Wednesday, August 01, 2007

You've Paid For It

The latest fuck-up in the NHS, I mean. Full details here, but I would just like to highlight a few things. Firstly:
"Over 1,000 appointments were made in the last three weeks of July alone... (The BMA) said consultants were unable to plan operating lists because they did not know which junior doctors would be on their team."
Right, so the NHS waited until the end of July to make appointments that would impact on the organisation's ability to function in the beginning of August. Does no-one look at the rotas say, oh, in June or maybe May, and say "hang on a mo, chaps, these appointment things could be a bit of a headache in August, maybe we should have a think about it now so it doesn't really fuck us up later in the year." If this happened in the private sector, then the HR Director would be "leaving the business with immediate effect".
"They also said junior doctors were missing work because of last-minute interviews."
Not being funny, I do understand that people need to interview. But a good boss would look at what their sub-ordinates are doing, and how essential their work is, and maybe stop them from missing work if need be. And if they didn't turn up, then maybe I'd go with some sort of, well, disciplinary action. But I'm old fashioned. I expect people to do the job they're paid to do, not focus on a job they may be doing in the future, maybe, if they do well at interview.

Of course, the government thinks everything will be OK:
'Deputy Chief Medical Officer Professor Martin Marshall said: "We know that August is always a quiet month with fewer outpatient appointments and fewer operations, which is why the junior doctor rotation happens at this time every year. The numbers involved will be higher this time, but NHS trusts are used to dealing with this issue and have plans in place to make sure services run properly during August."
However, somehow, the guarantees of the government ring hollow in my ears. Can't think why... oh, wait, it may be because they are a gaggle of lying, incompetent cockmonkeys who aren't capable of lacing their own shoes without getting lost in pointless deception and trying to charge you for the privilege.

Which is the point, really. It is your money, and my money, that has paid for the NHS to go and fuck up in spectacular fashion yet again. We're lazy in the UK about the NHS - we don't question why it exists and have become numb to all the problems. A cock-up in the NHS is like background noise now - a really ground breaking news story would be a success in the NHS. And why are we so blase about the continual fuck-ups? "Because the NHS is a free service".

Except, it really, really, really isn't. It is free at the (generally extremely crappy) point of service but you've already paid for the NHS through your taxes - regardless of whether you use the services or not.

People should be angry about the NHS. They should be demanding radical change, and expecting their main political parties to question whether the NHS should actually exist. But what do we have instead? A bitter apathy as the NHS lurches from catastrophe to catastrophe, backed by a deafening silence on the issue from our main political parties.

23 comments:

Tomrat247 said...

I am for socialised medicine; it is all very well saying that it should be a fee based service but this is really one of those things that is best left in the care of the masses so that when one gets sick the majority can pay for them to be nursed back to health. The great unwashed would just not buy health insurance, prefering to spend the £30-50 on WKD Blue and fags.

What is wrong is the apparent apathy with which people view the NHS - its there when you need it - but few really understand that massive government interventions, top-down, top heavy management techniques and poor management of funds have collided with the vast majority taking it for granted. If people really knew how much it cost them (fee at the point of entry; I dont like it much but maybe a partial rebate at the end of the tax year on income tax for those who utilise the services they turn up for) then we would fight to ensure it was money well spent.
If we take as an estimate, based loosely on the number of disabled, underage and oldage (~30% out of the total population), and the unemployed (approximately 1.7 million) as a proportion of the total population (~60.8 million) we would need to fund their healthcare by ~33%; if comprehensive health insurance for the average individual is ~£50 a month then this would equate to approximately £60-70 total to enable our insurance payments to cover the shortfall in other peoples healthcare. However, looking at my last wage slip I find that I spent 112 on national insurance. Where is the other £40 quid going?

Mr.D. said...

Excellent rant, Sir!

flashgordonnz said...

ARe you sure its a "gaggle" of cockmonkeys?

Vindico said...

DK, i am remined of a quote by Eugine McCarthy - "The only thing that saves us from the bureaucracy is inefficiency. An efficient bureaucracy is the greatest threat to liberty"

Chertiozhnik said...

