Tuesday, October 09, 2007

Rant: losing it

Generally, I enjoy Team Rant, but their primary spokesman seems to be losing his tiny fucking mind.

Today's ill-considered post is a simplistic exposition based around the following title: The NHS is shit. The alternatives are shitter.

That's right, ladies and gentlemen: despite reams and quires of evidence to the contrary, every other healthcare system in the world is worse than the NHS.
I think in 10 years time I will be watching all this from abroad with my kids thinking, thank fuck I saw the writing was on the wall and got the fuck out.

Really? And what system of healthcare will that country have?

Perhaps we might urge a couple of the other medicos on Team Rant to sign the Sectioning forms for their unbalanced leader...

49 comments:

Anonymous said...

Give the guy a break. The NHS is expanding its gay & transgender outreach facilities. There's to be a gender reassignment co-ordinator in every GP surgery; free KY in every public toilet and a complimentary copy of Gay News for everybody admitted to hospital.

To pay for this, the drugs budget is being slashed. Rant's lithium dose has probably been reduced to an ineffective level. Hence he's ranting more than usual.

the a&e charge nurse said...

What other health system will that country have ?
One that provides preferential treatment based on earning power rather than clinical need, of course - or at least one that is spending more of GDP than the UK.

the a&e charge nurse said...

Incidentally Devil if we accpet the the avove criteria [discrimination/increased expenditure] which counrty outperforms the NHS if we accept the WHOs rating system rather than the devils ranting ?

Anonymous said...

the a&e charge nurse:

As if any of us are going to listen to a nurse about the NHS.

You've destroyed your own vocation trying to professionalise it in a misguided attempt to achieve a similiar status to the quacks, which was a laughable idea considering the differential in intelligence and knowledge required for the two jobs.

You now spend years sitting in nursing college learning irrelevant sociological crap, but then you have to be taught on the job (by the few competent older nurses left) to empty bedpans and take blood pressure.

You've even managing to squander the admiration and respect of the tabloid-reading public due to the apparent lack of care and callousness of many modern nurses. But then modern nurses have been taught at college to resent the description of the themselves as "angels", mistaking naive sentiment as a patronising attitude. Well nurses got their wish: not many think of them as angels any more.

anthonynorth said...

With all that 'shit' are you sure they're not just talking about the toilets?

Roger Thornhill said...

a&e:What other health system will that country have ?
One that provides preferential treatment based on earning power rather than clinical need, of course - or at least one that is spending more of GDP than the UK.


False dichotomy. It is not a choice between "earning power" vs. "clinical need". And are you against increased healthcare spending? Seems so.

The UK has a preferential treatment system based on spending choices (not "earning", as earning money gets you nothing but a bank balance - one must SPEND it), it is just that one has to pay twice to get it, unlike some other places that only asks you to pay once. Result: options limitation to the very rich and the political classes. In the UK it is "spending power" vs "funding constraints".

Now as an expectant father I get healthcare professionals trotting out, erm, disingenuous spin lets call it (not "lies", I am being generous) to cover up for the fact that treatment is being rationed not on clinical need or common sense but on funding constraints. Twice I have had to pay for services that others get - subsidised by me I might add i.e. I get DETRIMENTAL service because I am forced to a) subsidise others b) pay for myself anyway with what little money I have left.

If you take "distribution" out of the mix, the NHS does not look that good at all AND YOU KNOW IT. How many more times am I going to have to repeat that the WHO report even admits it puts a disproportionate weighting on "distribution" so bumping up the NHS final score?

The bankrupt socialist dogma is a failure. it was not even MEANT to be this way - the hospitals were not meant to be nationalised, just a form of universal "safety net" insurance scheme. Oh no, the socialists cannot resist building a monopoly and forcing everyone to like it or lump it.

Because of this it is systemically dysfunctional. The entire time one must constantly manage and adjust the NHS to try and mitigate the adverse effects of it being a monopoly, but I do not see anyone trying to do that with much success.

the A&E Charge Nurse said...

Anonymous - you have obviously been spending far too much time in cliche city.

