a 20% cut in income is unlikely to survive. You are right that the NHS would survive because the government (at the moment at least, Lansley wants to change this) has a responsibility to provide the service. But it will not be the service we have today, and it is unlikely to be able to treat anything other than urgent, life threatening, cases. That would be tough if you have cataracts, or a hip that needs replacing.

@17

But seriously, it is a massive problem that NHS beaurocrats have no incentive whatsoever to make savings or control costs, and often quite the opposite. Cutting NHS spending back to 2006 levels (in real terms) is not going to mean the destruction of the NHS, going to deny the so-called poor medical care and wouldn’t even affect patient care if productivity had managed to improve at all, rather than falling.

Tyler, you really don’t know what you’re talking about.

1. Healthcare bureaucrats may have a lot to answer for but there have been year-on-year cost savings for the past 15 years. The “unit costs” i.e what hospitals are paid for specific services have been reduced – so hospitals are doing the same work for less income (they are increasing again but only in-line with inflation).
2. Simplistic analysis that argues that NHS productivity has falt-lined is completely flawed (but a blind mantra by some). It is based on a simplistic analysis of money in and activity out. Not allowing for significant capital expenditure or the well-known significant lag in the effect of certain types of spending.
3. Given that healthcare inflation is higher than regular inflation and we have an ageing population with increased healthcare needs it is ridiculous to not realise that a return to 2006 levels (even in real terms) is a massive cut in service provision.
4. The comparisons with other countries is extremely tedious. The NHS – for all it’s failings is still the best system (with some tweeks). If we end up adopting a French or German model (which seems to be Lansley’s intention) then we end up with appalling healthcare unless we increase our expenditure to at least the European average levels. Three problems with that, firstly, where is that money going to come from? Well, for most of us it will be either via our employer or some other insurance scheme and we’ll all end up worse off. For the poorest I somehow doubt the public money will really be available. Secondly it will be a significant drag on growth of the economy at a time when that’s the last thing the economy needs. And thirdly, until 2000, our health system was massively underfunded. There is still an investment gap and if that is not met then we’ll never get close to World class healthcare.

There are lots of historic and cultural reasons why the NHS has not been widely copied across Europe. Some of them are the same reasons why if we were starting from scratch now, the NHS is not what we would create. That doesn’t change the fact that for lots of reasons the NHS is the best way to do healthcare. Destroying it is a crime. And I fear it is a crime that Lansley will get away with.

AFZ

@ 20 Richard

Are you saying that in 2006 the NHS was in a dire state? It’s funding had increased massively, as you keep pointing out, and has never really been cut. Surely, as Labour kept pointing out, the NHS had neve been better….so I’m not entirely sure where you get your 20-25% cut number from…..my guess is pure hyperbole.

You can’t have it both ways – if it was fine in 2006 a reduction in the rate of increase in spending (which is actually happening, not a 4% cut as you make beleive in the article) is not going destroy the NHS.

You also seem to favour above inflation, above growth year on year increases in funding. How, may I ask, is this to be funded long term? We can get away with it for a few years, but not long term….

My feeling is that your point of view is purely ideological, and not based in fact. Labour loves the NHS and Tories want to destroy/privatise etc.

@ AFZ

1. If a manager manages to make cost savings, his departments budget often gets reduced….

2. The analysis has been produced several times over the past two decades by a number of third parties. I’ve seen data compared to public secotr productivity as a whole, private sector as a whole and private medical. The NHS has lagged far behind all, and in most reports shows productivity to have dropped. It’s not some “mantra”, it’s an observable.

3. We’re talking a real terms return to 2006….i.e. inflation adjusted. So not a cut in cash terms. Are you saying that healthcare was a disaster zone in 2006?

4. You would say the NHS is the best system. I would argue, and in my own personal experience, it isn’t.

A lot of the people who work in it are fantastic, but find me a Doctor who doesn’t despair of the way the NHS is organised. There are more beaurocrats in the NHS than Drs and nurses combined now. Your position, like Richards, is purely ideological. The NHS to you is sacred, and should never be touched, but just should have money funnelled into it. In my world, the realism is that we don’t have unlimited resources, and the NHS is extremely inefficient and bloated, and should face massive reforms. Reform doesn’t mean ignoring the poor or reducing quality of care – they mean just that – reform.

