Choice
That is the word which, I'm told, lies at the heart of today's NHS Plan. Don't be surprised, however, if other more politically appealing words such as "quality" (as against "quantity") and bottom-up (as against "top down") take pride of place in the presentation of what we're being told is the most important day for the health service since it was formed 60 years ago.
The surgeon-come-minister Lord Darzi believes that patients need to be given greater clout in the health service and that the information revolution will allow this to happen. He's planning to give us all absolute freedom of choice about where we're treated and to supply us with the data to allow us to make informed choices.
Surgical teams will be forced to publish annual quality reports which record their performance in terms of safety, medical outcomes and patient satisfaction. So, in theory at least, we'll all be armed with the equivalent of "Whichdoctor" and able to travel anywhere from Lands End to John O'Groats to get the best possible healthcare.
What's striking about this is how similar it appears to be to the recently released proposals from the Tories. Ministers say that Team Cameron can't mean what they say since they resist the introduction of increased capacity to the NHS - in the form of controversial new GP-led health centres or polyclinics - and hospital reconfigurations.
Whoever's right, it leaves me wondering how much choice there really is between the government and the opposition in this the NHS's 60th year.
I'm 
© MMIX~RS~q~RS~~RS~z~RS~52~RS~)
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Nick,
If there is virtually no difference between the Conservatives and NuLab in respect of the NHS, why is it that the Beeb allows ministers and others to claim that a Conservative government would mean the end of the NHS as we know it?
All the best.
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I'm sure many people will say this, but I don't want the "choice" to travel hundreds of miles to get treatment. I'd like a decent hospital near me for everything except particularly specialist treatment.
Luckily, I've had nothing but excellent service from my local hospitals and other healthcare in Bristol. Bit of a long wait sometimes, but nothing that'd make me want to travel for hours to go elsewhere - what'd be the point?
Just spend the money on improving services. Please.
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Nick
If you are right about 'quality' being the spin to sell the notion of the debased coinage which 'choice' has become, do you think it might occur to those concerned that if we had quality we would be less concerned about choice ?
The problem isn't that we lack choice it is that we need choice - due to standards too often being poor.
Also, I read with great apprehension you comment that Lord Darzi thinks the information revolution is key to all his ambitious plans. You would think that NHS of all organisations would know the perils of grossly over-estimating the effectiveness of informations systems and horribly under-estimating their costs.
As for performance data, surely we know by now that it will be manipulated and unreliable and bring with it dysfunctional behaviours ?
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2:
I think if it's a question of life saving treatment you don't mind the travelling bit. I have been compelled to travel to The Royal Liverpool from Surrey on numerous occasions to have treatment for an eye melanoma and have also had good service from ward stays in my Local Hospital. On the other hand I've also had to wait hours in casualty and in consulting waiting rooms for various afflictions but have just accepted it as part of The NHS promise to treat everyone. The latest initiative is on the right lines but I'm afraid I'm now so cynical about this Government's motives for making announcements that I'm tempted to take it all with a pinch of salt. It's a sad legacy of their previous actions on all kinds of matters.
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Wendy Alexander going, 5th in Henley, major donors coming out to put the knife in....The above is a policy issue on which you zero expertise to comment and what the BBC do not do enough of. Stick to the politics.
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When a politician says 'choice' it does not mean what we the English public would expect it to ordinarily mean.
No Sir.
When a politician says 'choice', he or she usually means within a carefully defined framework, often based on some political dogma.
So, the politicians 'choice' means you may be able to send your children to a school, but it will be a school on a list that we will provide i.e. no independent schools will be on that list, and other 'filters' will apply.
So in reality you, the parents, actually have hardly any meaningful choice at all.
Ditto, as per this blog entry .. hospitals.
You'll have a 'choice' of hospital to attend but it will probably not include any quality private hospitals in your area.
Choice but no choice ... the politicians effortless paradox.
As MP Diane Abbott cheerfully said 'yes, its indefensible '.
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I don't understand why politicians think that 'Choice' is a vote winner.
It sounds so bland!
When compared to other countries, I expect the NHS to provide me with 1st class care.
I expect as a minimum standard excellent care from all NHS facilities and that I will need to attend certain locations if I require very specialist treatment.
I don't want to hear how I will be offered choice - I want to hear politicians who are going to demonstrate how they are going to raise standards and survivability.
Policies should reflect the current governments failures:
- More people die of hospital contracted diseases in the UK than in other countries.
- Tax payers do not get value for money
- Spend more money on the front-line rather than wasted in Quangos or PFI contracts
- Reduce waiting times (not fiddle figures)
- Demonstrably improve the health of the nation.
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The only reason Labour want polyclinics to be open twelve hours a day is to try to make GP's work longer hours. Labour need to peg back some of the money which was mistakenly given out to GP's a couple of years ago. This was a huge monetary mistake at the time although it wasn't given much publicity.
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Nick the answer to your last paragraph is a "No brainer"
Cameron was the author of the Conservative parties last manifesto, I suggest people look it up and read about patients passports. Then the next task I would suggest is to question Andrew Lansley thoroughly and ask him what exactly did he mean when he said verbatim quote:
"Any Hospital that over-spent it's budget would not be baled out. They would go into recievership."
He said so loud and clear, beyond a shadow of a doubt on anothe news Channel and the Political Editor did not even bat an eyelid at that statement!
The Conservatives wanted to smother the NHS at birth, they fought against it tooth and nail before 1948, they had to be bribed to accept it,reluctanlty went into it kicking and screaming then, and have tried ever since to undermine it and privatise it.
To have the Conservative in charge of that would be akin to having Dracula in charge of the blood bank.
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Shame it didn't come out 8 years ago before the then Chancellor hosed money at the health service with very little to show for it.
It's still getting away with killing thousands of people every year and not being held to account.
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2:
I see now that you did add 'for everything except particularly specialist treatment.' which was the case with me. Of course I would have preferred a Hospital much closer to me as I always find a car trip to Liverpool quite traummatic.
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First let me say that I was conceived on or around the 5th April 1948, born 7th April 1949. I hope that everybody therefore understands my absolute belief in the NHS.
Also, understand why the NHS came into place on 5th April 1948 because nine months later people would be born in the new tax year! Ah, the planners were thinking into the future even in those days.
I have been well treated throughout my life, a broken leg, a hernia, malignant melanoma, gall baldder removal, sight problems and dentistry. Also, a few psychological problems but that's something else.
However, I cannot say the same of my parents, and it is here that I think the problems of the NHS become manifest. It is not acute care that we need to worry about. It is the chronic long term care where I demand that the government, of whatever faction, take action, urgent action, to solve the problems.
There must be a formal merger between Health and Social Care, with the costs being born nationally, not through local taxation, that is the council tax.
My reasoning! In the westcountry many people retire here because of the climate. Now, the people have usually lived, worked and paid their local taxes where they lived, the SE, Midlands, NE etc.
However, the burden for their care in old age falls on the westcountry, yet there has been little or no contribution to the local economy. The burden for care cannot, no must not, fall on the taxpayers of the westcountry.
I know that these people have paid for their taxes in their local community but it is not where the want to receive the benefit.
So, unless they want to return to where they came from for their long term care then the situation is unsustainable. Do they have a choice, yes! But will they want to take that choice, I very much doubt it.
Finally, as for choice remember that most people will want to be treated where their family live, to give support, so it is unlikely that somebody in the westcountry will want to go to Newcastle for their treatment. Where would be their support mechanisms. Can you even imagine somebody from Lands End wanting to be treated in Bristol. How on earth would their family travel to see them. That is unless you are operated on in Bristol and then returned almost immediately after surgery to a local polyclinic!
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Dear T A Griffin. As I'm sure with your poor mother's 12 month gestation, an excessively painful burden of is borne willingly in the hope of a bright future from latent potential - this however does not rule out the need for "corrective action" to tackle bad behaiviour.
As for choice, I agree with most people that I'm not interested in choice if the local services are decent, but show me to a bed on a dirty ward and I'd want the choice to go somewhere else.
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"controversial new GP-led health centres or polyclinics"
yep; they are very controversial; what I don't understand is how a polyclinic (ie a new larger centralised clinic) means that your own local GP surgery can still remain open; that's what the government say will happen but I don't see how that can happen.
The local authority only get so much money, and the GPs can't be in 2 places at once, so the government line on that doesn't seem to make any logical sense.
Maybe some of the labour supporters on here can illuminate how we can have new/larger/centralised polyclinics while at the still time still also being able to see our GP in our existing local surgery.
The only way I can see that being physically possible would be if the government suddenly magic'd up thousands of new GPs and doubled the spending on local authorities' GP services. Is that what they're intending to do?
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The difference may not be evident in the words they use, but it is very clear in what they actually do. I suppose it's possible that a Cameron government would not run the NHS down by long-term underinvestment, as previous Tory administrations have always done in the past; but his opposition to providing the funding that has made the new announcements possible does not bode well.
I do agree with #12 T A Griffin (TAG) that there is a massive problem with long term care. I declare an interest here, but I think we need a review of the priorities that the NHS should address. It seems odd to me that obesity and infertility should be regarded as 'medical' conditions, whereas dementia is not. In fact I often wonder where the idea came from that a woman has a 'right' to have children.
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Th eNHS has never let me or my close family down. My great uncle (probably once removed or whatever) is in a wheel chair because there wasnt a cardiac specialist surgery bed available to treat his disecting aortic aneurysm before the blood loss was too much.
However, the NHS has saved my dad twice, my arm once and is giving okayish prenatal care for me and the Mrs, although our choice consists of going to this hospital, and no others.
However, it turns out we can use a specialised maternity centre in another PCT, but had to find it all out by ourselves.
Related to NHS care, our ante natal classes consist of 4 sessions, with two midwives who dont do it very often, are reading from cue cards and thats it. Luckily I could stump up the £120 for the local NCT classes or I'd be bloody terrified, compared to the just terrified I am at the moment.
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#14 getridofgordonnow :"....... if the government suddenly magic'd up thousands of new GPs and doubled the spending on local authorities' GP services. Is that what they're intending to do?"
Well I know you were trying to be facetious, but as I understand it the simple answer to your question is 'yes'. The health centres/polyclinics are being funded from completely new money, and the massive increase in the investment in training doctors means that there will be more available. There's no magic involved though; just solid investment in the NHS.
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12. T A Griffin (TAG) wrote:
"First let me say that I was conceived on or around the 5th April 1948, born 7th April 1949"
Three months overdue? Your poor mother!
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The choice I want is who to vote for in a general election.
We have been denied that twice already - can we have an election soon to have a chance of being rid of this shower in government, and to have some sort of normality from the 'big brother' cullture that is enveloping us.
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Jim - probably because with out kids, the country dies out
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no difference between Tory and NuLabour NHS policy?
I beg to differ.
Compare and comtrast posts #7 and #15
#7 hats off to the choice is smoice argument; what taxpayers have paid for is 1st rate service. What doctors and nurses signed up to all those years ago to deliver was 1st class service.