"but NHS trusts are used to dealing with this issue and have plans in place to make sure services run properly during August"... why does that cause a sinking feeling?

Theoretician said...

on another note maybe you would like to make a some derogatory comment about one of my blogs so I too can start a list of testimonials - the nauseatingly self-congratulatory bit http://welshwomensvoice.blogspot.com/

Roger Thornhill said...

tomrat247

You present a false dichotomy : NHS or unregulated private free-for-all, which is the typical socialist attempt to blow-off any criticism of their communist agenda, of which the NHS is a part.

It does not have to be one or the other.

Part of the general malaise of this country is because people like you are happy to keep the "great unwashed" from any form of consequence.

100 years ago the great washed (as they were then) DID look after themselves. The only reason the Lumpen Illitariat are unwashed and uninsured is because of the infantilisation of the Welfare State pushed by you but funded by us.

Mark Wadsworth said...

What Roger says.

Tomrat - it's got bugger all to do with National Insurance, that is just a payroll tax. They manage to sepndv (from memory) £90 billion a year or so on the NHS, that's around £3,000 per taxpayer. Or £1,500 per head of population (a more relvant figure). Or twice as much (adjusted for inflation) as ten years ago.

the A&E Charge Nurse said...

Libertarians - so far none of you have passed the A&E charge nurse test to find a country in Europe [or the States] which spends less of it's GDP on health yet provides a better service than the NHS.

Incidentally don't mention 'heatwave' to the French [15,000 deahs in 2003].
Or strike action to the Germans, not mention the recent political manouvres to shore up the untenable wads of cash thrown at their health system.
And for gods sake don't mention 'Sicko' to the Yanks.

Roger T - I'm not really sure what you mean when you say the great unawashed looked after themselves [100 years ago].
It seems you are completely oblivious to perinatal mortality rates, for example, a statistic made much worse by the debiltated state many women where in by the time they reached term, happy days, eh ?

anthonynorth said...

The NHS used to have lots of small hospitals and small salaries. Now they are moving to a few big hospitals and big salaries.
The answer's obvious. Power to the local hospitals!

The Remittance Man said...

Simple question here: when is the official NHS budget year end? Call me a cynic if you will, but might it not be 31 July?

If this is the case then simple stupidity becomes cunning stupidity. All those appointments will be recorded in the 2006/7 figures and hence be proclaimed a success. Hooray! Double chocolate rations and flipping great bonuses all round.

The small problem of all those cancelled appointments? Well, that's a 2007/8 problem and there's twelve months to gyppo...er, sorry...sort out that particular cock-up.

Roger Thornhill said...

Of course A&E likes to disregard Switzerland because "it spends more", forgetting the fact that a significant amount of it is voluntary and the quality of service people get from the state mandated minimum package sold by a plurality of providers is like a "very good to excellent" private package in Germany or the US.

By looked after themselves, I mean as in using friendly societies to provide medical cover.

Devil's Kitchen said...

Theoretician,

I'll repeat the comment here that I left at your place, viz.

I'll check my emails for your message, but I would like to point out that "heavily edited" rather assumes that there is something dodgy about the testimonials; this is not the case, and you can check that: all of the testimonials are linked to the orginal post in which the quote appeared, so that you can check the context.

As for why they are there -- perhaps we all enjoy being flattered? Perhaps they are there, in my case, to counter the argument that I continually get: because I swear, obviously I cannot write anything worth paying attention to.

DK

Devil's Kitchen said...

"Libertarians - so far none of you have passed the A&E charge nurse test to find a country in Europe [or the States] which spends less of it's GDP on health yet provides a better service than the NHS."

Charge Nurse, it is not the amount that is spend that annoys us Libs, it is the way in which it is spent, i.e. much of it pissed up the wall, and the way in which it is raised, i.e. extortion with menaces.

Sure, other countries spend more and other countries get a better standard of healthcare.

To say that the NHS is better than anywhere else because we spend less of our GDP than other places is to ignore the fact that the medical care that the NHS provides (and, in other cases, fails to provide) is a bit crap really.