@22

I can’t be bothered to argue each point. Richard Blogger will do it better than I can. Are you deliberately misunderstanding the figures c.f. 2006 levels?

But I will respond to one bit:

4. You would say the NHS is the best system. I would argue, and in my own personal experience, it isn’t.

A lot of the people who work in it are fantastic, but find me a Doctor who doesn’t despair of the way the NHS is organised. There are more beaurocrats in the NHS than Drs and nurses combined now. Your position, like Richards, is purely ideological. The NHS to you is sacred, and should never be touched, but just should have money funnelled into it. In my world, the realism is that we don’t have unlimited resources, and the NHS is extremely inefficient and bloated, and should face massive reforms. Reform doesn’t mean ignoring the poor or reducing quality of care – they mean just that – reform.

A doctor who doesn’t despair of the way the NHS is organised?
Here’s one: me.

All of your statements are based on non-facts’ more bureaucrats than drs and nurses comibined? really? are you sure? especially when nurses are the biggest single group of NHS employees?

Let’s look at the actual figures shall we?

(source, the Kinds Fund: 2009, whole time equivalents)

Total NHS staff: 1,177,056
Doctors: 132,683 (11%)
Nurses: 336,007 (29%)
Scientific, therapeutic and technical staff: 128,331 (10%)
Qualified ambulance staff (i.e. paramedics): 17,241 (1%)
Support to clinical staff: 301,235 (26%)
Hotel services, estates: 58,221 (5%)
Central functions (HR, finance etc): 101,983 (9%)
Other GP practise staff: 58,572 (5%)
Managers and senior managers: 42,509 (4%)

Even if you assume that all the ‘support to clinical staff’ are bureaucrats, which is ridiculous, then that number added to central functions and managers still only adds up 39%. Doctors and nurses making up 40% between them. It would be more accurate to describe central functions and managers and senior mangers as bureaucrats which is ~13% of NHS staff.

Oh, and by way those percentages are essentially unchanged since 2009. Just the total number of staff has increased.

Oh, btw, the reforms that Lansley is bringing in will treble some of the bureaucratic functions of the hospital I work in. How will that make things better?

Show me some facts and then I might be interested.

AFZ

P.S. I am not against reform; I can give you a list of things that need reforming if you want. I am against expensive reforms that makes healthcare worse which is what Lansley is proposing.

CJ @ 11

Hold on a minute though. You have to admit that the Tories starved the NHS of recourses during the eighties and nineties, no matter how they manipulated the figures. Everyone knows that if you scratch the surface, your average Tory finds everything about the NHS and the ideology that brought it into existence totally repugnant. Sure, you may find support for it in some quarters, but for more than a huge slice of the Tory Party ‘free, at the point of use’ of anything is a total anathema to them. You know as well as I do that the huge support for the NHS among the general public was the only thing that saved it from being killed of by Thatcher in the eighties.

I bet you could go to any Tory conference at any time during the last thirty years, get about 12 delegates drunk and they would have all admitted they would have happily saw the whole thing brought down.

Tim J @ 15

I think the Tories peruse some pretty ‘evil’ policies, many of which appear to be fundamentally aimed at attacking the poor. That is hardly in dispute is it? I mean, I bet you can look at the Tory manifesto and you will find policies that would have left some of the poorest members of society worse off. In fact, only this week we have seen a shift in the tax burden from the rich onto the poorest people in society and that policy has been described as ‘progressive’ by the right. They have found it necessary to ignore all the evidence that points to a VAT increase as regressive to conform to their own ideological goals.

The point is Tim, at what point do look at the victims/losers of these policies before we can conclude that it ceases to be a co-incidence? How many ‘evil’ acts must any individual commit, before we can count the perpetrator as ‘evil’? I suppose the best analogy I can come up with is the mother who describes her son as a ‘good kid led astray’ no matter what crimes he commits. Whether or not the rank and file Tory Party members or supporters are ‘evil’ is a moot point, why these people consistently come up with nasty policies is the real question.

@ Jim

“I think the Tories peruse some pretty ‘evil’ policies, many of which appear to be fundamentally aimed at attacking the poor. That is hardly in dispute is it?”

I don’t think anyone sensible would dispute that, within the British political spectrum, the Tories are generally the party that defend the interests of the rich at the expense of the poor.