#15 eleven years in and ten reviews later the NuLabourites want yet another review; they still haven't decided what exactly itis they want to do with it. How can you possibly claim to be an effective party of government if after eleven yers and ten reviews you are asking for another review to decide what to do.
Total incompetence and vacillation. Ditherinng and distraction and prodigous wasting of taxpayers money. No wonder Patricia Hewitt was booed by our nurses.
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re: 17 jimbrant
"The health centres/polyclinics are being funded from completely new money, and the massive increase in the investment in training doctors means that there will be more available."
really? that's pretty scary stuff; I honestly didn't know the underlying logic behind it because it didn't seem to make any sense the way the government described it.
so, what they're saying is that we already have the right number of doctors for patients give or take a few, but that they want to double up the number and just double the budget so that they can create an extra layer of services that they don't need at the moment? doesn't that strike anyone here as a bit of a waste of money? why fund the same service twice?
Remember that all "new money" comes from tax payers; it's our money not a magical government pot that appears from nowhere.
If doubling the budget to create an extra spurious level of service that most people don't want is labour's way of doing things, then when it comes to all arguments about Brown/Labour not being economically competent or being able to manage things generally, I think I rest my case!
Our local surgery's going to close because of this by the way; so those new doctors and the extra budget that you talk about doesn't seem to have appeared where I live.
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16#
Don't worry lad it gets easier after the sixth.
Just wait until you are at home and the new bundle of joy arrives before the Doc or Midwife and you are a husband who does not know if he is going for a shampoo, "s... "or a haircut as he is in his usual state of panic while it was happening as mine never failed to do.
That is what is called terrifying.
They still survive hardy little blighters, with the "Help" of husbands or not.
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I think choice is very important.
I would like to choose to opt out of the NHS for all but emergency treatment.
I would use the saved money to pay for my own treatment (should I ever need any) from far more efficient sources - leaving me more money for other things.
p.s. The only reason I'd need the NHS for emergency treatment is because their current virtual monopoly excludes any competition.
The NHS is not 'free', it is paid for -in full- by tax payers. It is an inefficient state monopoly of the worst kind.
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Let me tel you a story.
After about 35 years of no contact with the NHS whatsoever I visited my doctor with a small problem.
My doctor said that she wanted to refer me to a specialist. Some time later I received a letter, complete with a password, asking me to phone an appointment making centre to arrange a hospital visit.
On contacting the centre I was placed no. 7 in the queue, after 2 previous attempt this was my best position yet so I held. I think I waited about 45 mins before I reached a human. I was then told it would take about 10 minutes to arrange the appontment. Simple maths would indicate that the human concerned was probably the only one of two on duty, and given an average say 6 hour effective working day only about 72 appointments a day could be handled.
So the ten minutes started. I was asked first for my ethnic origin - why for goodness sakes, confirmation of my name and address, and my doctors name. With quite large gaps between the questions. All this information could easily have been transferred to the appointment centre prior to my call.
The point of this is that the are clearly opportunities for productivity savings in the NHS without degredation of service, probably with improved service. And I thought in my absence of contact that it was all supposed to have got much better.
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15#
the proof of the pudding is, just take a look at Cameron's voting record on the NHS. He has opposed everything.
Then ask yourself is the NHS safe in his hands.
I would say it was just about as safe as playing hopsctotch in the fast lane of the the M1.
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Of course there's no difference - that's why brown asks cameron so many questions at PMQs as he doesn't know what to do next himself.
... then they take the tory policy, water it down, gilt edge it, implement it badly, watch it fail and then blame the tories for coming up with the idea.
Choice in the NHS is good... yes, people want all hospitals to be good and don't want to always travel hundreds of miles to get treatment esp. if it's for something simple, but if I have something like cancer then tbh I wouldn't mind travelling around the world if it meant a better chance of survival - I want that choice and the information and advice to make that choice - not just be told where I'm going and if they have manipulated their stats well to hit abritary targets.
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25#
Just think how it was under the Conservatives.
If you were lucky enough you got placed on a list after 2 years waiting to see a specialist.
And if you were lucky enough not to die within the next two years you might even have got to actually see the Specialist without paying privately for it, and managed to get a bed.
But not in the winter as there was a winter bed crisis every year for 18 solid years.
Happy, halcyon days, let's have the Tories back, tax-cuts, services slashed and quite a few happy people, whose God is "Money"
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@23 - Trudy, 6? Bloody hell, I dont know whether to offer congratulations or commiserations ;)
My main aim is to ensure the Mrs has had her finger nails cut and that I'm at the clean end, also that I remember my trunks to go for a swim in the birthing pool. (pre birth of course).
For those who are pregnant or looking at getting pregnant, the NCT classes are well worth it.
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Just in case I become Ill, were do I get the brochures? If I have an accident, Will there be some on the ambulance?
Choice will be a luxury of the middle classes who can afford to travel or move house,like with schools. As well as sink schools we will now have sink hospitals. Who feels they are qualified how to interpret this data? A gimmick from both Labour and the Conservatives who are offering this.
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6 years ago, the NHS saved the life of my mother-in-law, for which we were all greatful. However, a year later when the cancer returned, it took them six months to arrange a scan to determine where it was, and in that six months it had spread too far to do anything, so having saved her life they then condemned her to a slow painful death.
My father has just had a cancer scare. Having finally made it from one list to another until they had decided he needed scans in hospital, he was told he would be phoned and provided with a number to call so that he could speak to the bed manager about when to come in (why the bed manager couldn't just phone him when there was a bed available I don't know).
After a week of hearing nothing he got in touch with his consultant, who informed him that he should ring the hospital twice a day to pester them for a bed because "those who shout loudest get the bed first". He eventually did get a bed. He arrived on time in the afternoon and was told the doctor would see him that evening - nothing happened. He was then told he would be seen in the morning - nothing happened. He was then taken for tests (different tests than he had been booked in for) and told the doctor would see him at lunch - nothing happened. He was finally seen by a doctor in the afternoon who told him that he still needed the test he had originally come in for, but that would be done as an outpatient at another hospital.
He has now had the test. He has been given an appointment to discuss the results exactly 4 weeks after the test. However, when he asks when the results will be ready, he is told that they don't know. He even asked if the results would be ready for his appointment and they said they couldn't be certain of that! In other words, the apopintment is there because of target waiting times, and if there are no results to discuss at least we've ticked that box.
I'm afraid my recent experiences of NHS care have not been great, and that's without going into what my gran had to put up with for years as well.
Cut the admin, cut the red tape, let doctors and nurses get on with the job and stop interfering.
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I can still remember the allegations by New Labour that only they could be trusted with the NHS. A vote for the Tories was a death knell for treatment free at the point of delivery. The Tories will privatise the NHS Etc Etc.
Now, after a decade of throwing billions at it for precious little return in improvement, Labour are starting to embrace private involvement in health services. With the ever spiraling cost of modern treatments, and an ageing population, it was always inevitable. How much has the decade-long denial of reality cost the taxpayer? How many lives have been lost or irreparably impaired for pure political cant?
Labour politicians should be ashamed.
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29#
Stay cool Lad, stay cool.
The ladies have been doing this since before Eve,
despite help, not because of help, from our well intentioned husbands.
It's well worth it when the bundle of joy arrives.
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I broadly agree with the definition of 'choice' described by #24 .. that choice within and without the NHS.
It is important to understand that the State, via the taxpayer, must be there as the 'provider of last resort' for health care.
This is because some items of medical kit are so expensive that a 'private' provider could not justify the cost of the equipment as they would never obtain a satisfactory return on investment.
If we English could somehow remove political dogma from health matters, we'd all be a lot healthier.
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The NHS is a beautiful thing and a stunning invention!
It may not work all the time, but those who complain whould try getting treatment in the US for free!
The problem with the NHS is that it will never be perfect and we have come to expect perfection. It is odd that we should expect so much considering it has never been ideal.
Whatever anybody does to the NHS it will be a positive move for one section of society and negative for another.
What the Govt needs to do is let the NHS manage itself (like a private enterprise but not private), cut out the red tape and free up the staff to do what they have been trained to do.
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So can I 'choose' not to hand my national insurance contributions over to the shareholders of private companies?
Didn't think so....
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Churchill's "choice" was to abolish it in his first government after the war! Thatcher got rid of thousand of 'unnecessary' beds and flogged off the sites to...
Now, all parties declare that the NHS is safe in their hands, but is it. The Conservative Party deeply worries me about their commitment to the NHS. They have a history - a very worrying history.
Politicians on the advice of their Civil Servants have made a number of poor decisions. The positively idiotic way in which the computerization was ,and is still, being undertaken for example.
Unfortunately 'Choice' will not be able to be implemented until, and if, the computerized booking system is implemented and working along with the patient record system (2015?) That is after the government after next! (2 General election's away.) So any party talking about choice is talking through its ignorant hat.
Of course a rational and sensible way of computerizing the NHS may result in an earlier date, but only by a few years. On this basis I question any party's commitment to any form of patient centered choice. They are either ignorant or dissembling.
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I find the notion of choice in healthcare a complete joke and a buzz word used by the political classes which means absolutely nothing in practice but which they think they can fool ordinary people into thinking they are doing something .
The Idea of markets is also a joke since people who are ill have no choice as to what treatment they need regardless of supply and demand and the idea that a large hospital will be allowed to go bankrupt and close its doors is a choice piece of fantasy
People want to be seen quickly and close to home when they are ill and receive effective treatment as soon as possible not be given the choice of 5 hospitals and a long waiting list
Choice is only relevant if people want a private room, Films or want to order something better than hospital food
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Trudy Victoria - sorry when you walked into a hospital under the Tories did they trun you away and say 'sorry, you vote Labour'.
I'm sorry but despite the ramblings of all the NuLabourites here the NHS was still a functioning service before eleven years, 97bn spent per annum and ten reviews. All that has happened is pay has gone up and the number of managmenet consultants has gone up.The treatment is still the same.
What is diabloical is the level of demoralisation amongst its staff which is a direct product of eleven years of NewLabour meddling.
Get you hands off our NHS.
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Yes, Nick, I think you're absolutely right.... the only difference between Labour and the Tories is the rhetoric they use.
What we must remember is that we do have political choice in this country only not with those two parties. The Liberal Democrats seem to be the only party that knows what they're doing at the moment, however, the electorate are ignoring them.
Maybe we as voters need to have a look at ourselves and think about the part we've played in making a mess of things. I'm still stunned that anyone voted for Tony Blair 11 years ago - you could smell the cheap aftershave a mile off.
Anyway, health proposals, yes, great, they even got the right man for the job. Just wonder how these proposals will look once the politicians and bureaucrats have tried implementing them.
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The NHS must not give into kneejerk reponses on the basis of shallow critique from the selfserving BMA types who were the ones who opposed the creation of the NHS at its inception and now oppose any attempt to make it responsive to the current needs. They want the money but expect all of us to go on bended knees to avail ourselves of the services that are paid for from the public purse not unilike the denizens at the BBC.
