Why haven&#x27;t other countries copied the NHS?

Original post by L i b

Yep, I've had family members work in the NHS and the tales like boxes of computers stacked up in storage rooms after having been purchased in an end-of-year splurge and never opened were constant.

These reasons are obvious.

Those in charge of finance know that unless a budget is spent, it will be reduced in the following year (this has been a perennial problem with UK public sector finances-no carry forward). Therefore the budget must be spent.

The only way to spend money quickly is on what the rest of the world would regard as capital equipment. However the NHS accounts for the whole expenditure in the year it is incurred rather than writing down a capital asset over its lifetime. That means buying capital assets works in the NHS in the way it wouldn't work in any organisation using normal accounting principles.

There is no need for any end user to have requisitioned this equipment. As installation and training costs would fall in the following year, no provision is made for these. To do so would be self-defeating because those costs will fall on next years budget and reduce it for doing whatever the hospital or department needs its budget for. The purpose of buying equipment was to protect next year's budget, not to be a drain on it.

(edited 8 years ago)

Reply 42

Trevormacdonald

Original post by TheCitizenAct

Why would they want to copy it when they can just turn the British NHS into the world health service? It's called health tourism. Let a small part of the world pay for it, and bleed them dry.

It's multicultural, don't you know?

Do you believe EVERYTHING the Daily Mail tells you. You really do live in your own Alice in wonderland land world, don't you. Lol. Don't worry we will all be under Shariah law soon enough then you can say "see I was right".

Reply 43

Original post by Bornblue

If you don't like it, don't use it but millions upon millions love the NHS and couldn't live without it.

You do realise that, presuming nulli tertius lives in the UK, he's actually paying for it with his taxes? He has every right to complain about a service that he's paying for. 'Don't like it? Don't use it' is only a proper comeback if you also concede that he has the right to stop paying for a service that's dissatisfied with -- knowing your position on healthcare, I doubt you'd concede that, so please stop repeating this nonsensical comeback.

Reply 44

heimdala

Original post by Bornblue

Stop thinking of it like a business. Stop thinking about 'efficiencies', and start focusing on the wonderful service is does provide and has provided.

Not sure if serious... :curious:

Reply 45

silverbolt

Original post by anitax

How come countries like Sweden with even more tax than the UK haven't copied it though? :smile:

Which managerial issues?

When i worked for them (about 8 years ago now) it was ridiculously top heavy and bureaucratic - full of jobsworth trying to justify their paycheck and no on takes responsibility for anything.

It was the main reason I left.

Reply 46

Original post by Hydeman

That logic doesn't apply too well. I don't like my taxes going to trident for example but I get shouted down and called anti-british if I say that.
I don't like my taxes going to Saudi Arabian oil or to bombing Syria...
We all pay for things we personally don't agree with.
Unlike Nulli though I don't have any influence over the armed services, he does over his healthcare.

It seems a bizarre complaint though. The NHS doesn't have magic money pots, it is only as good as the amount of money going into it.

He seems to be complaining the NHS isn't great and wants to cut funding to it - it's illogical.

It's saying 'it's bad because it's underfunded so let's fund it less'.

He of course has a right to complain, but not a right to nonsensical criticisms and not a right to accuse people of GPs being over-cautious. Over cautious beats under cautious.

Would he rather a GP waste a bit of time, or miss out on a potential sign of a serious illness?

(edited 8 years ago)

Reply 47

Original post by heimdala

Not sure if serious... :curious:

A free-at-the-point-of-us health service which regularly is rated as one of the best in the world and allows even the poorest to be treated. How awful!!!!

Reply 48

Original post by Bornblue

The NHS doesn't have magic money pots, it is only as good as the amount of money going into it.

That is the fallacy. The return on each pound spent on the NHS diminishes and in isolated cases spending more money even produces lower gross outcomes

He seems to be complaining the NHS isn't great and wants to cut funding to it - it's illogical.

Did you read my earlier post? There is no practical way of cutting funding at the present time and probably never. The realistic aim is to hold funding and increase outcomes to keep up with demand.

He of course has a right to complain, but not a right to nonsensical criticisms and not a right to accuse people of GPs being over-cautious. Over cautious beats under cautious.

Would he rather a GP waste a bit of time, or miss out on a potential sign of a serious illness?

The GP doesn't waste a bit of time in the sense that he would otherwise be reading Golf World. He spends his time not treating those that need his care in favour of treating those who don't.

This isn't my view. This is the view of the royal colleges that £2:3 Bn a year is wasted in the NHS by doctors even without any form of demand management.

http://www.aomrc.org.uk/doc_download/9793-protecting-resources-promoting-value.html

(edited 8 years ago)

Reply 49

Original post by nulli tertius

That is the fallacy. The return on each pound spent on the NHS diminishes and in isolated cases spending more money even produces lower gross outcomes

Did you read my earlier post? There is no practical way of cutting funding at the present time and probably never. The realistic aim is to hold funding and increases outcomes to keep up with demand.