Your use of the word “evil” is very obviously in dispute, as is the idea that the Tories AIM at attacking the poor. This is important. There’s a big difference between not caring whether your policies hurt the poor and deliberately setting out to hurt them for the sake of it.

For my money, I suspect many Tories rub their hands with glee when they think about a cartoon benefit scrounger being turfed out on his arse, but I’d definitely say it’s an unfair caricature to suggest that they’d laugh at the idea of the unfortunate starving on the street, for example.

Chaise Guevara @ 27

I am using the word ‘evil’ purely subjective terms. You are correct that terms like ‘evil’ are pretty useless in political debates.

I do not think that ALL Tories are intrinsically ‘evil’ in that sense. Of course, Tories don’t eat babies nor do most support death camps or genocide either for that matter. On the other hand, I do genuinely think that the consequences of some of their policies can legitimately be described has having a pretty disastrous effects for millions of people in the long and short term. On the other hand, Brown’s ten pence tax folly had a pretty poor outcome, but that is long way from marking him out as ‘evil’.

The problem arises for me when these policies start to make a pattern. Once you see the same people getting kicked in the balls time and time again, you need to ask ‘is this just a co-incidence?’. We could dissect this all day, so let me give one example:

The Global Warming debate:

There has been a scientific Conesus on the existence and cause of Global Warming for the last, what? Twenty years? Yet one group of people seem to be reluctant in accepting this. Those on the political Right of the spectrum have been putting up the same feeble ‘objections’ to the theory for the last twenty plus years only for them to have been pretty swiftly debunked. However, these same objections, myths, half-truths and lies are trotted out every time the debate comes up. I bet you have heard the recent (and now current) snow being cited that AGW does not exist.

The same people have been denying AGW for close on a quarter of a Century, with not a single piece of science to back them up, why? The bottom line is the Tories have been denying this, not because they have spotted the single flaw in the theory that the entire scientific community have missed, they have kept this charade up in order to save themselves a few fucking quid. Millions of people can be washed out of their homes, starve to death, have their homes destroyed, their crops wither in fields and still the Tories deny it is anything to do with them. They cling to their lies, no matter what evidence is presented for the basic reason, namely ideology.

What kind of person would deny the science and allow millions of the World’s poor to suffer the consequences, in order to preserve their own petty ideology? It was bad enough when the church disputed the Sun’s position in the solar system as it had very little influence on the working of the planet, but our climate? These people are willing to damage the entire climate for a fucking BMW? These people are not ‘misguided’, nor are ‘their hearts in the right place’ or ‘trying to do the right thing’, they are condemning millions of people to poverty and suffering for their own greed. The same can be said when we discuss unemployment, mental health, the NHS, education and everything else.

That counts as evil in my book, tell me why that is wrong.

The tories are scum, we’d be better off as a people if they were all executed.

“That counts as evil in my book, tell me why that is wrong.”

First, the obvious: denying AGW isn’t Tory policy, and I imagine most serving or self-identifying Tories don’t do it. It DOES correlate with the right, though.

My suspicion is that many AGW deniers, especially those who don’t have interests in a polluting firm or drive a gas-guzzling car, have convinced themselves that they’re in the right. It’s attractive to some minds to believe that you can see through the big conspiracy that has fooled the masses (“Wake up, sheeple!” etc).
Many people will also be tempted to disagree with their perceived enemies on a subject they don’t understand simply on principle, and if you do that for any real amount of time cognitive bias kicks in and tells you that you MUST be right. After all, the guy disagreeing with you is a bleeding-heart idiot, yeah? This is pretty much proved by the vast number of people who think that cold weather in winter disproves climate change.

With “bleeding heat” we have the third point: environmentalists are often seen or portrayed as goodie-goodies, which creates an attack-on-sight response in some. The very fact that they feel like that probably either reflects a guilty conscience or is caused by them being suckered by media portrayals of straw environmentalists, but in either case that’s due to subconscious prejudice rather than a “fuck the planet” attitude.

@ Jacob: I see the Jacobins are alive and well, may you embrace their fate.

@ Chaise & Jim: For me, and many on the sceptic side, (as opposed to the deniers who are at least as moronic as those on the unquestioning pro side), the issue is threefold; 1, Is the science reliable? ( I maintain considerable doubts on this), 2, Does the science to date, even if reliable hold sufficient explanatory power, (factoring out other influences is I admit very difficult) and 3, even if 1 & 2 are satisfied what is the best course of action.