To say that because we spend less we should put up with a shitty system is not a particularly strong argument.

DK

the A&E Charge Nurse said...

Ahh the Swiss, 2nd highest spenders on health after the profligate Yanks.

A small, wealthy country with a population less than that of London - while the UK recieves almost half a million migrants each year on top of a population nearly ten times that of Switzerland.

If you REALLY want a better health system then Joe Bloggs needs to make a few simple lifestyle changes all known to reduce the risk [and associated expenditure] on diseases which are largely self inflicted, such as type II diabetes, ischaemic heart disease, and chronic obstructive airway problems [leaving more resources to be directed elsewhere].

In other word if the general population cut down on smoking, excessive boozing [as well as other drugs] fat, salt & sugar then the general health of the population would be much less than problematic than it is now.

These changes which admittedly are unlikely to ever happen [especially given the depressing stats on childhood obseity] would produce more startling results than handing over millions of euro's to the insurance fat cats.

the A&E Charge Nurse said...

Devil - don't get me wrong if the NHS folds [which it surely must] then I along with all the other grunts will roll with punches in order to seek a niche in the shiny new market.

But my honest view is that we will be merely exchanging one set of problems for another - in other words there will be winners and losers, just as there is in the NHS.

Mind you, if the rail service is anything to go by it's not just 'the socialists' who have a monoply on crap planning, expensive services and avoidable disasters.

Roger Thornhill said...

A&E, the Swiss seem to get their money's worth. If we talked of a system that cut healthcare spending you would be moaning about that. Because I propose one that has the people voluntarily spending more you moan as well.

Half a million immigrants are the responsibility of the same bunch of clowns wrecking healthcare. The problems are fundamental and this issue may make a bad problem worse but it does not excuse or explain it.

The general population are unlikely to cut down for their health while they remain isolated from the true cost of the "free at point of use" healthcare. If they did not have Employer NIC but had to write out a cheque for their healthcare they have a chance to wise up a bit. Public education is a good thing but people's lifestyles do not explain away the state of the NHS in terms of maladministration, centralised madness and waste.

I'd rather be handing over my cash to an insurance fat cat of my choice than being forced to hand over the same or more to a monopolistic State-run bureaucracy with no choice whatsoever in the matter.

Devil's Kitchen said...

"In other word if the general population cut down on smoking, excessive boozing [as well as other drugs] fat, salt & sugar then the general health of the population would be much less than problematic than it is now."

That sounds like a very boring world that we would all inhabit, Charge Nurse; very much like the rather joyless existance that the people of the USSR might have been under.

People will always abuse themselves; it is the nature of humans. And you admit this when you say that these changes are unlikely to happen. So, why posit a solution on a premise that will never ever be fulfilled?

So, you should make people pay for their choices.

Someone wants to sit around on their arse all day and get hideously obese, despite being warned of the health consequences? Fine, they should pay for that choice.

Someone wanbts to carry on smoking, despite being warned of the health consequences? Fine, they should pay for that choice.

Someone wanbts to carry on drinking to excess, despite being warned of the health consequences? Fine, they should pay for that choice.

And all of these lifestyles are choices; no one forces any of this on people. Thus, it is only right that they should pay for the consequences of their actions: in other words, they should pay for the healthcare that they need. Is that wrong?

No, it is right both economically and morally. There is little point in telling people that they might get x disease in y years: people are notoriously bad at realising these concepts (everyone thinks that they are immortal, if you like).

If people realise that their choice is costing them money now in higher premiums, then they may well alter their lifestyle in order to save that money and thus you would save their health.

"Mind you, if the rail service is anything to go by it's not just 'the socialists' who have a monoply on crap planning, expensive services and avoidable disasters."

Ah, but unfortunately, there really isn't much competition in the rail industry. No one, for instance, is going to go to the capital expense of building another east coast line from London to Edinburgh in order to run cheaper services. Though it is also useful to remember that the railways (and the Tube) were all built by private companies and not by the state (which stole them from those companies during nationalisation).