The GP doesn't waste bit of time in the sense that he would otherwise be reading Golf World. He spends his time not treating those that need his care in favour of treating those who don't.

This isn't my view. This is the view of the royal colleges that £2:3 Bn a year is wasted in the NHS by doctors even without any form of demand management.

http://www.aomrc.org.uk/doc_download/9793-protecting-resources-promoting-value.html

It's not a business and shouldn't be treated as such. Of course there will be waste, but you are acting like private systems are perfect and there is no problem at all.

There would be something wrong if it was making a profit. I want every penny of tax payer money going into the system providing more money for patients, treatments and training.

Why should funding ever be cut? Why not more and more money into the system so it carries on becoming better and better. There should never be a stage where the service is just 'good enough' - it should always be improving and always be getting increased funding.

A GP has a duty to treat anyone who comes before him. It's not for you to say who does and doesn't need treatment. Again i'd rather wasted than cut corners. I'd rather GPs are over, not under cautious. I'd rather risk wasting time than missing potential signs.

The NHS isn't a business. Don't compare it to one.

Reply 50

Original post by Bornblue

That logic doesn't apply too well. I don't like my taxes going to trident for example but I get shouted down and called anti-british if I say that.

Has nulli tertius done that though? It doesn't make sense to say, as you're effectively doing here that, 'because people make invalid arguments against my position on a different issue, it's okay for me to do so here.'

We all pay for things we personally don't agree with.

That's not the point though; you're trying to shut down legitimate criticism of the NHS by offering the 'don't like it don't use it' mantra as justification. You're entitled to complain about Trident and our trade relations with Saudi Arabia, as are the rest of us to criticise the NHS. It's nonsensical to say that nulli tertius should just cease to use the NHS if he doesn't like it as a way to stop him from making legitimate criticisms of it because ceasing to use/support it doesn't actually do anything about the fact that he's still paying for it through his taxes.

I'm not saying that he shouldn't pay those taxes; I'm saying that you're wrong in telling him that simply not using it would remove from him the right to complain about it.

He seems to be complaining the NHS isn't great and wants to cut funding to it - it's illogical.

It's saying 'it's bad because it's underfunded so let's fund it less'.

Well, that's just an out-and-out straw man. His position is that it isn't underfunded. A real summary of his position would be phrased like this:

'The NHS is very inefficient owing to a number of structural and management problems and could do with reducing these inefficiencies so that a reduction in funding may be possible at some point in the future.'

To which you've replied:

Original post by Bornblue

Stop thinking of it like a business. Stop thinking about 'efficiencies', and start focusing on the wonderful service is does provide and has provided.

Which, quite frankly, amounts to a call to sentimental avoidance of the problems of the NHS and proposing to solve it by unthinkingly throwing more money at it.

He of course has a right to complain, but not a right to nonsensical criticisms

This seems to be something of an oxymoron... You cannot say that he has the right to complain, but not in a way that you find nonsensical. It's either all or none in this case, I'm afraid.

(edited 8 years ago)

Reply 51

Original post by Bornblue

Of course there will be waste, but you are acting like private systems are perfect and there is no problem at all.

nulli tertius has neither said nor implied this.

Reply 52

Original post by Bornblue

Why do you keep referring to a business and a profit?

The NHS is monumentally inefficient for a variety of reasons mostly related to its scale.

It needs to be made more efficient regardless of who owns it. Governments have thought that introducing internal pretend markets would increase efficiency. In no real sense have they done so and it is more than arguable that they have added to the NHS's problems.

They NHS can contract with a private supplier to do 500 knee operations or the such like but that has no real impact on the internal management of the NHS. It merely says here are a few operations that are not subjected to that management.

We could get in some private sector management to try and run the existing system better. They have tried one hospital. It didn't work. The problem isn't that the quality of NHS management isn't high enough. The problem is what they are managing.

The entire NHS or parts of it could be flogged off to a private company with the government paying a fee for using the service. This might work. The great success stories are BT and BA. But against them, put Railtrack and the National Air Traffic Control Service. If we did this, we would have to expect that some things are done differently.

None of these things necessarily has any impact on how the service is paid for and we can change how it is funded without changing how it is managed at all.

However the danger of changing how it is funded without changing how it is managed, is that the new funders (be that patients, insurers, employers, mutuals etc) will vote with their feet and buy provision elsewhere with new entrants setting up in opposition to the NHS and without its baggage.

Reply 53

MatureStudent36

Original post by Bornblue

Whereas it's all sunshine and roses in corporate firms.

Public sector does have a reputation of needlessly spending money to ensure all of the budget is used up. Recruitment firms, suppliers etc all live the month or two before the end of the financial a year as that's when public sector splurge.