The chances of the conservatives reassuring us that the NHS is safe with them is like getting a straight answer about Caroline Spelman and her nanny. Nick is there any reason why we have continued silence from you on this too !!!!!!!! whilst we are
being reassured by Levy on newsnight under the auspices of Miachel Crick that he is a now a
paragon of virtue and best placed to comment on the leadership needs of
the labour party and the country.
There is a better chance of improved choice and care in the NHS than there is of balanced comments from the BBC/conservative central office . Is Jeremy inviting you to the next fishing trip with georgy osbourne!!!
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Why are my comments no longer getting through? I suddenly lost the ability to post about an hour ago for no obvious reason.
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Hi Nick
The only thing what concerns me about todays NHS is the level of bureaucracy that exists. I hope today's announcement will go someway to removing the uneccessary targets and red tape that is rife.
Wether or not people are a fan of "Socialised Medicine" as Ronald Reagan put it, we should all keep in mind that we are the envy of the world and that no other country either richer or poorer has any healthcare system that comes anywhere close to the NHS.
As a former Hospital Porter, Today like most days I feel immensly proud of the NHS and all it's staff.
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#39. As it goes, 32,000 beds have been lost in the NHS between 1997 and 2007. This was given in a Parliamentary answer in May 2008. The statistic takes the average numbers of beds available in England across all sectors. This means that there were more beds under the Tories than there are under Labour.
In 2007, 40% of mothers in labour were turned away and hospital acquired infections have increased.
What the Tories failed to do when in Government was implement fully the PFI programme they devised soon before they were voted out. If they had of done, who knows what the public impression would have been?
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Dear #13, and my #12
you are of course absolutely correct. What you must understand is that I always try to make one deliberate mistake so that then people write comments like yours which then proves to me that somebody has read 'my piece'. I was definitely born on the 5th April 1949 so, to be exact my conception was on or around 5th July 1948.
Thank you for being so observent. However, I am not able to check with my late parents to obtain their view as to whether I was conceived to celebrate the NHS. What I would say is that father always made me feel just that little bit guilty that I was not born in the previous tax year. He would have got a full years tax allowance. Just joking dad.
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For anybody who has any complaints with regard to the imminent end of single doctor GP practices I would suggest that they remember the late Dr Harold Shipman, that is why there is a problem in the NHS. The man was a disgrace and has caused this change in our historic way of having local GPs. How was he able to get away with his fould deeds for so long. I would like to use some very strong words to describe what I feel about that man but they would be moderated out.
Suffice to say he has ruined the wonderful relationship which existed between GPs and their patients.
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#44 TerrNo2: "In 2007, 40% of mothers in labour were turned away "
I would love to know your source for that amazing, and I am sure inaccurate, statement.
It is true that there are now fewer beds in the NHS. That's because fewer beds are needed. Advances in treatment mean that procedures that used to require a couple of weeks in hospital can now be done and the patient s allowed home on the same day. That is a better situation, not worse.
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#22 getridofgordonnow: "Our local surgery's going to close because of this by the way"
Sorry getridofgordonnow, the system won't let me reply to your post. Goodness alone knows why.
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Here's heresy: the NHS does not offer the best healthcare medical care in the world. Far from it.
It is over-bloated, inefficient and expensive compared to European services - which are mostly superior in all respects.
It is, however, the world's third largest employer.
Another interesting fact: In 2005 MSRA, C. difficile and other infections killed over 5,000 people in hospitals in England and Wales. In the same year 3,201 people died on the roads. (I've not been able to obtain reliable statistics - ONS or similar - for 2007).
invisibleMorrissey @43 claims:
"we should all keep in mind that we are the envy of the world and that no other country either richer or poorer has any healthcare system that comes anywhere close to the NHS."
To which I can only respond:
a) you are 60 years out of date.
b) you obviously haven't travelled abroad.
The NHS is being treated like a holy cow. It needs slaughtering and a totally new, fair and efficient system to replace it.
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My wife was a RGN, but due to only having 33% of her shifts with patients, the rest doing paperwork, she's left the vocation.
Its one thing to be efficient, but the constant changes in policies has destroyed the NHS. Using a medical analysis of whats happening is akin to having a scab and keep picking it off. he only way it will get better is leave it alone and let it have time to cure itself. The longer the NHS scab is picked the bigger the chance of it becoming infected, in the NHS's case, Labours tinkering amounts to polictical MRSA - Ministers Ruining State Assets.
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Just quality please. Everywhere.
Like most people, I would like a quality hospital near me with reasonable waiting times. I then wouldn't worry about choice.
Did anyone see Andrew Marr's progeramme on Sunday? Gerry Robinson, who made the programmes on Rotherham Hospital (and is a Labour donor - £70k) made a very telling comment.
He said that with a budget of £100billion per annum the NHS should be the best health service in the world. And that could happen if politicians kept their noses out . He said if they appointed people to run the whole heath service and only set the parameters it could be much, much better.
And he said that when he was at Rotherham, everyday the chief exec received new instruction which sometimes went against what had been required a few days before.
Total lack of strategy.
Also politicians, all politicians, are no good at management and should leave it to those who can.
Very interesting.
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47 jimbo - correct
The actual news item was
"Maternity units closed to mothers
Many hospitals across England had to turn away women in labour last year because they were full, figures show.
More than 40% of 103 trusts that responded to a survey by the Tories said they had shut their doors or diverted women to other sites."
Not 40% of mothers but quite bad I think.
But since it was Conservative research it will surely be rubbished!!!
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#47, and people returning to hospital after complications because they've been sent home too early is a symptom of this idealology. People are people and have different needs, sadly the clipboard types don't recognise this fact, they say "It says on my list that they need to be kept in for 24 hrs (or whatever)" and the vunerable are sent home before they are ready.
And for the misinformed, a bed is counted as having the required staff ratio to manage it.... How many nurses have left the service, on a 32,000 reduction on beds?
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#47. Here's the reference. However I have to say that I meant to say that 40% of maternity units turned away mothers in labour as opposed to "of mothers in labour". Sorry for that. Here's the reference:-
20/03/2008
Financial Times
Nicholas Timmins
NHS and Health Sector News
Almost half of NHS hospitals were forced to turn women in labour away last year because they were full, according to new figures that reveal the "shocking" state of NHS maternity services. The figures, based on information from 103 of the 147 English NHS trusts that provide maternity services, show 42 per cent admitted having to turning women in labour away at least once during 2007. Nine per cent did so on more than 10 occasions. Maidstone and Tunbridge Wells NHS Trust, which was at the centre of a major clostridium difficile scandal, is to build the first hospital in the country in which every patient will get their own room and ensuite bathroom in an attempt to combat superbugs.
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Alas, just more bla-bla-bla.
How often have we heard that single-sex wards will be the norm, and yet, the patients, particularly the elderly are forced into ward arrangements which deny them basic dignity. Ah yes, dignity, that's the word being bandied about in this new 'charter' of promises.
Then there is cleanliness. We don't want to hear about massive spring cleanings, where what should be done daily is made to seem a unique sterile operation!
In the end, what we have heard is the same old target nonsense. Bla-bla-bla!
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#54 TerryNo2: thanks for the reference, and the admission of error.
Of course the figures look bad (that was the intention of the so-called research), but in fact they are almost certainly not. Included in the 40% are those who only did it once in an entire year, and of course the reasons for it happening are not explained. According to #52 mikepko, the numbers 'turned away' (emotive phrase) included those just referred to a different unit, so we are really not looking at the stable in Bethlehem scenario.
There have been problems in maternity care, partly caused by an unexpected increase in the birth rate (I think), but this sort of scare mongering does nobody any good. Tory spin, anybody?
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#53 wighttory: "And for the misinformed, a bed is counted as having the required staff ratio to manage it.... How many nurses have left the service, on a 32,000 reduction on beds?"
32000 fewer beds. 82500 more nurses. You answer your question, and question your assumption.
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# 49 slates the NHS.
I remember being in Christchurch, NZ a couple of years ago and reading an article in the local paper by a healthcare expert.
He pointed out that the NZ NHS and the British NHS both have the worst health outcomes in the developed world.
The article went on to explain that there were other healthcare models that offered more positive results, I think the German model was particularly well though of.
The problem here, as I see it, is that the NHS has become a political totem/sacred cow for both Labour and the Tories.
That attitude is a kind of closed mind and really unhelpful.
Dump the main-stream party politicians and things would rapidly improve and not just in the area of healthcare.
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I guess it does look rather odd, that maternity units turn mothers in labour away, although given a reduction in beds it's not surprising. But the reason for the reduction in the number of beds, we're told is because of improved treatment. Since treatment is always improving then we should expect more wards to close. However. at the same time, the number of nurses have - we're told - increased by 82,500 and so have the number of cases of hospital acquired infections. It's a odd collection of statistics.
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Bet Lord Darzi saw the Tories files Nick!
There is quite a lot that the Tories do not agree to in this dossier.
The main difference is that the Tories might want us to believe that they are doing the same things in a different way, when in actual fact they are giving us CUTS.
Good night Nick.
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57. At 7:31pm on 30 Jun 2008, jimbrant wrote:
#53 wighttory: "And for the misinformed, a bed is counted as having the required staff ratio to manage it.... How many nurses have left the service, on a 32,000 reduction on beds?"
32000 fewer beds. 82500 more nurses. You answer your question, and question your assumption.
--------------------------------------------
82500 taken on, but I asked how many left the service. IIRC its in the region on 46,000 since 97.
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#61 wighttory: No, it's not 82500 nurses taken on. It's 82500 more nurses being employed. The number who left may be interesting in itself, but it is immaterial to the relationship you quoted
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@ 49.
Yes granted I was quite general in my first response, Cuba is the only place which might come fairly near.
You obviously have no grasp of what reality is like in the NHS, Or you are a paper shuffler who never sees a patient from one year to the next.
People come from across the globe to access Specialist centres on the NHS for
eg... Hepatology,Haematology etc...
So in my view the puts our NHS as a worldwide leader in both terms of excellence and prestige.
Also judging by your points I'm guessing you've never experienced healthcare or spoken to anybody regarding healthcare in the USA then? People having to take loans out just to have basic drugs/investigations etc...
And yes I have travelled abroad on many occasions.
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#58 JohnConstable: In common with a number of others on here, you claim that the NHS comes out badly in international comparisons,but I think that should be challenged.
It is notoriously difficult to make this sort of international comparison in any area of activity; it depends to a considerable extent on the factors you choose to measure, the extent to which thay are actually measurable, and the contextual factors that come into play. For example, the NHS has to deal with a population which has probably got used over decades to the poorest diet, the greatest level of binge drinking, and relatively high levels of smoking.
However, comparisons are made. You might be interested in a recent (2007) study by the Commonwealth Fund, a private US Foundation that specialises in health care research. They looked at six* developed countries, and assessed the quality of their health care systems using a 9 factor process. It might surprise you, and others, that the UK NHS came out as the best system overall. It scored highest of all on quality of care, coordination, efficiency, and equity; and was in second place in terms of offering the 'right' care, and safe care.