"I'd rather be handing over my cash to an insurance fat cat of my choice than being forced to hand over the same or more to a monopolistic State-run bureaucracy with no choice whatsoever in the matter."

I completely agree, Roger; you see, Charge Nurse, it is the choice thing which so exercises us Libs. We should be able to choose; we should choose how we pay for our healthcare and who we pay it to. We should be able to choose what hospital we want to attend and we should be able to get that care promptly, not after a matter of years.

DK

AntiCitizenOne said...

> Better service than the NHS.

Here's 2

http://www.casualtyplus.co.uk/

http://www.doctortoday.co.uk

Lets allow people to opt out of the UKs extortion funded treatment rationing schemes. After all it should be your body, and socialism killed more people than anything last century.

the A&E Charge Nurse said...

Devil - the choice you crave is as illusory as the 'Stalinist monoply' that inevitably gets conjured up by the libertarians whenever the NHS is mentioned.

I can promise you that doctors & nurses are far too busy getting on with the job to absorb themselves in Das Kapital, and how this doctrine might apply to health economics.
Beside we have seen the various reorganisations and meddling come and go with few sustainable benefit

Of course, any pychology undergraduate can tell you that 'personal choice' is, in fact, a complex and murky business - influenced by how often you were beaten as a child, economic/emotional stability within the family network, then later success [or failure] in the job and relationship markets, and so on.

Is it really the libertarian position that we [as a society] are the sum of these labrynthine and barely understood processes [left virtually unmediated by nannying politicos]- or is that we are no more or less than our individual economic worth, and those social forces that favour one person rather than another ?

I agree that trying to warn the public about future health risks feels like pissing in the wind most of the time - how many alcoholics were deterred by photos of a jaundiced and gaunt looking George Best during his final days in a [private] ITU ?

The NHS is clearly living on borrowed time but I wouldn't be suprised if comes to be described in revered terms after it is finally put out of its state sponsored misery.

Devil's Kitchen said...

"Is it really the libertarian position that we [as a society] are the sum of these labrynthine and barely understood processes [left virtually unmediated by nannying politicos]- or is that we are no more or less than our individual economic worth, and those social forces that favour one person rather than another ?"

No, of course it is not. The point about personal choice is that people are so complex and so different from one another that only the individual can decide the best way of pursuing their own happiness.

Some people, for instance, will forego a higher salary in order to spend more time at home; some will work like demons to pursue wealth; others will find their own balance, etc.

What we do know is that central governments attempting to dictate how3 people should choose to live does not work. This is self-evident, isn't it?

So, the greater personal choice people have, the greater their chance of finding their own happiness. No one is going to be happy all of the time, but generally they are happier in a freer society than those in a more centrally "ordered" society.

If people are unhappy with their lot, they can strive to better it; and in days past, even if they were unable to progress themselves, they were eager to ensure that their offspring did. This is called social mobility and the rate of it has fallen the more that NuLabour have attempted to boost it.

Because, you see, it is a personal choice issue; if an individual does not wish to better themselves, no amount of government intervention will force them to do so.

DK

the A&E Charge Nurse said...

anticitizenone - still banging the drum for 'casualtyexhorbitant' I see.

Assuming your injuries are so slight that they can actually be dealt with by 'casualtyexhorbitant' [say an uncomplcated radial head fracture] then who provides;
Fracture clinic follow up ?
Surgery if the bone fragments shift position a week or so down the line ?
Physio if full range of movement is lost ?
O/T [if adaptions at home, etc] are required.

Not 'casualtyexhorbitant', I'll bet - and notice how they avoid use of the word 'emergency' - no, they wouldn't want any sick people [anymore than they would want any poor people] cluttering up their expensively designed waiting area.

Mark said...

Re the interviews - you need to keep in mind that in the past almost all appointments for doctors were for 6 months (at the most). So One month into your job you would be looking at the classifieds and two months in you'd be interviewing! Everyone was always interviewing all the time. You would get phone calls from doctors asking what your job was like after you'd been there a fortnight because they were coming to interview for your job! In the last half of an appointnent all the doctors were off on interviews once a week in my experience.