The mentality isn't often seen in privately run organisations. Nobody gives you a well done for spending money unnecessarily.

Reply 54

Fullofsurprises

Original post by anitax

Even ones like Sweden, Finland etc.?

Sweden and Finland's systems are quite similar to ours - both mainly state funded and free at the point of use. (Some small charges for some things, as with the NHS.)

https://en.wikipedia.org/wiki/Healthcare_in_Sweden
https://en.wikipedia.org/wiki/Healthcare_in_Finland

The only real difference is they devolve more to local authorities than here, although the comparison is complicated, because social care for the elderly and disabled is provided by local authorities in the UK, whereas this is more centralised in Sweden and Finland.

Most other EU countries operate free-at-point-of-use or 'minimal charge' systems, less so in the poorer emerging E. European states.
.

Reply 55

Original post by nulli tertius

The NHS is monumentally inefficient for a variety of reasons mostly related to its scale.

Providing a service for a nation is always going to be, but you don't seem to admit any of the good things it does, nor have you said anything positive about it at all. Again i'd rather a few inefficiencies, then serious corner cutting.

It needs to be made more efficient regardless of who owns it. Governments have thought that introducing internal pretend markets would increase efficiency. In no real sense have they done so and it is more than arguable that they have added to the NHS's problems.

Again I refer you to Blair's waiting lists, which dramatically reduced as he poured money into the NHS. There's only so much 'efficiency' you can get by on, I know the tory mantra is 'more for less', but there comes a time when you do just need more money to provide a better service. There is no magic money tree. If we want the NHS to have the resources to treat us all then it needs more money. Yes it can be more efficient but the end result is it needs funding.

We could get in some private sector management to try and run the existing system better. They have tried one hospital. It didn't work. The problem isn't that the quality of NHS management isn't high enough. The problem is what they are managing.

The entire NHS or parts of it could be flogged off to a private company with the government paying a fee for using the service. This might work. The great success stories are BT and BA. But against them, put Railtrack and the National Air Traffic Control Service. If we did this, we would have to expect that some things are done differently.

Different doesn't equal better. And yes some services can be done better by private but the NHS is not one of them.
Shown by how it regularly rates as one of the best in the world.

However the danger of changing how it is funded without changing how it is managed, is that the new funders (be that patients, insurers, employers, mutuals etc) will vote with their feet and buy provision elsewhere with new entrants setting up in opposition to the NHS and without its baggage.

It really should be as simple as more money going into the NHS = a better service. That's it. You can be as efficient as you want, but if you don't have the money to buy a new cancer machine there's nothing you can do.

What do you want? To scrap the NHS? To make it not free at the point of use?
It's a great system and you seem to have nothing good to say about it.

Reply 56

heimdala

Original post by Bornblue

A free-at-the-point-of-us health service

You seem to believe that there is only 2 ways of running a health care system, UK or USA. Neither are particularly good, for different reasons.

Original post by Bornblue

which regularly is rated as one of the best in the world and allows even the poorest to be treated.

Please do provide sources, the exact measurement that are used and why such measurements are relevant. As you will soon find out a lot of healthcare rankings are misleading. For example the WHO penalises the US system for not having a sufficiently progressive tax system, not providing all citizens with health insurance, and having a general paucity of social welfare programs. Such judgments clearly reflect a particular political point of view, rather than a neutral measure of health care quality. Other rankings will include life expectancy as a measure even though this is affected by exogenous factors such as violent crime, poverty, obesity, tobacco and drug use, and other issues completely unrelated to health care. Infant mortality, a common measure in crosscountry comparisons, is also highly problematic. In the US, very low birthweight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low birthweight babies die soon after birth, which boosts the infant mortality rate of the US, but in many other Western countries, those high-risk, lowbirth-weight infants are not included when infant mortality is calculated. Many countries use abortion to eliminate problem pregnancies. For example, Cuba has low infant mortality rates, yet the country has one of the world’s highest abortion rates, meaning that many babies with health problems that could lead to early deaths are never brought to term.

Original post by Bornblue

How awful!!!!

To be honest, i agree that those of low income should also be able to receive healthcare. I don't understand why criticising the NHS for its failures and wanting a more efficient system is wrong.

Reply 57

Original post by heimdala

You seem to believe that there is only 2 ways of running a health care system, UK or USA. Neither are particularly good, for different reasons.

Which one is better, one that ensures every single person is covered and can receive the same level of helthcare, or one in which 40 million people are priced out of healthcare?

Neither is perfect, but seeing them as 'equally bad' is absurd.

Reply 58

Original post by Bornblue

As is treating them as the only two systems possible, which you seem to be doing here. At no point has nulli tertius argued that the NHS should be scrapped or privatised or that the USA's private healthcare model is preferable and yet you've repeatedly attacked him for apparently doing so, on the basis that he hasn't praised it enough. Please stop doing that.

(edited 8 years ago)

Reply 59