This does not mean that your report from New Zealand is wrong; the study found that in terms of 'healthy lives' the UK and NZ were (equally) behind everyone except the US. BTW, the US came out sixth overall in this study.
I don't claim that this study is in any way conclusive; I'm sure that its methodology will be criticised, because academics ( and especially clinical academics) always criticise other peoples' methodologies, and it does not include the grossly overfunded French system. But it does indicate that the assumption that the NHS does badly in international comparisons may not be entirely justified, if at all.
(*The six countries in rank order in the study were: UK, Germany, Australia/NZ (equal), Canada, USA.
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jimbrant getridofgordonnow TerryNo2 mikepko etc
Interesting article below that I would like to throw into the pot.
http://news.bbc.co.uk/1/hi/health/6314301.stm
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invisibleMorrissey @63 wrote:
"You obviously have no grasp of what reality is like in the NHS, Or you are a paper shuffler who never sees a patient from one year to the next."
The last time I was in an NHS hospital it was to see the dead body of my grandfather. He was left to die of thirst.
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#65
If you have the stomach for it, here's something else ...
http://www.audit-commission.gov.uk/Products/NATIONAL-REPORT/F27AD3E2-7FF4-4cdd-BB92-DF5C4BDD18FF/AuditCommissionReviewoftheNHSFinancialManagementandAccountingRegime25July06REP.pdf
Try flipping to pdf page 67 for the Recommendations.
It's the results of an Audit Commission report into the NHS. What it shows is that financial mangement in the NHS has been weak. Increased spending has clearly not been been managed to achieve an optimum level of output. 32,000 fewer beds, 85,500 more nurses, 40% of maternity wards turning away mothers in labour. Just about says it all.
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Argh, we don't want to choose between good or bad hospitals, we want them all to be clean and safe and organised. My mum works in the NHS and she's related countless stories to me of managerial ineptitude and box-ticking gone wrong. And the amount of waste is eye-watering--- just one example, the staff are forced to spend unnecessarily from any leftover budget in order to save it from being cut in the following year. After all, they obviously have too much and it should be cut in future instead of adding it onto the next year, right? My mum's ward bought several microwaves for the staff room. If they hadn't, they would have been punished for being under-budget.
The NHS as it is a horribly tangled web, and instead of untangling it and tidying it up the New Labour spiders are gorging themselves on our statistical juices. Somewhere along the line the government have forgotten that the NHS is there to provide on-the-spot medical care, not to harvest data so they can spy on us. Get a grip government! People will respect you for sorting out problems, not for (amongst other things) monitoring our every move and trying to wrong-foot other parties and look good in comparison. The NHS is not a toy--- sort yourselves out!
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# 64
That is fair enough, as you mention these sorts of comparisions are notoriously difficult.
I prefer to think of the NHS like the proverbial curate's egg, good in parts.
By co-incidence, a close relative went in a private hospital today for a minor ankle operation.
It could have been done on the NHS, often by the same surgeon, but he would have had to have waited months, and as a keen amateur footballer, was not prepared to wait.
I visited the hospital and frankly it was more akin to a plush hotel than a hospital.
Marketing is very important to these private hospitals so I was not too surprised to see nurses and matron dressed in the traditional outfits.
Of course, my relative had his own room and was tucking into some salmon when I arrived and was watching Wimbledon on the TV.
It was so good I said half-joking .. you want to stay in here as long as you can.
All-in-all, a very professional and orderly feel to the place.
Completely different to an NHS maternity hospital in a major South Coast city which was so bad, we got our relative and baby out of there as soon as we could, around a year ago now.
It was truly ghastly, a horrible 1970's feel to the place with very stressed under-staffed nurses rushing around.
As the mums were grouped in 'pods' of four, then during the night, if one baby kicked off, they all started up.
Horrible.
I was left wondering what the hell has happened to all the money that this Goevrnment has poured into the NHS ... we suspect much of it never reached the frontline.
Finally, a few years ago, my son had a serious accident ... the NHS care he receieved was truly outstanding ... in fact, if the accident had happened 30 minutes before, he would have been air-lifted by helicopter to the hospital.
As it turned out, the medical staff did a brilliant job, including the post-op physio stages.
Even the private hospital staff admit that in an emergency the NHS pulls its finger out.
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#67 TerryNo2:
I despair sometimes. Of course the NHS could improve its financial management - show me an organisation that couldn't.
However, your final couple of sentences do indeed say it all - about your level of understanding.
1) You seem to think that the success of a health system can be measured by the number of people who at any one time are ill enough to need a hospital bed. Can't you see that that's crazy, and the reverse of the truth?
2) You seem to think that all nurses are employed on hospital wards, and that there is a fixed quotient of nurses that cannot be disturbed. Can't you see that neither of those things represent reality?
3) quite apart from your emotive use of the phrase 'turning away' (image of poor mothers-to-be staggering into the night to give birth in the gutter), why not just think about the figures that the Tory researchers dredged up? A bit of maths:
33% of 103 Trusts had to refer mothers to other centres at least once but less than 10 times during the year - let's assume the mid point average of 5. So thats 34 Trusts times 5 = 170 cases.
9% of Trusts (to make up to 42% overall) had to refer people elsewhere more than 10 times in the year. Let's make an assumtion/guess that the average was 20 times for those Trusts. So that's 9 Trusts referring 20 people, making 180 in total over the year.
So in total during 2007 350 mothers could not attend the maternity unit they first thought of, but had to go elsewhere. Now I don't minimise the effect on those people at such a time, but can't you see how miniscule this problem is? There are typically between 600k and 650k births each year - so the problem affects 0.05% of births. To make sure that every maternity unit could deal with every demand on its services (ie cope with the once a year 'peak') would cost a disproportionate amount, don't you think?
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Alan Johnson runs the NHS
Prior to that:
Education and Skills for 13 months
Department of Trade and Industry 12 months
Department for Work and Pensions 7 months
What an amazingly talented man he must be to master a new departments each year.
Or could it be that hes there because hes Browns buddy.
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What the NHS really needs is to be freed from political interference.
Brown has the 'Midas Touch' in reverse - so he should stop trying to micro-manage.
The service also needs to be properly funded. It's a disgrace that anti-dementia drugs are withheld from people with Alzheimer's at an eraly stage; people have to wait until the condition has deteriorated before they are allowed treatment.
It's also shameful that people with dementia are having to sell their homes in order to fund their own care.
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#71 Russell Holmstoel
Ys, he's Brown's buddy, and in addition, what usually happens to useless employees who have "protectia" he was kicked upstairs!
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"Nick,
If there is virtually no difference between the Conservatives and NuLab in respect of the NHS, why is it that the Beeb allows ministers and others to claim that a Conservative government would mean the end of the NHS as we know it?
All the best."
I had no idea the Beeb was responsible for what comes out of the mouths of "Ministers and others". I must investigate this new state of affairs.
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"You'll have a 'choice' of hospital to attend but it will probably not include any quality private hospitals in your area.
Choice but no choice ... the politicians effortless paradox.
As MP Diane Abbott cheerfully said 'yes, its indefensible '."
I'd prefer money was spent on improving public healthcare rather than taking badly needed cash to allow people to pay for private healthcare.
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For those who take an interest in these matters what did happen to Community Health Councils, the means by which ordinary people could get involved. Oh, that's right they were abolished by the labour government.
Here in Exeter what happened to our local Primary Care Trust, oh that's right it was merged by the labour government to create a Devon primary Care Trust. Some of us could go to our local PCT and ask direct questions which were answered! Now, guess what we can't because the meetings aren't publicised any more and they held at funny times of the day in far off places. so much for local accountability.
We also had a very good local hospital where we could go to board meetings and ask questions. Guess what? there is now a foundation hospital where there is absolutely no local accountability.
Do watch out for sponsored fun days held by anybody in the NHS. This is there way of saying this is local involvement and part of the consultation process.
The other thing to watch out for is pursuing perfection, raising the bar etc.. this is what they mean by quality.
Of course there is no loss of service provision, why because you will hear about hubs and spokes and the fact that services have to consolidated because of concentration of experts. Surgeons need to be trained and it so inefficient if they practice in isolation so the training needs to be consolidated.
Is it any wonder that there are problems with cleaning, contracting out has been such a success!
It is sixty years since the birth of the NHS, what will be brilliant is that now the chickens are coming home to roost with the current pension crisis. Ah, the wonderful NHS, it was brilliant whilst it lasted.
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Nick,
Are you honestly surprised that Conservative and Labour plans are similar? Despite a radical increase in funding New Labour has only slightly altered previous Conservative policy. With regards to the NHS, policy has developed incrementaly for the past 25 years. Since the Griffiths report was published in 1983 choice has been high on the agenda. Previously this meant competition in the NHS internal market. Now it means an extension of the pre-exsisting choose and book service. These policies are a natural extension of previous Conservative and New Labour policy and seem only to seal the rise of the citizen-consumer. Something that both parties have desired for some time.
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The wonders of choice.
There is a problem which nobody wants to seem to talk about and it relates to insurance.
Let us say that you have no medical health insurance. You notice a lump or a changing mole. This might indicate either breast cancer or some form of skin cancer.
You know that if you had health insurance then you might be entitled to a payment. However, if you take out insurance then you are told you cannot claim within six months, or you must not have a diagnosed condition so you take out the insurance and wait for six months.
In six months you go to your GP who then says what you always knew. You have either breast cancer or skin cancer. You then claim on your insurance.
The problem, if you had gone to your GP when you first knew then something could have been done, however, because you had waited six months before seeing your GP your condition is now terminal. Either that or your quality of life, and that of your loved ones, after surgery, is not pleasant. Oh, and you are going to die.
At least you have the knowledge that you have collected thousands on your insurance, you can live life to the full for those last few weeks of your life. If only!
Investigations showed that you knew and therefore not entitled to any payments. The wonders of insurance. Or you may collect on your insurance and then have to pay for any treatment through the NHS.
A fanciful story, or is there an element of truth? A wonderful thing choice isn't it!
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If I had been asked for my input into choice then this is what I would say.
My father died in the early nineties after being discharged from hospital and on being taken home in an ambulance. His bed was needed and he had a heart attack in the very ambulance bringing him home, he died in the hospital which had just discharged him.
My Mother died just over a year ago and effectively died of starvation and dehydration. She was however treated with dignity and care. She died in the same hospital as my father.
Now I have no problem in saying that if anybody thinks that I am going to die in the same way as my parents then dream on. There must be an alternative and that is that I will choose when I want to die. I want that choice!
If I find out that I have either of the curses of modern living, namely either Dementia or Alzheimers, or any of the conditions which result in me not being who I am, if you understand my meaning, then I will demand an early death.
My way, my choice!
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Interesting statisitic
in 2007 the NHS budget was just over 100 Billion pounds
About the same amount as the Times reckons Browns Quangos cost us.
Perhaps we could slim down the Quango CEOs salaries and employ someone to clean the hospitals properly.
Just a thought
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to #71
You make the point about Alan Johnson being just a figurehead as he cannot possibly have grasped the full complexities and nuances of such a huge department, and I agree with you.