Re point 3, the fact that almost all the emphasis is on reducing our standards of living rather than innovation is guaranteed to rile anyone on the right.

“Re point 3, the fact that almost all the emphasis is on reducing our standards of living rather than innovation is guaranteed to rile anyone on the right.”

In fairness, there’s a lot of innovation going on in the energy industry, and I’m not sure how the general public can be expected to be innovative (besides changing their lifestyle, which could always be argued to be for the worse – driving smaller cars, paying for more expensive green equipment etc).

Chaise Guevara @ 29

Not quite the direction I wanted to go, but fair enough.

I never said it was ‘Tory Policy’ as such, but the deniers on the Tory Right help shape the broad spectrum of policies. As I said, these people will bend and/or deny science to satisfy their own greed.

If they cannot be on the correct side on an open goal, ideologically neutral issue, like climate change simply because they are crippled by ‘Political correctness’ (in the truest sense of the term), then what chance have they got on any other issue? If their vision is clouded here, then can you think of a reason why they are likely to understand issues like unemployment, health, mental illness, crime etc?

Falco @ 30

Re point 3, the fact that almost all the emphasis is on reducing our standards of living rather than innovation is guaranteed to rile anyone on the right.

In other words, if the science is unpalatable, then the science must be amended o fit in with what the ideology requires. So if the ‘answer is ‘curtail population growth and end Third World immigration to Europe, then the laws of physics turn out to be correct?

Yes, your third point sums up the Tory Party to a tee. This is not the ideology of people with their hearts in the right place; this is political sloganeering of fuckwits.

@22. Tyler

Are you saying that in 2006 the NHS was in a dire state? It’s funding had increased massively, as you keep pointing out, and has never really been cut. Surely, as Labour kept pointing out, the NHS had never been better….so I’m not entirely sure where you get your 20-25% cut number from…..my guess is pure hyperbole.

The total spend on the NHS in the England in 2006/2007 was £78.6bn, in 2010/11 it is £103.8bn. This comes from a parliamentary briefing paper recently published. (Table 2, p15). Going from 2010/11 figure down to 2006/07 figure is a cut of 24% (you do the maths). I don’t do hyperbole, I let the figures talk.

33

And in 2014 it will be £110bn – some reduction from £78bn or even £103bn eh?

Let the figures talk indeed.

@Tyler

[Bugger, submitted too soon]

You can’t have it both ways – if it was fine in 2006 a reduction in the rate of increase in spending (which is actually happening, not a 4% cut as you make beleive in the article) is not going destroy the NHS.

I explained that elsewhere. But since you don’t seem to have read that, I will try again. Since the Spending Review the OBR has revised up its estimate of inflation and so this means that the NHS budget will actually be a real terms (ie not cash terms) cut of -0.3% per year. This was calculated by the Kings Fund economist John Appleby.

-0.3% (Appleby) or +0.1% (Osborne) is effectively flat funding. You’ll be an idiot to call +0.1% a real terms increase. However, we have the £20bn “efficiency savings” to consider. Lansley says that if the NHS can suddenly become yet more efficient any money it saves it can spend on healthcare. Wow! As we all know, what he is saying is “you would normally expect a 4% increase year on year for the next four years, well you ain’t gonna get it, but you’ll still be expected to do the same or more without it”. Well that clearly is a cut, since the NHS will not be getting the money it needs to do its work.

You also seem to favour above inflation, above growth year on year increases in funding. How, may I ask, is this to be funded long term? We can get away with it for a few years, but not long term….

This is not me. It is healthcare, and it happens in every country, the NHS is not special in this respect. Healthcare has a higher rate of inflation than consumer prices. (Appleby’s calculation uses the OBR’s calculation of inflation and not the higher healthcare inflation, so the Spending Review funding is even less in real terms.) We have always had this problem, it is not something special of this year. Then there is the problem of the population getting more elderly and getting more dependent upon the NHS. That raises costs year on year.

You are right that this situation cannot be sustained. But lots of people have known this for a long while and have been trying to change things. Labour knew that there should be a shift of more care from hospital to community care. It’s not been too successful. This is why I am not too fussed about GP commissioning. The fact is, there has to be a shift towards GPs doing more care, it’s just that Lansley’s policy is not the way to do it. In my local PCT’s strategy for the next five years (published a year ago) it says that over the five years acute care funding will drop by 20% and primary care funding will rise by 30%, this will save the PCT a significant amount of money.

