NHS in meltdown

[Mike T]

Milton Friedman is an economist and clearly had little understanding of health care - he regards the reduction in occupied beds by 11% over a given time period as an example of inefficiency - it is the exact opposite. He does make a couple of good points - once you have nationalised a system you cannot nationalise it again, so any gain in votes is only temporary, and nationalised systems do tend to do a lot of what they shouldn't - the NHS does a lot that Social Services and indeed the public should be doing.
The current winter crisis is the worst since at least 1980, when I started to work in the NHS. I am so thankful I am retired, but that does not help those at the coal face. Stay away from A+E if you can, and from others if you/they have a transmissible infection. One of the main reasons for the annual winter pressures is the bug mixing festival we call xmas.
Any international comparison chart you care to look at shows that the NHS is under staffed/bedded/financed, despite which it gets surprisingly good outcomes. If it did not have to act as the fall back solution/safety net for social service failures/omissions/delays it would do rather better, but no government dares to grasp that nettle.

[CL]

Clearly? Tell us Mike how a reduction in occupied daily beds implies an increase in efficiency?

[Mike T]

Clearly? Tell us Mike how a reduction in occupied daily beds implies an increase in efficiency?

Because it means you have treated the people coming in in a shorter period of time. Of course the assumption is that the supply of patients is constant, which is false as the population is growing and ageing, so in fact demand is increasing, not constant. The NHS has considerably shortened its length of stay over the years, which fits with Friedman's observation, but his explanation of what this means is wrong. Hospitals are only meant to have 85% bed occupancy maximum, for efficiency and infection control - some at the moment have 104% - yes more patients than beds, hence patients on trolleys/chairs/on the floor/stuck for hours in ambulances.
This is planned failure so that the public will accept privatisation - and think of all the money making opportunities that involves. If you want to see how well this doesn't work look at the States health care system - about twice the cost of the NHS, far worse outcomes, a lot of people are not covered, and health care bills are a very common cause of bankruptcy.

[Mike T]

I have experience overseas. My son fell from a height in Menorca and had a lump on his head. Luckily a GP surgery was just across the road.
He wouldn't touch us until he saw the insurance.
At hospital, they X rayed etc and then advised he needed to stay in, so I stayed overnight.
The morning after, I had to wait for a Doctor to sign the release.
I advised I would just go if they didn't get on with it.
the allocated interpretor came to see me and explained that if I discharged my son before the Dr did, my insurance would be invalidated.

They realised him 24 hours and 4 minutes after we were signed in.

I called the insurers to advise them that they refused to accept under the then E111 and they said don't worry it is par for the course.
They also advised me that a 24 hour stay is more lucrative, hence the long wait until being released.

That is the problem with private health care - things that are not necessary but can vaguely be justified are done, and of course charged for. As an example, one of the biggest risk factors for having your gall bladder removed is having gall stones, but the other big risk factor is private health insurance.

[Witton Park]

This is planned failure so that the public will accept privatisation -

I think many might say it is planned failure so that the Government can be blamed.

[Witton Park]

That is the problem with private health care - things that are not necessary but can vaguely be justified are done, and of course charged for. As an example, one of the biggest risk factors for having your gall bladder removed is having gall stones, but the other big risk factor is private health insurance.

The problem is that we play ball. In our NHS they don't even ask for the European Health Card most of the time.
They treat and don't bother to claim back.
They also treat people from outside of the EU who do not have entitlement to free treatment.

The NHS has estimated that we lose £500m a year through this. If the NHS estimate this, you can bet it is higher.

But the BMA put a spin on it.
https://www.bma.org.uk/connecting-do...m-39-crackdown
Note they say "People who deliberately come to the UK to benefit from NHS care cost £100-300 million per year".
By using the word deliberately, they can promote a lower figure.
They can discount those that come, have insurance or the EU Health Card, but the NHS treats them without question and without using the patients insurance, which is bought and paid for and would save our NHS money, or bring it in much needed revenue, whichever way you view it.

But never mind, it's only a few hundred million. £300 million a year (at the lowet estimate) which is collected over the last 10-15 years would wipe out much of the current budget deficit in the NHS.

I think this brings to light the real problem, when one of the industry professional bodies has such as casual attitude to £100s of millions, is it any wonder that the NHS is in trouble.

The Treasury will stump up more, and if it doesn't, we'll soon have a Government that will.

[CL]

Because it means you have treated the people coming in in a shorter period of time. Of course the assumption is that the supply of patients is constant, which is false as the population is growing and ageing, so in fact demand is increasing, not constant. The NHS has considerably shortened its length of stay over the years, which fits with Friedman's observation, but his explanation of what this means is wrong. Hospitals are only meant to have 85% bed occupancy maximum, for efficiency and infection control - some at the moment have 104% - yes more patients than beds, hence patients on trolleys/chairs/on the floor/stuck for hours in ambulances.
This is planned failure so that the public will accept privatisation - and think of all the money making opportunities that involves. If you want to see how well this doesn't work look at the States health care system - about twice the cost of the NHS, far worse outcomes, a lot of people are not covered, and health care bills are a very common cause of bankruptcy.

Lets say I have 100 beds one day that can occupy 100 people. If I treat people faster due to efficiency savings I could drop the number of beds to say 85 and still treat 100 patients. But if I'd increased the number of beds to 125 or kept it at 100 with the increase in efficiency I'd still be able to treat more patients.

You cannot say with any certainty that the 11% mentioned by Dr Gammon, relayed by Friedman is down to people being treated in a shorter time rather than less beds. You're assuming efficiency but what about things that affect inefficiency such as red tape? For example it is known that hospitals started discharging people before they were properly treated to massage the statistics I.e. make them look more efficient than they actually were.

[CL]

Because it means you have treated the people coming in in a shorter period of time. Of course the assumption is that the supply of patients is constant, which is false as the population is growing and ageing, so in fact demand is increasing, not constant. The NHS has considerably shortened its length of stay over the years, which fits with Friedman's observation, but his explanation of what this means is wrong. Hospitals are only meant to have 85% bed occupancy maximum, for efficiency and infection control - some at the moment have 104% - yes more patients than beds, hence patients on trolleys/chairs/on the floor/stuck for hours in ambulances.
This is planned failure so that the public will accept privatisation - and think of all the money making opportunities that involves. If you want to see how well this doesn't work look at the States health care system - about twice the cost of the NHS, far worse outcomes, a lot of people are not covered, and health care bills are a very common cause of bankruptcy.

But Mike the USA private health care system isn't the only private system open to us. We can remove it's flaws and adopt it's virtues. For instance by deregulating the system. Here's one example argued by Milton Friedman: https://www.youtube.com/watch?v=UmVrfbfKBIk

[CL]

Mike-T, since you argue the superiority of state health care over private health care, am I correct in presuming you wouldn't touch private medical insurance?

[noel]

Mike-T, since you argue the superiority of state health care over private health care, am I correct in presuming you wouldn't touch private medical insurance?

This is an interesting argument that I've heard in a number of situations. It's akin to politicians who back state education being called hypocrites for sending their kids to a private school.

It would be possible for someone to believe that a state health system is the best way forward and to believe that this should be adequately funded and well managed. However, if the NHS is not functioning properly in their local area, it would also be reasonable to opt for private medical insurance, while still holding the view than the NHS is the best way forward long-term.

Or to put it a different way: I wouldn't call someone a hypocrite if they were calling for improvements in water quality, while at the same time refusing to drink river water.