But think on - who is in fact running the NHS (and indeed all of the other departments of state - the MOD etc. ) - the permanent government of the UK - our always hidden Civil Servants!
Why are we so ready to ignore the role of the Civil Servants? These are the people who gave us the appalling implementation of a NHS computerization system (and buy helicopters that cannot fly in poor weather or at night (MOD)). They are the ones that mess up time after time and all that happens to them is that they are promoted - at least politicians can be, and are, sacked!
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In Jan 2007 the average wait was 49 days,
In 1997 it was 41 days
Policies were also introduced to fast track minor illness so as to meet the Government's 18-week target.
Figures from the NHS show that waits for cancer treatment increased. Personally Id wait 6 months to be seen for my eczema, but want my cancer dealt with this week.
This is the result of a politicians looking for a sound bite
Leave the policies and the running of the service to the proffesionals and not to a Ministers who hop departments every 12 months.
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@#44 - Terry of those 40%, I'm guessing most of them had just started having contractions and werent actually close enough to warrant being in hospital, hence were turned away.
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#70. Remember Jim, that this is taxpayer's money. Financial mismangement in the NHS isn't an unfortunate blip that needs a bit of time to correct.
I guess "turning away" 350 mothers in labour is an emotive term and 350 is, after all as you say, it is miniscule in context, although I imagine that if you're one of the ones being turned away then just one is too many. In some people's world though it's just a statistic that's immaterial, probably lost in the rounding-up (or down). As for saying that to deal with such mothers would be at a disproportionate cost, then sorting out the finances ought to be a major priority and not dismissed as an everyday occurence. However it remains odd that we have 82,500 more nurses, as you say, and still this happens. After all, you say that the loss of 32,000 beds under this Government is because of improvements to healthcare. Buy not everywhere, eh Jim?
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81. John_from_Hendon
Agree entirely.
Just thought I would shoot at the politician this morning.
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If the way forward for the NHS is similar for both main political parties is similar, then that must be good, too often because one party is in opposition it doesnt mean everything must be opposed.
When it come to choice the majority of people would say closest to home, but they way progress has been made with specialization and technology this might mean passing the door to the local hospital to one may be 50 to 100 miles away for specialist treatment.
I have experienced both personally and through my family many visits to hospital in a number of hospitals and in life threatening situations. Our hospitals in my opinion are all I could want and the care, openness, and treatment have never let us down.
The press (sorry nick) are by the nature of their role only pick up on the news worthy stories which are basically negative not the fact that many millions are treated quickly, with care and with expert specialised treatments.
We have great Hospitals and GP's lets celebrate the progress over the last 60 years and see the developments take place that we all want.
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This comment was removed because the moderators found it broke the House Rules.
Ha ha, just reading through some of the comments and have the following comment....
jimbrant: do you always miss the point or were you just having a bad day?
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Something that seems to be missed by the bloggers is Nicks comment "Lands End to John O'Groats". We should all remember that Lord Darzi's report is on the NHS in England so stops at the border, which is why Gordon Brown Prime Minister of the United Kingdom but also MP for Kirkcaldy and Cowdenbeath was visiting a hospital in Leatherhead rather than his own constituency.
Of course the health outcomes of his own constituents has been devolved to the Scottish Parliament and except that it receives and spends more money per head of population than is given to the English NHS has nothing to do with "his nibs".
As an aside the furor of drugs and the two class health service alluded to by Alan Johnson recently doesn't apply in Scotland because those same drugs have been approved for use in Mr Brown's constituency. Which posses the question is there a 2 tier health service in the UK?
Ken Clark most certainly agrees that there is a 2 tier democracy and the English voters are again on the bottom tier.
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#70
Of course the NHS could improve its financial management?
Then why doesn't it? Where is the pressure being put on tthis organisaion to put its financial house in order?
There is none because it was flooded with £100bn of NewLabour cash... aka tax payer cash.
It's drowning in a culture of if it's not working spend more money; handed to it by the government.
Like any addict it will just come back for more.
The whole NewLabour project needs to go into rehab where it belongs and take its profligate ways and endless reviews with it.
And you can take the snooper society with you.
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# 89
Well, I for one never miss points like this any more.
I'm not the brightest pea-in-the-pod, but I would say that within six months of becoming interested in politics around 1997, I realised that the political entity 'United Kingdom' was a total sham.
The sooner it is over, the better it will be for all concerned, English, Scots and Welsh.
Somebody did point out to me recently that after the Scottish independence referendum and the Welsh departing around 2010/11, we English will be stuck with the one bit we've been trying to extract ourselves from for the last few decades - Northern Ireland.
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89. skynine.
Very good point, but not one restricted to the NHS
Current public expenditure in each area of the as a proportion of the GDP
Scotland 50%
North East 57%
East Anglia 35%
South East 34%
The average of all regions being 43% up from 39% last year
Funny how the money seems to follows the Nu Labour Strong holds.
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Nick,
Perhaps you'll take a look at the exchange of letters between Gordon Brown and David Davis.
Brown suggested that Davis 'debate' him at PMQs. David retorted:
"Now, you insist that any questions I wish to ask on this vital national issue be raised within the narrow confines of Prime Ministers Questions, where you have developed the novel practice of asking - rather than answering- the questions.
I'm really surprised that the BBC has not featured this.
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Nick,
Suggest you follow up #93, which is interesting and seems to have been missed.
We tend to forget that it is supposed to be "Questions to the Prime Minister". As David Davis correctly says, PMQ has degenerated in the last year.
Brown is even worse than Blair and Thatcher at ducking the question, making prepared mini-speeches regardless of what is asked and demanding the questioner answer a different question of his own.
Of course, Speakers over the years have always let Prime Ministers get away to a certain extent with not answering the question but the current incumbent seems to be highly partisan and more tolerant towards GB's evasions than past office-holders have of the PM at the time. And GB gratefully uses that lattitude.
But journalists and politicians alike seem to be terrified of even the mildest criticism of Mr Speaker Martin.
Show us you're not, Nick.
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Isn't it funny how when "Thatcher got rid of thousands of beds" this is seen as being a horrible thing, and running down our health service, but when New Labour gets rid of 32,000 beds that is because of improvements in treatment and clinical outcomes.
To add to my earlier list of poor service on the NHS, my wife was forced to have a Caesarian for the birth of our second child, because the midwife who fitted the heart monitor did it wrong (and all the other people in the room at various times failed to spot this until it was too late). This meant that they believed our son's heart was in difficulty, hence the Caesarian.
Incidentally, this means that the "very strong recommendation" is that we have no more children, as our first was Caesarian as well, and they really don't like having children after two Caesarians. So, despite wanting another, we can't because we have been told the risks are very high.
Thanks NHS.
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My perception may be wrong, but as far as I can see, the National Health Service (NHS) has improved substantially under New Labour.
Cost savings were made in the NHS in the last Conservative Government. As a result, many people who could afford to, paid for private health insurance.
In the late 1980s and early 1990s, two people close to me died in NHS hospitals of conditions which are being treated far more successfully and compassionately today.
Those of us who could not afford private health insurance had to accept what was offered.
For instance, inexpensive but debilitating drugs were used to treat mental breakdown in young people.This could result in an inability to get work or complete their education at a crucial stage.
Soon after the 1997 election this aspect of mental health treatment was highlighted in the press. Armed with this knowledge, those affected by the previous Government's policy could work towards a less debilitating treatment and more fulfilling life.
I know of several cases. where former psychiatric patients have turned their lives around as a result. I also know of severely disabled now able to lead relatively independent lives and some are even able work part-time because new opportunities have been opened up to them.
These are among New Labour's achievements for a health service, which, whether my perceptions were right or wrong at the time, I felt was being run down with the intention that it would be superceded by private health insurance under the previous Conservative Government.
But New Labour cannot rest on its laurels and is seeking further improvement to an already improved service. What I find hard to accept is the Conservatives claiming New Labour are following their ideas.
The Conservative Party has been forced to change over the 11 years of an encumbant Labour Government, but is the change so radical that it now is presenting us with the complete opposite of its former policies?
All credit to the Conservatives for keeping on the NHS case. But can they claim they would have made the improvements we have seen in the National Health Service over the past 11 years?
And in my opinion which is based on personal experience, Conservative promises for the future of the NHS can only be a continuation of the improvements we have already seen under New Labour.
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Whatever Brown does, I can't see the public getting behind him.
He's had 11 years to sort out the NHS but we've still got long waiting lists and superbugs. As
The Spectator said he's been known as the 'roadblock to reform' for too long:
http://www.spectator.co.uk/coffeehouse/805796/brown-poisons-labours-health-reform-message.thtml
Why should we think he will reform any thing now?
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#88 extremesense: "jimbrant: do you always miss the point or were you just having a bad day?"
Thank you for that incisive and well argued contribution. You must be very pleased with yourself - given your 'handle' you obviously are.
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It is curious that many contributors discussing choice have not actually read either the news report or your commentary Nick.
You said:
"Surgical teams will be forced to publish annual quality reports which record their performance in terms of safety, medical outcomes and patient satisfaction. So, in theory at least, we'll all be armed with the equivalent of "Whichdoctor" and able to travel anywhere from Lands End to John O'Groats to get the best possible health care."
This is much more sensible than a choice of hospitals. It's the quality of the surgical team that matters Currently in the private sector you have to do your own research to find a good team and then choose the hospital. It is not too clear if private HOSPITALS under contract to the NHS will be included in the choice (they are supposed to be included currently in the 5 on offer) and whether there is a Euro choice.
On the other hand choice is all very well but the best evidence shows that concentration of specialist services gives better results.
Incidentally is John O'Groats, a possible choice under the proposals since my understanding is the Nations as we must call them nowadays, ,are responsible for their own NHS policies,.
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#98
jimbrant you still haven't answered the question put at #21.
Why aftee the eleventh review in eleven years are you proposing that we have another review to discuss the priorities in the NHS?
Is there no end to the profligacy of NewLabour?
Is there no end to the vacillation and dithering and indecision? Commissioning a reveiw straight after the conclusions of the last one is published is utter incompetence.
NewLabour is unfit for government precisely because it has no concept of how to manage and consequently can't stop spending our money 'consulting' on what to do.
All we are asking for is value for money and competence and we are given splashy grandstanding, overspend and bungling.
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newtactic
You defeat your own argument.
You said "Soon after the 1997 election this aspect of mental health treatment was highlighted in the press. Armed with this knowledge, those affected by the previous Government's policy could work towards a less debilitating treatment and more fulfilling life."
In other words, if it hadn't been highlighted, then the changes would not have happened. Nothing to do with who was in office.
Incidentally, the idea that it is government policy that radically improves patient treatment and outcomes is baloney. Improvements in medicines, technology and understanding the illness account for the vast majority of improvements in any illness you care to mention - in fact, pick an illness and a decade, then look at the same illness a decade later and you will see improved outcomes, regardless of which party was in power.
The job of government is to enable medical staff to treat illness, not to bury them in red tape.