My feeling is that your point of view is purely ideological, and not based in fact. Labour loves the NHS and Tories want to destroy/privatise etc.

I cannot fault that. I am tribal. I am also right on this issue, as the figures prove 😉

2. The analysis has been produced several times over the past two decades by a number of third parties. I’ve seen data compared to public secotr productivity as a whole, private sector as a whole and private medical. The NHS has lagged far behind all, and in most reports shows productivity to have dropped. It’s not some “mantra”, it’s an observable.

I would be interested to see these reports. Can you post some links?

I can find few publicly available reports on the productivity of the private sector, and those studies I have found say that they are incomplete because the authors have not been given access to complete data because of “commercial confidentiality” (even so, they showed that the private sector had lower productivity than the NHS). I look forward to the recently announced OFT investigation into private healthcare because it will mean that we will get real figures, once and for all.

3. We’re talking a real terms return to 2006….i.e. inflation adjusted. So not a cut in cash terms. Are you saying that healthcare was a disaster zone in 2006?

OK, the figures

4. You would say the NHS is the best system. I would argue, and in my own personal experience, it isn’t.

A lot of the people who work in it are fantastic, but find me a Doctor who doesn’t despair of the way the NHS is organised. There are more beaurocrats in the NHS than Drs and nurses combined now. Your position, like Richards, is purely ideological. The NHS to you is sacred, and should never be touched, but just should have money funnelled into it. In my world, the realism is that we don’t have unlimited resources, and the NHS is extremely inefficient and bloated, and should face massive reforms. Reform doesn’t mean ignoring the poor or reducing quality of care – they mean just that – reform.

@Tyler

[I am being so fat fingered today, second try…]

3. We’re talking a real terms return to 2006….i.e. inflation adjusted. So not a cut in cash terms. Are you saying that healthcare was a disaster zone in 2006?

OK, the figures I gave above were cash figures, but the referenced document gives the funding in 2009/10 prices too (inflation adjusted)

2006/07 £84.5bn
2010/11 £100.9bn

So it would be a 16% cut to go back to 2006/07 levels.

A lot of the people who work in it are fantastic, but find me a Doctor who doesn’t despair of the way the NHS is organised. There are more beaurocrats in the NHS than Drs and nurses combined now.

Oh dear, you really have not looked at the figures, have you? This is from the NHS Information Centre (the latest figures are 2009):

All Doctors 140,897
Qualified Nurses 417,164
Managers 44,661
Support to clinical staff 377,617

My guess is that you take the “Support to clinical staff” as being “beaurocrats”, personally I think that receptionists, health record clerks, clinical coders etc are necessary. I would also say that the people in charge of procurement and (this is something you’ll hear a lot more about in the coming year) commissioners are also important since they are these to keep costs down. I also suspect that you regard managers as “beaurocrats” so to satisfy what you said above:

“Drs and nurses” 558,061
“beaurocrats” 422,278

It looks like there are more clinical staff than “beaurocrats”.

Your position, like Richards, is purely ideological. The NHS to you is sacred, and should never be touched, but just should have money funnelled into it.

I am ideological, sure. But I don’t believe that is should have money “funnelled into it”. As I have mentioned above there are huge savings to be made from shifting more care into primary care. Personally I would like an integrated system and GPs having the responsibility for a community. That is, I want each and every one of us to have a family doctor that we know and, yes, grow up with. That GP should be integrated with community health services and social care as well as acute services. What I do not wanht to see is the fragmented system that Lansley is designing. A system that is as much designed to kill our family doctor system as it is designed to privatise our hospitals.

We are losing hundreds of millions at the moment due to the fact that social care and NHS are two separate systems. The recent NAO report on the NHS highlights this as a problem. A patient who is in hospital is a patient that local authority social services does not have to pay for. The fact that a day in a hospital is something like three times as expensive as a day in a nursing homes (and perhaps an order of magnitude greater than care in the patient’s home) does not matter to the local authority trying to keep down their council tax. Integrate the two and we can get a system that is cheaper to run and is far, far better for the patient. What is Lansley’s response? He wants a far more fragmented system with lots more providers and the push-me-pull-me dilemma of funding still in place.

Lansley is not reforming the system, he is breaking it up.