Of course, you're not going listen to a fallen angel, sorry nurse, you don't seem to have the capacity to either listen or learn [judging by the sub-Daily Mail drivel you are spouting].

May I commend the militant medical nurse, you can find her at;
http://militantmedicalnurse.blogspot.com/

Be warned though, she has a very low threshold for opinionated Daily Mail readers with learning difficulties.

Incidentally, I see you don't feel up to meeting the
A&E Charge Nurses challenge - i.e. naming a European country ranked higher than the NHS by the WHO that spends less GDP on health than the UK, yet has better clinical outcomes ?

And here's another one, the nurse quacks have been around for well over a decade, in the UK, Oz & USA, to name but a few countries [but presumably these nurses are crap as well].

The research evidence [and there's a fair amount of it out there] proves that the quacks are doing OK [at least comaparable to SHOs] - but perhaps having scoured all of the relevant medical journals you can find something that says otherwise ?

Needless to say the opinions of the Sun or the Dail Mail [which you replicate so faaithfully] doesn't really count, however exciting you might find them.

chris said...

which country outperforms the NHS

OK, shall we start with Estonia? Or the Czech Republic? The NHS isn't even close to France, Germany, Sweden, Finland or any other industrialised country. In these countries health care is directed according to clinical need, unlike the NHS where it is based on centrally imposed targets and quotas.

Mark Wadsworth said...

Roger, if you are angry at the State now, just wait for the ensuing battles with health visitors, officious midwives, waiting lists for half-way decent schools, child assessment crap in nurseries, shit state schools and so on, in five years time your head is going to have exploded at the fuckwittery of it all.

I was a pretty easy going middle of the road blokle 6 years ago. My kids are now 4 and 6, and boy am I sick of it all.

the a&e charge nurse said...

Evidence please, Chris [and a quick visit by a few UKIP delegates on a stag weekend in Prague doesn't qualify, sorry].

Roger, good points as always, I hope all goes well for you and Mrs T.
My three were all born in NHS maternity units and it all seemed to go OK [admittedly my role consisted of little more than shouting push harder love, time is money].

Anyway, we never agree on this subject but just a couple of points to leave you with;
When the NHS is dismantled [work currently in progress] punters will, by and large, be treated by the exactly same NHS doctors and nurses, albeit in slightly smarter designer uniforms.

Secondly, there is the slippery slope argument.
As a prospective father you may be vaguely interested in the abortion stats ?
In 1968 there were approx 24,000 abortions, the figure increased to around 185,000 in 2006.
I'm not against abortion but undoubtably the culture of production line terminations reflects certain aspects of "consumerism" when explicitly applied to health [the baby is inconvenient, it will cost too much, I'm too young/old].

By all means bin the NHS with a promise that principles of a comprehensive and universal service MIGHT be replaced by a fragmented system of private providers and insurance companies, how long though before cracks start to appear ?

Look at the disasterous effect fragmentation had on rail [in terms of corporate accountability, for example].
Hell, even getting different departments in the same hospital to co-operate can be a minefield sometimes [since they all have different cost codes].

As the effects of overpopulation begin to bite in the richer countries things will turn meaner, and health will become a commodity just like the prepared meals in Tescos - still, at least the A&E Charge Nurses mortagage provider will be content given the publics propensity to eat, drink and smoke themselves into a state of chronic disease.

Mark Wadsworth said...

A&E a fragmented system of private providers and insurance companies

No! No! No!

The FUNDING side has nothing to do with the PROVISION side. These are two COMPLETELY DIFFERENT TOPICS.

On the PROVISION side, who said they had to be private? Hospitals and clinics might be owned and run by local councils, trade unions, churches, charities, universities as well as insurance companies or owned privately (like GP's surgeries!). As long as there is some competition, that is waht matters.

On the FUNDING side, there is nothing fundamentally wrong with the bulk of it being funded out of general tax receipts*. If people want to top up their health-vouchers and pay for a single room instead of being on a ward (as exists in many NHS hospitals) and so on then fine, they are free to pay out of their own pockets or out of private health insurance.