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There is little doubt in anyone's mind that the concept of the NHS is unrivalled. The dedication of the staff under so much pressure from the less than competent bureaucrats is nothing short of a miracle. However, I fear we are missing an important point here. Competence in government is being increasingly measured by the parties' attitudes to the NHS thereby making it a touchstone, the holy grail of power or how to attain it.
The issue I respectfully raise is that in its present form, WE CANNOT AFFORD IT!
When the economy's health is based upon confidence in the housing market (fickle at best), the measure of performance changes with the wind (RPI, CPI, include mortgage interest or not...), planning for a leviathan like the NHS is impossible.
I can see the only way forward is statutory medical insurance. And don't anyone say 'we have it already in National Insurance' you are deluding yourself. It is like saying VED is raised for road repairs!
The sooner the politicians wake up to this issue and front it properly, we might then get something sorted.
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If the NHS was founded 60 years ago, isn't this its 61st year as opposed to its 60th?
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#100 RobinJD: "jimbrant you still haven't answered the question put at #21."
Nobody responds to every comment, and I'm no exception. To be blunt, I didn't think your comment pearticularly worthy of a response. The conundrum you pose has a perfectly straightforward, and I would have thought obvious, answer. As the money has gone in and progress has been made the original problems have been replaced by new ones, so as time has gone on the situation has been changing. When the question changes, it is necessary to review your solutions.
I note that all you are asking for is "value for money and competence". Perhaps you would take the time to look at my #70 in which I report the conclusions of a very large study conducted by (arguably) the most respected independent health care research organisation in the world. That concluded (in 2007) that the NHS was the highest ranked of the six countries compared. It was the most efficient, most equitable, provided the highest quality of care, and delivered the most coordinated care across specialisms. I think that of UK organisations only universities would do so well in an international comparison.
Of course, your own in depth research based on your unrivalled expertise comes to a different conclusion. Strange.
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#99.
Please note that what you say is perfectly valid. However, there is a problem.
When working in the City a team of fund managers were responsible for the investment policy of a bank. The good performance was down to them. However, because they were good they were headhunted to other firms.
However, the original bank was still able to market themselves based on the performance of the now departed fund managers.
Surely the same problem applies to a brilliant surgical team at a hospital. They get expertise, they have built up a brilliant reputation and then, they are persuaded to go to another hospital. Do you follow the surgeons to their new hospital, which may well be in the USA, Australia or New Zealand.
Answers on a post card to Gordon Brown. He knows all about building up a good team.
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#104. Jim - I'm afraid you misquote your reference. It certainly wasn't in #70.
I hope this isn't a reflection on your attention to detail.
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93 sceptic max, And of course whatever David Davis writes or say's is always right I guess. It was Dave Cameron that said that he wanted an end to punch and judy politics, that is until he got to the dispatch box since then he's created more punch and judy politics and name calling than I have ever seen before and thats what the speaker should'nt allow.
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#104 jimbrant
noen of this alters the point that you are not getting value for money if you have to review the review every year. Calling for a review as soon as the last one is completed is utter incompetence.
You fail to understand this simple point. Shucks. Looks like you're going down.
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grandantidote @107
You put the apostrophe in the wrong place in shouldn't .
Don't bother to reply.
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CHOICE.
Well this is a word I have long hated - when it comes out of politicians mouths.
It has been the favoutie buzzword for politicians to give the impression they are offering something new - usually the result is actually "less choice" - unless of course you are "extremely rich"
Remember satellite TV - that was brought in to increase "TV viewing choice"?
RESULT - Very little terrestrial football and satellite subscribers having to pay two suppliers this year for full football coverage.
Remember de-regulating the Telephone market to increase consumer choice?
RESULT - We all have to switch every 6 weeks to stay with the most competitive supplier, and as with all business driven by cost - customer service is poor at ALL OF THEM. Huge variations in broadband download speed - companies breaching advertising rules in order to increase market share.
Remember de-regulating the energy suppliers to increase consumer choice?
RESULT - non-existent customer service across the industry (record complaints), illegal selling practices (driven by sales pressure), increased volumes of energy futures trading as individual suppliers try to fix the price = increased speculation on energy markets by traders who are trying to exploit the situation which of course results in increased prices.
Remember the de-regulation / switching of building societies to become banks?
RESULT - Increased number of banks who answer to shareholders = more aggressive strategies = more speculative lending = credit crunch.
Increased pressure to find new products (i.e. CDO's, MBS, ABS) that will produce monster profits.
De-regulation of the Rail network
RESULT - say no more - every commuter will already know that there is less choice when it comes to purchasing your ticket - only the 'off peakers' have benefited slightly (if at all). Increased number of fatal accidents, reduced track maintenace and an effective Re-nationalisation of the rail network at taxpayers expense.
Lifting restrictions of local government sub-contracting.
RESULT - Council services operated by companies committed to drive down costs - poor customer service, reduced services, absolution of responsibility, poorly paid and poorly motivated workforce.
None of the above policies relate to any particular party or political philosphy, but the results are all the same for the consumer - less choice.
When a government says 'Choice' - read 'disaster about to happen that will cost the consumer dearly'
The problem with the NHS isn't choice, it isn't funding either - it's how the funding is being spent (wasted) by managers and hospital trusts who have blagged their way into their positions but who don't have a bleedin' clue about either managing a large institution or hospitals.
I watched Jeffery Robinson's programme on the NHS - it's at that point I realised society is doomed as we have resorted to rewarding the stupid (NHS managers) and preventing the clever from learning (by introducing student fees creating a barrier to learning). Meanwhile the people on the ground are being asked to 'restrict their pay increase demands' by Alistair Darling.
How I shall laugh when this country is run by ex-apprentice failures and big brother evictees - we've already made a start in London with Boris Johnson, it's only a matter of time now...
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I swear I must be related to JohnConstable
An excellent point and one I missed off my list.
- School choice
Does anyone realise that the biggest congestion in London these days is around the 9am and 4:30pm school pickup times?
Sure parents can choose their schools - but their choice has impacted on everyone else who needs to travel at those times (who perhaps have no choice). The result of choosing a school halfway across town is evident and as John pointed out was all started by a 'cover for poor standards'
...and what of the choice of the child who is left behind in the local comprehensive?
As we have seen - once again the choice of schools revolves around your ability to pay. If you can afford a second house / flat in the catchment area of your choice - then you too can have the choice.
Otherwise - you have less choice - and the standard of what you are left with is now markedly worse.
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This comment was removed because the moderators found it broke the House Rules.
Well, Well, Well, there we go again.
It is a sorry state of affairs when one cannot conduct a decent debate without referring to anothers Grammar or lack of it.
This is the last resort of the desperate, those that cannot win or convince by debate or argument alone, they then resort to their last line of defence.
And use Attack!!! someone else's shortcomings to hide behind and take refuge in their own lack of political nous.
Pathetic to say the least!
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About Nick from sky website
Can't resist this opportunity to poke fun at a friend and rival. Where was the BBC's Nick Robinson earlier this evening?
I can reveal that he was spotted at the Odeon, Leicester Square, attending the premiere of "Mamma Mia", the Abba chick flick based on the successful West End stage musical.
Not merely attending, either. But inside the media enclosure, excitedly taking photos of the film's stars, Meryl Streep, Piers Brosnan, Colin Firth and Julie Walters.
Someone once said that politics is showbiz for ugly people. Seems Nick is now moving among the beautiful people.
Perhaps I'm just jealous. Or perhaps "Money, money, money" is a song about MPs' expenses.
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#56
I have followed this trail regarding the 40% of mothers turned away.
How can the voters be expected to make a serious, considered and accurate decision when there are so many 'lies' printed about every piece of Government policy.
It's clear that all (3) people involved in that conversation got a different impression of what it meant - not surprising now I have read the article that was referred to.
Maybe if we were able to get to the truth about such matters then the voting at the polls would be very, very different.
Maybe just 1 new law - civil prosecution for any news article which is not 100% accurate, along with a jail sentence for any editor who oversees such stories.
- Now that would make the press reporting much more accurate and trustworthy.
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Nick,
It is becoming something of a fad to have a dig at the Scots, et al whenever public sector spending is being mentioned, yet few people seem to tie together the ends of their own arguments.
Were it the case that vast sums of expenditure led to great quality, then Scots would live far longer than any other group in the UK. Yet the opposite is the case. I am sure some left leaning, NHS acolyte will be happy to explain this particular conundrum.
Perhaps the real problem is not that the NHS is so weak in Scotland, perhaps it is the figures upon which the debate is based.
I would be happy for anyone to outline the total monies (per head) spent in England compared to Scotland rather than just identifiable expenditure. When these figures are examined, my understanding is that the huge disparity mysteriously dissolves. Imagine that. The government spends as much in England per head as in Scotland.
Equally, you need to examine in a bit more detail the figures that make up GDP per region / country. Depending on the assumptions made, different figures can be derived. For instance, my understanding is that oil production is not allocated to any particular region or country. Most people would assume that this then undersates Scotland and the North East areas.
What is unquestionable is that the South East absorbs much of the expenditure in the UK and employs the majority of the highest pad individuals, who in turn spend into that market. The same phenomena can be seen in retail locations when a new large shopping centre opens, and spending is sucked in.
My own personal view, for what it is worth, as I travel between England and Scotland is that the soft southerner has no basis for complaint. There are huge advantages in terms of longevity and job opportunities (public and private) in the South East. The vast bulk of the top paid jobs are not to be found in Scotland, and when key decisions are being taken about future strategic investment, it tends to focus upon the South. By all means, we can change the way the country is governed, but let us at least look at the reality before spouting off what are otherwise highly selective figures of comparison.
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Trudy_Victoria @133
Why do you presume that my contributions to this blog are for the purposes of debate?
You flatter yourself.
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#106 TerryNo2: Yes, sorry. I should have referred to #64
"I hope this isn't a reflection on your attention to detail. "
So do I. But thankfully it is more probably because I am fitting this in between cooking , doing the laundry, washing up, shopping, and caring for my wife.
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#108 RobinJD: I always thought that it was an accepted feature of good management that you continually review your performance against the latest information/situation. I have never previously seen such behaviour characterised as indicating incompetence or being a waste of money, but I'm sure you know best.
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116. smfcbuddie
Interesting statistic
In 06/07 spending per head on health and social care
Scotland 2,313
Wales 2,109
England 1,915
The figures, released by the ONS, show the gap between spending between England and Scotland widening by 12 per cent in 2 years.
The ONS figures, based on Treasury statistics, show the gap between England and Scotland increasing from one of £355 in 04/05 to £398 in 06/07
Imagine if an English PM implemented the reverse.
What would the Scottish do.
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116. smfcbuddie
And heres another (this is total spend not just health care)
In 2005 the English subsidised the Scots by £2,200 per head (Doubled since 1997)
Gordon Brown’s spending means Scotlands budget is at Scandinavian levels at a time when Scotland’s tax burden is below that of England, Poland and Canada.
In 2003-4 the Government spent £45.3 billion, putting Scotland in the rare position of countries where state spending is more than half of GDP.