@34. Max

And in 2014 it will be £110bn – some reduction from £78bn or even £103bn eh?

Let the figures talk indeed.

Sure, I gave the cash figures, I have given the real terms figures in 36. The £110bn represents a real terms decrease of 0.3% as I mention in 35 with a link to its calculation.

Satisfied now?

@37

So it’s not 4% a year decrease then, but 0.3% – which figure do you say is right now?

Anyway, more fundamentally – if a private company can run my local hospital for less money and to the same standards – why is that bad? I’m paying for it & it sounds good to me. Are you suggesting that is should be nationalised and thus increase the costs? Or is it the usual ‘I know what’s best for you’ mantra?

@Chaise: The problem is that most of the money is going not on innovation but on subsidies to support uneconomic “carbon neutral” alternatives for energy production, (whether direct subsidies or feed in tariffs). By skewing the incentives, by politicians picking the winners, (almost a guarantee of disaster), you are far more likely to get the wrong solutions. According to the Stern Review we are already taxing carbon more than enough, going further in this direction is likely to be highly counter productive. The major problem though is the ethos, we should not be aiming for “smaller cars” or “paying for more expensive green equipment” but finding ways of making what we require more efficient and cheaper, (so far as I am aware there is only one way that we have found to achieve this).

@ Jim: I don’t support either of your sarcastically supplied solutions and I note that you didn’t bother addressing the first two points I made. Perhaps if you bothered to engage the matter between your ears you would recognise that people who disagree with your undoubtedly mighty intellect have valid concerns.

Falco @ 39

I am not sure what comments you require for your first two points. The science is out there and in the public domain. If you are STILL, after all these years, still not sure about any aspects of AGW, then I suggest you buy a book on the subject. We have been explaining it to people like you for decades. You need to learn to move on and at least attempt to understand the science. Once you do that, you will see that your ‘concerns’ are little more than bleatings from sad, little greedy bastards more concerned with their wallets than the damage you are doing to the planet.

Falco @ 39

The problem is that most of the money…

The ‘money’ and outcomes therein do not affect any of the science. Youy deny the science. If you want to talk about the solution, fair enough, but you are attempting to claim the science is flawed because the economics are unfavourable. Can you explain how the laws of physics and the laws of economics are linked?

@Jim: “you are attempting to claim the science is flawed because the economics are unfavourable”

That is not what I have I claimed. I have concerns over the science, I also have concerns over the responses to the science even if the various studies turn out to have a higher degree of reliability than I believe they hold.

“You need to learn to move on and at least attempt to understand the science.”

The latter part of which I have been doing for some time and it is this that has lead me to approach AGW studies with some caution. Unlike an arrogant, rude and blinkered fellow going by the name of Jim.

In no real order;

Spending is going to be roughly flat inflation adjsuted going forward

From the NHS website there are 1.17m non-medical NHS staff to 560k medical.

20bn of efficency savings are not cuts. The spending will still remain.

I don’t really want to get into a nuanced argument about the organisation of the NHS – I don’t know enough about it.

Deloitte published several reports about NHS productivity. I think another major accountant did as well as others.

I do know though, at 100bn per annum, the cost per head in the UK is about 1500 GBP. My all encompassing health insurance was cheaper than that, and provided a significantly better service, though i’ll take the point it didn’t cover A+E (though it does pay for my eyecare….)

@ 40 Jim

One of the main problems with AGW is that the science is NOT out there in the public domain. The various data series are not all publicly available and the algorythm Hadley, CRU and NASA use to fill in the blanks has not been made available either – so much so that CRU were actively denying people access to their unmolested data. There are obvious and documented problems with NASAs models as well given the way they extrapolate data to areas where they have none.

If nothing else, we are told that the world has warmed 0.7C in the last 50 years. Of course, the margin for error there is +/- 0.3C. Do a little experiment at home….take 5 different thermometers and put them in boiling water. I’ll bet that the range of readings you get are more than 0.5C (when at boiling point they should all match). At room temp he errors are likely to be even larger…

…just measuring temperature accurately is really hard. Doing it accurately accross the world, then accounting for the factors driving any change is near impossible.

I’m sure you know that there is a similar consensus amongst economists that free markets are the best way to allocate resources and create wealth, and that free trade / globalisation is a core part of that process and accelerates the elimination of world poverty.