*cf. vouchers for schools. These would also be funded out of the normal DfES budget, i.e. out of taxpayers' money.

the a&e charge nurse said...

Mark - what about the HUGE implications for training of medics, physios, radiographers, nurses, pharmacicts etc, etc.

Then there are a vast array of post-Reg courses, continous professional development and specialised training [or "lifelong learning" to use NHS jargon].

Not to mention the sphere of clinical R&D with complex issues relating to [profitable] patenting/ownership of intellectual property, and so on.

Then there is the problem of defining a framework which joins up the work of different professions; social workers, O/Ts, docs, etc - are you really suggesting that these issues can be worked out at the next local parish meeting ?

Fragmentation = territorialism.
Good for some, certainly, but bad for many others.

What makes you think mortality from MIs would improve if trade unionist got involved ?

Mark Wadsworth said...

A&E, I do not have detailed knowledge of this, but it works fine in Germany and other countries.

Training is training is training. Are you suggesting that medics in the private sector are completely exempt from any sort of training regulations? Methinks not.

The Parish Council would choose who is to run the hospital, provided the management makes a reasonable fist of it (patients are happy to go there and the hospital can provide the services at a cost that is equal to or lower the equivalent NHS cost), there is no need for politicians to get involved any further.

That is the whole point.

If there is no MRSA, no long waiting lists, and no three levels of fuckwit bureaucrats to battle with before you can get a bandage and a tetanus shot, then local people will be happy.

If not, they will grumble to their local councillors and local councillors will sack the management, terminate the contract and hand over to somebody else.

lost_nurse said...

"If there is no MRSA..."

Eh? I hope that's just clumsy wording...

the a&e charge nurse said...

Mark - any doc working in the private sector is NHS trained [apart from oversees recruits obviously].

Many of the plastics guys, for example, who do very nicely out of breast augmentation and liposuction will have learned their trade in MRSA infested NHS hospitals.

But remember the real clinical "artists" work in the state sector - primarily because they are driven by clinical excellence rather than profiteering [the sort of guys that pioneered liver transplants, etc].

The privates may appear to be better than the NHS [I'm sure they're probably OK most of the time] providing you don't get really sick in which case they will ship you out to an NHS hospital, or providing you don't develop a post-op complication [see death of Penny Marshall] because they won't see you.

Yes, the private patients get to a see consultant once a day and have nicer room but thats because they don't have to deal with EVERYTHING & ANYTHING that comes in through the door - spend a few sessions sitting with a GP or in A&E triage and you will see what I'm talking about.

By the way the battle against treatment resistent organisms, such as MRSA & clostridium difficile can never be won so long as we use antibiotics.
Flemming anticipated evolution of bacteria [after exposure to penecillin] 60yrs ago.

The more antibiotics we have the greater scope for bugs to adapt and evolve - look at the rates of hospital acquired infections in some of the States swankiest hi-tech hospitals.

Indeed some microbiologists claim it is only a matter of time before organism evolve which will be resistant to every single antibiotic on the market.

Incidentally, if you've had a full tetanus schedule in childhood [x3 shots age 1-2, a booster at five, and a further jab around school leaving time, i.e. the standard UK immunisation schedule] you are probably tetanus immune for life.

Because of the wonderful service offered by the NHS, tetanus is almost unheard of nowadays [I have never seen a single case] - but there is one recorded death of an elderly lady [with no record of immunisation] who accidentally innoculated herself while peeling potatoes [presumably the source was in the soil stuck on the spud skin].

Mark Wadsworth said...

Lost Nurse, I said If there is no MRSA ... then local people will be happy.

Looks OK to me.

Mark Wadsworth said...

A&E Mark - any doc working in the private sector is NHS trained

So what? Most people get a free State education - does that mean we should all work for the State?

Simple market solutions:
1. Make doctors pay for their own training, e.g. via loans.

2. Reduce the value of the vouchers that the State gives to non-State hospitals by a certain %-age to reflect the fact they don't contribute directly to costs of training doctors.

3. Levy a surcharge on profits of non-state hospitals to fund training of doctors.

And so on.

Mark Wadsworth said...