Only £34 billion was generated in tax.
The remaining £11.3 billion was subsidised by English taxpayers.
Anyone see a conection between voting patterns and spending ?
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#120 RussellHolmstoel:" In 06/07 spending per head on health and social care
Scotland 2,313
Wales 2,109
England 1,915"
It is at least possible that this difference is entirely reasonable. I have heard senior Conservative politicians argue recently that funding should be more 'targetted' at areas and people most in need. Since I think it's the case that the Scots and (to a lesser extent?) the Welsh have poorer health than the English, you would expect more to be spent on their health care. As a socialist, that is what I would expect anyway.
More fundamentally, I assume it must be more expensive to provide health care services over the distances involved in the more sparsely populated Scotland, and especially to the islands. I wonder for example what the average distance travelled by an ambulance to attend an accident might be in the two countries?
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#jimbrant
of course it's incompetent to announce a review as soon as you have completed one.
what was the point of the previous review? And moreover any management team that put its name to a wholesale review once a yer for eleven years would be judged by their shareholders to getting it completely wrong.
The government has become incontinent with taxpayers' money.
One minute we have a review, then a review about the review; next minute we cut 10p tax then we review it and back track. Now we're still reviewing it because we were incompetent and missed off another 1.3million people.
These management errrors are happening in every government department because they are governing by target. When we don't meet the target we have a review. And then an intellectual snob like Harriet Harman comes along and tells me she knows best after all this reviewing.
NewLabour wil never learn just as you haven't learnt that centralisation simply doesn't work. A wall fell in Berlin testifying to the complete failure of central targets.
Tell me about how many more nurses there are and tractors and schools and how you met all your targets. Very interesting but all made up. Have another review. Why not? It's all the rage.
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117#
Pardon me I should have known better. Those that can debate do and those that cannot, ridicule and find fault with those that can.
Which categorie do you fall into, need I ask?
Please note deliberate spelling error on second last line of paragraph above (category).
Thought I would give you just a snippet to crib about as you cannot reasonably be expected to come up with a serious discussion.
That would be expecting far too much from you.
Have a nice evening.
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#123 RobinJD: I guess that if you don't want your prejudices confused by inconvenient facts you had better stop reading my posts. I will reciprocate.
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#120 /121
Sorry, if I am not being clear. I am interested in the total monies being spent by government. If your specific figures are accurate, please point me to the reference. For the avoidance of doubt, research was undertaken late last year that confirmed the general thrust of my point on spending - if I get the chance, I will dig it out and post the link. However, in part the argument was based around issues such as defence expenditure, a large portion of which occurs in the South East but does not show up on identifiable expenditure.
In any event, did you deliberately miss the question about how to calculate GDP and the absence of output from the Continental shelf? Is there any link between this being left out from the regions, and the fact that it suits some to portray the area outside the South as spongers?
When you also consider the fact that the government and industry has centralised the key decision making activities in the South East, would you expect GDP to be distributed evenly throughout the country? The higher paid jobs (and therefore Value Added / production) will tend to be inflated in these areas.
Finally, do you think spending per head should be the same in every region? Indeed, should spending per head be the same in areas of urban sprawl, when compared to highly distributed populations? If so, I have probably wasted my time trying to raise these points.
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Trudy_Victoria @124
None of the above.
My objectives in participating on this blog are:
1) to provide Nick with feedback about his reports.
2) to draw Nick's attention to political views and topics not usually prevalent or appreciated sufficiently within the Westminster Bubble.
3) to draw the attention of senior figures of this government to political views and topics that prevail outside Westminster. (Yes - surprisingly they do follow key political blogs - and are among Nick's readership. They can only benefit from receiving 'unvarnished' views provided by bona fide members of the public, not the 'packaged' or 'filtered' variety as provided by their minions, focus groups, think-tanks and other political groupies).
Plus, I also get the added bonus of teasing and annoying ZaNuLabour supporters, Nanny-State-Troopers, Enviro-fascists and other enemies of individualism and freedom.
At this time, when we are witnessing the slo-mo car-crash that is Nu-Labour's self-demolition, fans of Schadenfruede have reached new highs. The more their supporters squeal - the more we enjoy it.
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Must be awful supporting a government that says it has achieved so much and yet has managed to achieve all time record levels of unpopularity.
Could there possibly be a connection between the government's tin ear (and jimbrant's) to its critics and this spectacular fall from grace?
Could there possibly be a connection between disasterous byelection results and the new Lodon Mayoralty and the government's (and jimbrant's) tin ears?
Was this inability to listen to the crowd the reason the crowd overthrew every single Eastern European government?
Let's hope for a replay on home turf. At this rate it will be sooner than we think.
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# 127
I'm not sure sure it is that enjoyable.
For example, we have the likes of Ed Balls in full-blown rant mode savaging Grammar Schools - the one decent escape route for children from deprived backgrounds - that Labour and the Tories took away.
Balls should speak to his own colleague, Frank Field who will tell him that politicians have utterly failed the children of this country by not establishing the third 'technical' stream.
Believe me, we are all suffering for that now.
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The expenditure in Scotland cannot just be based on the Scots being in poorer health as the basis of my original comment was that a greater variety of drugs were available on the NhS in Scotland than in England.
As far as general health is concerned, you might find that those in the SE don't eat such a high fat diet or smoke as much. Life expectancy and health depends a lot on the decision of people to eat properly and that isn't predicated just on cost.
I am easily amused in the supermarket queue examining the shopping trolley of those in front of me. My research has concluded that those with the biggest backsides have the highest percentage of pre- pepared or processed, rather than natural foods in their baskets.
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IMO, we're always making top-down (what are Polyclinics if that's not a top-down initiative?).
Also, can someone tell me whether there is any mention about the different providers of health services?
My guess is that this Administration has (conveniently) forgotten to argue for diversity in provision, including a greater role for the Private Sector.
Why doesn't the Government just give us vouchers and we can choose for ourselves?
Or is that what the Noble Lord is suggesting?
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Nick
On a technical point, why doesn't the BBC introduce threaded comments for your blog, perhaps would make them easier to read!
E.g. Disqus etc.
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JohnConstable @129
The actions of this government are reprehensible - and definitely not to be enjoyed.
The writhing agony and pretzel-like contortions of its supporters attempting to justify the unjustifiable and defend the indefensible are, on the other hand, to be savoured.
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#130 skynine :"As far as general health is concerned, you might find that those in the SE don't eat such a high fat diet or smoke as much"
Precisely. That's probably why the Scots (and some regions in the North of England) have poorer health - so they need more drugs, and more health expenditure.
I'm not claiming that this is the absolute truth - jus one reason why it might be reasonable for Scottish health expenditure to be higher than England's.
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#131 Turkeybellyboy: "what are Polyclinics if that's not a top-down initiative?"
Well so far as London is concerned they are the exact opposite. The polyclinic idea came out of a bottom-up consultation among all health authorities in London as I understand it.
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109 sceptic max, thank you for pointing out a grammatical error, it shows you were paying attention, it also encourages me to know that you found nothing else wrong with the post.
117why would it be flattering to Trudie Victoria to presume that your contributions to this blog are for the purpose of debate.
The only flattering going on here is to you and that is that anybody bother's to read your rather pompous posts at all.
127 Not suprisingly I can believe that you sit in front of your computer conjuring up your words of wisdom to add to these blogs in the full knowledge that Nick Gordon and Dave are all waiting every morning knowing that it will be impossible for them to get through the day with out those all important words of wisdom from Sceptic Max with out you max the country would decend into chaos, you keep on in there max what would we do without your spiteful cynicism.
I seem to recall that you emphatically denied being a conservative. Another one Trudie.
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122 jimbrant
Spending targeted at need I can deal with, so it should be in one county. The benefits should be the same for all. They are not.
Interested to know why Scots need free personal care for the elderly and university tuition fees and the English don’t. I gather that you can actually find an NHS dentist in Scotland.
Even police and nurse pay reviews were preferential for the Scots and were back dated further than English ones.
In fact I cant think of one benefit that the English get that the Scots dont. I challenge you to find one.
Added to this the cost of living is so much cheaper.
This isnt socialism its Browns attempt to keep the Scottish on side and vote labour.
Despite throwing money at them they still want out from Nu Labours control. Speaks volumes to me.
I guess its only an 11 Bil though, small chips, barely covers a few Quangos.
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jimbrant
Come on now you cant defend this reviews thing.
Its become a catch phrase for the man.
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127#
Ah! that explains why you have failed miserably.
I think you feed to much on "Desperate Dan Pie"
Only his was full of cow meat whilst yours is full of Bull and the other.
Now we will see how fast you reach for the " help rescue me moderator button" as you did earlier on in the day.
And another Tory bites the dust!
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jimbrant
Any idea how many reviews GB has started
Its become a bit of a catch phrase for the man.
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# 137 RussellHolmstoel: I don't claim any particular expertise in regard to Scottish healthcare. I have simply given one or two reasons why spending on health would be expected to be higher there than in England; I don't know whether those reasons account for all the difference - in fact I doubt that they do.
As for your specific points, I would remind you that Scotland has devolved responsibility for a number of areas, so they decide where their priorities lie. They have decided to adopt the policies you mention, and in consequence they have less to spend elsewhere; that is what devolution means. One consequence of those decisions is that waiting lists have not been reduced as far or as fast as in England (there's your one benefit that I happen to be aware of; there will be others that I don't know of).
I would be interested in your data showing that CoL in Scotland is lower. It would be a bit surprising if true because costs in many parts of Scotland (eg the Highlands, the Hebrides) are certainly higher because of transport costs.
BTW, it's not only Scotland where you can get a NHS dentist. I have no difficulty in my town in middle England - they keep advertising for patients, in fact.
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136.#
Wait long enough Grandantidote and they come out of the long grass.
Little do they realise more gives them away than mere words do.
Such a shame he failed on all counts of his quest, innit eh?
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141#
jimbrant another glaringly obvious one is this.
Salmond to try and pull a fast one on Gordon Brown decided to pay the Scottish Police Force, the full ammount recommended, thus he left himself unable to provide extra recruitment of Police Officers that we enjoy here.
This was more a case of one upmanship, rather than a crefully thought out policy.
No matter what people's views are on that particular subject, I though his motives for doing it were all wrong.
They sent out a bad message.
Still Salmond is a past master at dirty politics always has been and always will be.
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141. jimbrant
Devolved responsibility should come with accountability. Its very easy to give your people benefits if they don’t pick up the bill. That’s the big problem faced by any government getting the taxation and the benefits right.
If we had what I call devolution the Scots could have what ever they liked, if the benefit was unique to Scotland they would have to pay for it. The tuition fees issue was outrageous, Scottish MPs voting for tuition fees for the English while MSPs voted against them. Scottish MPs refused to even abstain. Some conscience
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141. jimbrant
The waiting list point is probably down their poorer health and the fact that their population is slightly older. We know its not because they have cut spending on health.
I have not heard of any benefit that the English get and Scots don’t. But cant claim the point on what I don’t know. If you find a real one do post.