Perhaps it’s just me, but I am not inclined to call those who oppose those things “evil”, even though the approach they support (inasmuch as it is articulated at all) would condemn hundreds of millions to continued poverty and shorter lives.

@ 44

Consensus, eh? And here was me thinking there was a moral debate around globalisation and free-market capitalism. Maybe I dreamed it.

@43 tyler I would like to see the price of your “all encompassing health insurance” if you develop a serious chronic condition, or indeed when you reach 80. And please add the A&E option.

There is such a debate, as there is in certain circles about global warming.

But the consensus amongst professional economists, as among professional climatologists, is pretty clear.

You evil man!!

@ cjcjc

“But the consensus amongst professional economists, as among professional climatologists, is pretty clear.”

Um, no it isn’t. It’s a subjective bloody question for one thing. Goals aren’t clearly defined. The main problem being that when you say “the best way to allocate resources and create wealth”, does “best” mean “most effective at creating wealth” or “most likely to improve political equality and boost quality of life”?

Free-market capitalism is absolutely amazing at creating wealth. Unchecked, however, it does tend to encourage people being left to starve in the street.

When you are earning less than $1/day you only have one goal.

Thanks to globalisation there are hundreds of millions fewer people “starving in the street” than there were a decade ago.

CJ @ 44

The fact that you attempt to compare economists and climate scientists is both revealing and rather depressing. Economics is a completely man made construct, physics and the laws that govern it are totally immutable. Put three economists in a room and they will come up with four opinions. Pay an economist to come up with the answer you want and he will construct a model to give you the answer you want, because economics is a completely subjective subject. You can pay an economist to find evidence that immigration is good for the economy or you can pay another economist to ‘prove’ otherwise.

I suspect the fact that Tories find it easy to pay a think tank to say whatever it requires satisfying its agenda on any given subject, makes it so difficult to grasp who science works. They simply expect everyone else to be as venal as their own guns for hire and confuse integrity among scientists as ‘stubbornness’.

Physics is a completely different ball game. It is not about, ‘Left or Right’, ‘Capitalism or Socialism’ or any other. It is purely about what the evidence suggests. I choose Global Warming for a reason, namely because it is not a political issue. Or at least it shouldn’t be. It should be about completely objective measurements.

However, you Tories find such objectivity totally alien. You are used to buying and selling people and their opinions and think that is a perfectly legitimate act. The fact that Right Wing organisations have paid people deliberately falsify or misrepresent science is pretty fucking sick in my view. If this was merely about evolution, merely about the sun’s place in the solar system, then we could have a laugh about it, but the fact that this will affect the lives of millions of our fellow citizens makes those doing the lying nasty scum in my book. If they are willing to lie for this issue, it is a fair bet that they will lie on any other issue.

CJ, help me out here. I call the type of people who deny science because of curbs it will impose on their lives, whilst millions will suffer starvation as ‘vermin’. What is the ‘politically correct’ term for such people? ‘Differently moraled’, ‘ethically challenged’? what?

@ 50: “I choose Global Warming for a reason, namely because it is not a political issue. Or at least it shouldn’t be. It should be about completely objective measurements.”

The problem is that it hasn’t been about “completely objective measurements”. If it had been the there would be far less argument about it. However, as I said before, even if “completely objective measurements” had been made, the solutions required are very difficult to disentangle from political issues.

[Hint to Jim the myopic, there are two separate points above]

@ 49

“When you are earning less than $1/day you only have one goal.”

Yes. When you have a four to seven figure income and are a member of a democratic society you have options. For example, you may want to live in a society where market forces are tempered by humanitarian regulation.

But please do tell how low third-world wages show us that we need to privatise the NHS, I’m absolutely agog.

“Thanks to globalisation there are hundreds of millions fewer people “starving in the street” than there were a decade ago.”

That doesn’t change the fact (one that you seem almost frightened to admit) that unchecked free-markets can create an utterly desperate underclass with no welfare, no jon security and no real rights. The fact that markets are great in some ways does not mean they always deliver perfect solutions. Step away from the blind, worshipful ideology and start thinking.

Falco @ 53

If it had been the there would be far less argument about it.

As I said, by a good book on the subject and research it. The scientific arguments regarding the existence of AGW are over. Plenty of debate to be had over the likely outcome, though. The only people keeping this aspect of the ‘debate’ going are the lying Tory scum. Show me a decent person still ‘not sure’.