A&E providing you don't get really sick in which case they will ship you out to an NHS hospital.

This is all ad hominem stuff, y'know? You fail to refuse to discuss what I am trying to discuss. Instead you are attacking something that I am not trying to defend.

If the State is prepared to pay proper money to competing providers to treat the "really sick" then they will be happy to treat them.

In Germany THERE IS NO NHS! NONE! NONE WHATSOVER! And the "really sick" still get treated because hospitals know that their costs will be covered.

the a&e charge nurse said...

Yes, Mark only 186 cases of tetanus in the UK between 1984-2002, as opposed to 4 million heart attacks [approx] for the same period - so unless you have a soil contaminated wound [or penetrating animal bite, or significant devitalised tissue] that only leaves the bandage to worry about.

God, the NHS is good isn't it ?

Anonymous said...

the A&E Charge Nurse:

Ooo the "Daily Mail" argument. The new Godwin's Law. I give in, you've won.

But seriously, well done to nurses who have managed to transform their image from the "patronising" image of respected, efficient carers to an image of lazy, disorganised, militants. But, you know, you've been to university for four years, so surely you deserve the respect of the public. Hmm, haven't you get it?

Anonymous said...

"haven't you get it?" = "why haven't you got it?"

the a&e charge nurse said...

It takes £250,000 to train a UK doc, obviously, if they have to pay for their own training it will widen the field of potential applicants enormously won't it ?

How might the conversation go ?
"Dad, have you got a spare quarter of mil so I can train to be a doc"
"Sure son, now just put your black mask on and point the shotgun at the nice lady behind the bank counter".

And who would REALLY suffers if hospitals became voucher deficient ?
What contingencies would there be for balancing the dual demands of elective and emergency services ?

Germany does not have an NHS, perhaps that's why they have been paying so much more for health than the UK for many, many years.
We may have closed the gap in recent years [but still not equalled them], but the ACCUMULATIVE difference spent by the mullets is far, far greater than here.

And if Germany is so great why are their doctors always going on strike ?
http://www.bmj.co./cgi/content/full/332/7543/686-b

Mark Wadsworth said...

OK, it costs £250,000 to train a doctor, paid for out of taxpayer's money.

So what? Why should I, as a taxpayer and patient, give a shit whether that doctor sees me at an NHS hospital or at a privately-run one? I'll go wherever the treatment is better.

What pisses me off is this cunning NHS training revamp whereby half of those new doctors, whose training I have paid for, don't get a job in the UK and so have to f*** off overseas!

I note that you have not dealt with my suggestions 2) and 3).

Mark Wadsworth said...

Besides, A&E, you are ignoring the issue. I am not complaining about nurses and doctors, I am complaining about the layers and layers of bureaucracy and top-down politically motivated fuckwittery.

chris said...

NHS is 17th out of 29 countries, when value for money is taken into account it is 26th out of 29.

http://www.healthpowerhouse.com/media/Index_2007_matrix.pdf

chris said...

Of course all doctors are trained by the NHS, because of the NHS monopoly on the hospitals large enough to employ all those in training (e.g. everybody not a consultant). Are you trying to claim that without the NHS nobody would get trained? That there where no trained medical professionals before 1945?

the a&e charge nurse said...

Anonymous - you give in ?

Sorry, I didn't realise that you actually had anything to say.

Look at Gallup or any of the other polls on professions most trusted by the public, you will find nurses are top, or there abouts, in most of them - why do you think that is ?

According to your senile rambling nurses have;
"destroyed their own profession" - despite doing more than ever to care for patients [the list of skills/roles would be far too extensive to detail here, but think ITU, A&E, paediatrics, psychiatry, etc].

"Are any of us going to listen to a nurse about the NHS" - why ever not, unless you think nurses are unfit to comment on every day life on the front line - look at the stats on patient contact, who do you think spends most time with patients [I'll give you a clue, it's not the consultant] ?

"learning irrelevant sociological crap" - I mean just how ill-informed are you ?
Take a look at the threads on mentalnurse [if you can be bothered] to get some of idea of the actual content of current nursing curriculums.