No NHS dentists here, I gather that 23 million people in England had no dental care on the NHS in the last 2 yrs. People have actually started pulling out their own teeth. Pretty poor show.
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Nick,
I am a big fan of your party political analysis; always astute and penetrating. But there really is more than party politicking at stake here. It is a matter of complete disinterest to me as to 'who got there first' and whether there is clear blue water between the parties. That is just playground squabbling. What interests me is what lies behind these motherhood statements from Darzy: how these wish lists will be put into action and their implications in terms of NHS reorganisation. Can we look forward to more polyclinics? More centralisation of care? Fewer local hospitals? Maybe it isn't your remit but it would be good to have some meat on the bones of this story at some point.
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#143 Trudy_Victoria: Yes, I'd forgotten the trade off between the pay deal for police and the failure to recruit the extra officers.
But it was open to Salmon to do that. Devolution allows the different jurisdictions to come to different decisions on priorities. I find it amusing that the same people who want local decision making in one area then complain about it when it happens and we get told about post-code lotteries and how "The benefits should be the same for all".
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#145 RussellHolmstoel: "We know its not because they have cut spending on health."
Nobody suggested they had. They have just decided to spend it in a different way, with different priorities.
"People have actually started pulling out their own teeth" - well no - one person did that, and then made sure the press got to hear about it. There are more dentists now than in 1997 and more in training, though you wouldn't think it from the media reports. And remember it was the Tories who closed dental schools.
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147#
Salmond had the right to do so, he won the election fair and square with a one seat majority.
What I do find disturbing though is people putting over what they presume are facts and they are not.
I read a legal article and it appears that as far back as the 1970's the Westminster Parliament went to a great deal of trouble to hide the ammount of revenue Scotland would make regarding oil.
Salmond found this out under the Freedom of Information Act.
And Contrary to that which most people believe, Scotland pays more into HM Treasury than takes out via the Barnett Formula.
This is perfectly easy to check, as a matter of fact I have it on file somewhere or other.
I think it would do the less well informed a power of good to look this up on the internet, then they would not be quite so cocky when they are in receipt of the full facts of the matter.
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148#
Yes jimbrant the Conservatives did close the Dental Schools and as it takes 7 years to fully train a dentist and Labour have only been in power for just over 11 years, they have not done bad but could do better..
It is not good but certainly not as bad as a lot of Conservatives or the Right Wing Press would have us believe.
Plus the fact there are quite a number of Dentists here from Eastern Europe.
Labour at least are trying hard to fill the gaps.
Whilst the Conservatives do that which they do best, criticise and tell how they would do it better.
Russell complains for complaining sake, he never stops and says thanks for the improvements we already enjoy, courtesy of Nulabour.
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#150. Trudy - I think the criticism is a bit harsh. Every party goes through some kind of renewal, and I think this counts as much for the Conservatives as it did for Labour. Roll back to 1983 and if Michael Foot had his way we'd be out of the EU. Things change, as do people and what they end up believing in. After all, if a good selection of the Cabinet still held the beliefs they did when they were students they'd still have live M15 files.
I believe that the UK needed Thatcher as much as it did Blair. Each have contributed a different style at a time when a different style was needed. It was inconceivable that the UK could continue to be governed in the way that Sunny Jim left it - ie bankrupt - and when John Major left it: I felt that back in 1997 a drift back to the centre was needed.
For all the debate on the NHS, I think we'd be pretty nuts not to think that we ought to have seen improvements when spending has tripled from £35 billion to £110 billion a year. I don't accept the rather simplistic view that the Audit Commission review of the financial mismangement of the NHS was simply a routine event; this is taxpayers money we're talking about. Do I think that a successor Tory Government would have spent so much money - to be frank, probably not. Do I think that a future Tory Government would strip it back to a bare bone? Absolutely not.
My point in referring to the Audit Commission report was to show that lots of money can be spent but equally it can be wasted if not controlled. And, as we know, control over the £110 billion budget left a lot to be desired.
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147 jimbrant
You mix 2 very different issues here. I am for local devolution and allowing the different jurisdictions to come to different decisions on priorities and retain any savings efficiency.
They should not be able to rely on other regions bank rolling them.
If the Oil belongs to Scotland, can Londoners keep the income from the City. Where would this end. but interestingly many reports say that even if they kept the oil revenue that was theirs they would still be worse off.
If we do Thatcher can we also throw in Harold Wilson
9 Yrs ago Labour promised everyone would have access to an NHS dentist, Fail.
They also promised a bonfire of Quangos and turned 60 into 700
I complain cos I just dont see the return on my buck.
Brown has squandered too much of my tax to get a second go. But I wouldnt rule out another labour leader if he made the right noises on value for money and spending.
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152 RussellHolmstoel: "9 Yrs ago Labour promised everyone would have access to an NHS dentist, Fail."
True enough. They could have done so if they had compelled all the dentists whose training they/we paid for to work in the NHS, because there are more dentists now. But they didn't, and dentists realised that they could earn more by opting out of the NHS. But that is a temporary situation I think; as the numbers of dentists increases further their scarcity value will fall, and they will be grateful to get back into the security of the NHS.
As I've said elsewhere, I have no problem myself. My local NHS dentist has been advertising for new patients for some years now.
I can't respond to your other points because I'm afraid I don't understand them. What has Wilson got to do with it?
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#152 and other remarkably similar posters.
Not one of you has answered my fairly reasonable questions that I posted earlier, yet you continue to assert the same hoary old chestnuts.
Before another one of you decides to misrepresent the facts on expenditure and output, can you please point to the reference that proves that Scotland receives more than it pays in? Remember I am looking for the figures on total expenditure (see earlier posts if you are in doubt).
If you are unable to back your earlier claims up with real evidence and not partial material, can we stop with the line that Scotland gets out more than it puts in, or do you want to persist because it represents your own prejudices?
I had already pointed out that the UK as a net contributor to the EU subsidises poorer regions of Europe, yet not one of you seems to mind. Does this mean that your motives are purely Scots bashing? I hope not, but who knows.
For the record, I don't drink, smoke or drive an SUV, unlike a large proportion of the English. Does that mean that I am allowed to come on here and accuse the English of poor living habits that I am helping to subsidise?
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Choice sounds nice, but what I'd like to do is choose that my local hospital is at a high standard. I'd like to choose to have a small GP surgery with a doctor I can get to know, should I need to. I'd like to choose not to have to worry about reading reams of quality data to know which hospital I should select. I'd like to choose not to worry people will be served well locally regardless of their education and research capability. I'd like to choose an NHS based on need rather than want. However, I'm not sure that's what choice means.
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r
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154. smfcbuddie
Not read your previos posts, sorry
This was interesting though.
http://www.guardian.co.uk/politics/2007/feb/08/scotland.britishidentity1
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153. jimbrant
Not hard to come up with a binding contract after youve spent 7 yrs training is it? And still that contract remains unchanged today.
Reminds me of the article I posted on the GP contracts. Poor quality government negotiations seems to be a theme with Nu labour.
Agreed Harold Wilson is not relavant and nor is Thatcher. Lets not mention either again.
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I cannot understand why these frankly barking ideas receive so much credibility. What are they intended to achieve?
Let us assume that patients have perfectly free choice over where they go for treatment. Let us also assume perfect information about relative performance. Let us finally assume that patients are perfectly rational - they always go to the best hospital for their condition. In short, let us look at these proposals in the most generous light possible ignoring the obvious objections - namely that hospitals in worse off areas will suffer cuts in funding (because health outcomes will be worse) and the distance factor (which makes the policy unworkable in rural areas).
Assume three hospitals - A, B and C - and assume they are nearby in an urban area. Assume that A is top quality for heart bypasses, B is top quality for chest surgery and C is middling at both. What happens? All heart patients go to A, all chest patients go to B. Funding for these two hospitals increases, C's funding goes down the drain. But there is a lag between extra funding and extra capacity, so you end up with two excellent but overcrowded hospitals with long waiting lists (A and B) and an average hospital which could have taken some of the strain but where quality is being systemically sacrificed in favour of its neighbours. Of course, the alternative is that, being rational people, the patients of A and B will - seeing the waiting lists there - start to defect to the inferior C, in turn taking funding with them and taking us back to where we started and making the whole exercise pointless.
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#157
You should have tried a more recent general source - see
http://news.bbc.co.uk/1/hi/scotland/7465840.stm
The odd thing about all of these stats is the fact that they are constantly being argued over since such a large proportion of the figures are estimates, or proportionate shares of sums that are yet to be confirmed. However, I would appreciate it if someone could answer the point about what appears to be Scot bashing for the sake of it.
cheers
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128 robinJD, Yes Robin it is disheartening to know that a government that has worked hard for the people and yes have spent billions on improving our schools, hospitals bringing in massive unprecedented amounts of new equipment for our hospitals and our children, all the extra police and nurses, and all the good things they have done for the elderly, plus all the new maternity care both in care and maternity leave. Also the minimum wage which brought thousands out of poverty and the myriad other benefits that have been introduced to help people particularly the working class,not to mention the ten years of stability the very low interest rates and low inflation, yes it does disapoint one to know that the media and this quite unimpressive oposition can vilify the man that engineered all these things because of one or two miscalculations,that he is endeavoring to correct.
Yes I think I can honestly say that I am disapointed that people have such short memories. At this moment in time people are being swayed by a bunch of characters most of whom played a major part in the catastrophic government of the eighties and nineties, they have found a mouth piece who many think will be the answer to the present problems of our world but he is as tarnished as the rest of them.
I think that the country needs a conservative government for a few years, to bring people to their senses,the only trouble there is that they will set the country back for how ever long they remain there,
As for Boris Johnson he won the election fair and square but had he not been this character who is full of fun and nonsense
I am quite sure he would not have won. It was his rather youthful personality that won over over many young people who saw him as one of the lads and thats fair enough, but they will come to realise that he is one of the lads but definately not in their circle of friends. Although once again I wish him good luck I hope he does'nt do too much damage before leaving office.
Forgive me if I'm wrong but are you actually encouraging a rebellion in this country, I'm sorry old chap but your a couple of hundred years out of date for that to happen, that type of thing only happened before there was a Labour party.
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#161
Dear Grandantidote,
"Forgive me if I'm wrong but are you actually encouraging a rebellion in this country, I'm sorry old chap but your a couple of hundred years out of date for that to happen, that type of thing only happened before there was a Labour party"
I find this paragraph rather ominous. Do you think there could be no revolution because Labour is so good, or perhaps that nobody would dare revolt against a socialist regime? Please explain. Thanks.
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d
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A woman official spoke disparagingly about "crumbling one GP practices". She is a fool. Most are run by independent-minded, dedicated doctors. I'm lucky having a brilliant GP, but the receptionists are mostly Roetweillers, the nurses frustrated brain-surgeons, and now they have introduced REPEAT Subscriptions. At Boots, the assistants (with less than basic English) have to check everything with the overworked pharmacist. To complete my annoyance, they follow NHS directives, asking if I like my medicine, if it does me good, and do I take it!
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