This is not about Global Warming, this is about the type of people who openly tell lies and distort the truth to keep their ideology intact. If they cannot choose the correct side on something as obvious as Global Warming and are forced into defending the undefendable over it, is it any sunrise to learn that those same people get every other big question wrong?

@Jim: It is well known that trying to lead the monumentally stupid to reason is an exercise in futility so I shall end my attempts. As a general point you may find that you have you more luck convincing people of your point of view if you are a bit more civil from the off.

@ 53

” Show me a decent person still ‘not sure’”

Based on this conversation, Falco springs to mind.

In honesty, you two are at cross-purposes to some extent. Jim, you’re thinking about people who say white is black to avoid admitting that climate change is a problem, and Falco is more concerned about how the known facts are applied to policy, and whether some of those known facts get exaggerated.

Science-wise, I still come down on Jim’s side. But then Falco isn’t throwing words like “scum” at people who disagree with him.

Falco @ 54

Who is trying to convince anyone of anything here? If you refuse to accept the World’s scientific community’s findings then nothing I am likely to say will convince you, is there?

You hate science, fair enough, but if you are prepared to let millions die in order to retain the ability to drive your car whenever you want, I think you have a bit of a cheek to expect others to be civil.

To be honest, I have been scratching my head to think of something that would cause the ‘Left’ the same amount political anguish to the extent we would be forced to abandon science rather than our principles if a scientific consensus arose. I think that is possibly because the ‘Left’ are instinctively more rational people, perhaps.

From what I have read or saw, I think if the ‘Left’ saw a scientific consensus grow on anything, I genuinely think we would, as individuals, deal with it better. I think I could adapt my stance on anything, if science could prove my personal beliefs were wrong. If science could prove the existence of God, for example, I think I would stop being an agnostic for example.

Chaise Guevara @ 55

I totally accept that when it comes to policy on how to combat Climate Change, then there is a legitimate debate to be had. I even accept that we can divide into our familiar Left/Right trenches. I am more than willing to accept that ‘the Right’ could have valuable insights to this problem.

I would even go further than that: I would suggest that the long-term solution to Global Warming is rooted in ‘Conservative’ ideology.

Take responsibility for our own actions.
The polluter pays.
Live within our means.
Frugal lifestyle.
Leave a legacy for your next generation.
Be a good neighbour.
Put Britain first (for Christ sake).
Protect our borders.
Think of the future, don’t just live for today.

Falco, Tyler and CJ would agree with any and all of the above. Everything I have written is good, solid large ‘C’ (and small ‘c’) Conservative values that Churchill could put his name to.

If we where discussing ‘obesity’, for example. Would you think your average Tory would be demanding that we spend billions researching pills or ‘innovations’ to make people slim? Or would the ‘Right’ be demanding that people modify their behaviour? Would the right just expect that fat people do something about their beer guts, or would they side with the fast food companies and give fat busting pills free? No, why know what their answer would be. So, why is that when it comes to their own behaviour, the science is denied and we can just carry on until ‘someone builds a machine’.

I use the term ‘scum’ to describe people who deny the existence of the evidence, or just makes up ‘facts’as they go along just because they wish it to be true. If someone denies the existence of the holocaust because it clashes with their ideology, or makes up fact to link homosexuality with paedophilia, how would you describe such people? Misguided? Confused?

Syzygy: “It has been clear from the start that the GPs would not be doing the commisioning but would be employing private health companies, populated staff made redundant from the PCTs, and that the NHS would be put into straight competition with private health care providers.”

Damn right. Although I wouldn’t say it’s been ‘clear from the start’ because mos people still don’t seem to have noticed.

The apparent aim is to make the health service into a profitable industry for corporations. I’m not clear on whether the Tories actually genuinely believe this would be a good thing for patients, but I know it won’t be.

Recent experience suggests that hastily cobbled together “competitive” part-privatised systems which remain wholly taxpayer-funded (see: railways, numerous PFI projects) are even more inefficient than direct taxpayer-funded provision, because the corporations involved can make more money playing the system (worsening the service while crying for more subsidy) than by providing a better service.

JUngle @ 58

The saving grace for these huge providers is that they will become like the banks, i.e. too big (or too important) to fail. What happens when your local hospital is threatened by closure? The Government of the Day will have to prop it up, that’s what.