Devil's Kitchen said...

A&E,

Did I mention anything about a system with less spending? No. And, anyway, chris has rather slapped you down above.

Further, the idea that student doctors would not go in hock to the tune of a quarter of a mill is just silly: or has the US got no doctors? Damn it, all of those damn medical shows I keep seeing on my TV must be pure fantasy, for they have no doctors!

You might also notice that, in the US (for instance), students do a large part of their training in private hospitals, much as they do in the state teaching hospitals here.

Please, do me a favour and just try to think out of your socialist, statist mentality and be a little more constructive.

Let us assume that the NHS, as we know it, will not exist in 20 years. Now, you work in the front line: what pitfalls, given the proviso above, should we be avoiding?

Think about what is wrong now (and what is right), write it and I'll even give you your own proper post on The Kitchen, if you like.

DK

Mark Wadsworth said...

Chris, you walked into her trap!

The 'NHS' cannot claim credit for training doctors any more than I can. It is the taxpayer who PAYS for their training, whether you call it university, teaching hospital or NHS. The fact that there is a sign saying 'NHS' next to the door through which said trainee doctors pass every day for several years is neither here nor f***ing there.

Good follow up question, though.

the a&e charge nurse said...

Thanks Chris - the mission statement of Health Consumer Powerhouse is to move Europeans from "weak patients" to "powerful consumers" and that outcomes are "DESIGNED" [ffs] as "consumer information".

Some of their stats are unfathomable, for example the Swiss are rated as n.a. for MRSA - does this mean not applicable ?
What happens to the bugs when they reach the Swiss border, do they preferentially redirect themselves to some other country ?

Nontheless, the NHS does pretty well in the important categories [even] when judged by an organisation driven by self confessed vested interest rather than objectivity [unlike the WHO], for example;
The NHS is 7th for waiting times.

9th for outcomes [with the proviso that important chronic conitions such as schizophrenia, COPD, diabetes, etc, etc have all been excluded so how on earth do we make sense of the way countries are ranked ?].

And 6th for generosity of public health care systems.

Mark no dispute with your final paragraph and for me thats the nub of the problem - we only differ in that you would prefer market solutions whereas I [being a self confessed dinosaur] subscribe to the Rant manifesto [blogged a little way back] suggesting how the NHS might be improved.

the a&e charge nurse said...

Devil - the NHS is sliding inexorably toward the market driven solutions so craved for by Mark, Chris & Co [although I'm still unsure of the exact role that a later day Arthur Scargill would provide, if we take the suggestion of trades union involvement seriously].

In short we are bound to substitute one set of problems for a new set, and given the inherent nature of the market, the ability to pay [in time] will become its defining characteristic, rather than equality, and clinical need [irrespective of income].

Time and again I hear about the French, Germans, and especially the war fearing Swiss but remember health expenditure in the UK [until relatively recently] has lagged miles behind these countries, and still does even today.

So perhaps a more sensible question is how has the NHS managed to perform so well despite this massive handicap [answer UK docs & nurse have been working their bollocks off - especially junior doctors who until relatively recently where working 100+hrs a week, but only paid for a fraction of that time].

I do not dispute the achilles heel of the state is its prediliction for endless dictats - but even so this, in my view, is preferable to some greedy cunt deciding [at boardroom level] if a child with lukaemia gets to have an MRI or not.

Mark Wadsworth said...

A&E some greedy cunt deciding [at boardroom level] if a child with lukaemia gets to have an MRI or not.

Nope, WRONG AGAIN, this is not how it would be!

Assuming that there is any point to the operation, and the NHS-equivalent cost is £x,000, then that child (or its parents) gets a health-voucher for £x,000 and chooses whichever hospital wastes least on bureaucracy and spends most on actual care and treatment.

Mark Wadsworth said...

... for a nurse, your spelling of "leukaemia" leaves a lot to be desired.

Devil's Kitchen said...

A&E,

"In short we are bound to substitute one set of problems for a new set..."

Of course, we will: no system is perfect. However, we need to weigh up the one with the least problems.

"Time and again I hear about the French, Germans, and especially the war fearing Swiss but remember health expenditure in the UK [until relatively recently] has lagged miles behind these countries, and still does even today."

Yes, it does. However, most people do not have an objection to spending money if it is needed.

However, the way in which it's spent is important. Look, in the last ten years, I have been to a doctor three times and got a prescription each time (for which I have paid £6 odd).

And yet I pay enormously over the odds through NICs (and double, now that I have taken out private insurance). I object to that.

Perhaps I'm callous, but why should I struggle to survive – even to buy food – from day-to-day, as I have done in the past, and yet still subsidised the poor health of others (especially when, as you have pointed out frequently, it is often self-inflicted)?


"So perhaps a more sensible question is how has the NHS managed to perform so well despite this massive handicap [answer UK docs & nurse have been working their bollocks off - especially junior doctors who until relatively recently where working 100+hrs a week, but only paid for a fraction of that time]."

Apart from the fact that this is no longer possible under EU laws, it is an unsatisfactory situation. I am more than aware of it too, as you'll know from my past work and ambitions.

But this means that the NHS worked because it, effectively, paid near slave wages and totally exploited its staff. It could do this because the staff were not allowed to strike.

This is not a satisfactory or sustainable situation. Effectively, the NHS only worked based on the (partially enforced) charity of its staff.

"I do not dispute the achilles heel of the state is its prediliction for endless dictats..."

Which is precisely why the Rant manifesto that you referred to is just pie in the sky. It will never happen as long as politicians are in charge (or, it might for the term of a parliament, before the next lot of fucking toerags come in with their super-duper new ideas) and as long as the NHS exists, politicians will be in charge of it.

There is little use saying that you would like things to be just so, when the very circumstances of the situation mean that it never will be. It's like the Tories saying that we'd like to be in the EU as long as we can change such-and-such a rule: it's a fantasy based on a false situation.

"... but even so this, in my view, is preferable to some greedy cunt deciding [at boardroom level] if a child with lukaemia gets to have an MRI or not."

As it is, we have some unaccountable civil servant deciding whether the budget can stretch to a child having an MRI or not. All company managers are not evil profit-mongers, and civil servants certainly do not have a monopoly on altruism in any fucking way.

If you dislike the private funding model, why not look at somewhere like Canada? Canada does spend more than we do, although not too much more.

Canada: $2,998 per capita (in adjusted dollars)
UK: $2,317 per capita (in adjusted dollars)

Canada: 9.9% GDP
UK: 7.8% GDP

(1% UK GDP = roughly £10 bn)

The Canadian Health System is pretty highly-rated, and whilst the vast majority of it is government-funded, the providers are private.

But, ultimately, your problem is false. It isn't some cunt in a boardroom deciding whether a child can have an MRI scan.

It is whether the parents have paid there insurance and whether the insurance will cover it (yes).

Or, if they have no insurance, whether, for instance, they have the money around; or whether, as I have proposed before, the hospital will allow a loan (why not? Sofas, computers, etc. can be bought on three year credit: why not an MRI scan?).

Or, indeed, whether the government has some sort of Medicaid programme.

There are endless ways to look at paying; there is always some way to sort it out.

You constantly complain about people inflicting injury on themselves: do you never stop to think that 12% of what you are paid is going to provide "free" treatment, from over-worked and under-paid NHS staff, to these people?

Does it never make you angry?

DK

the a&e charge nurse said...

Mark - a tad pedantic for a small typo, perhaps you're a bit riled ?

Anyway you're plain wrong if you think that market driven insurance policies are all inclusive - what's the point of having a policy if you are entitled to a comprehensive range of services anyway [as it is under the NHS, of course] ?

Think about how the abortion rate skyrocketed once consumerism wormed its way into the process [is there a number of terminations that will ever seem unacceptable ? but I digress] - insurance policies might appear attractive today, but as competition for dwindling resources gathers pace [as we have already seen with the unsightly scramble for homes and the horrible fiasco over Iraqi oil] punters, especially those at the bottom of the heap, will inevitably be squeezed.

Devil - hospitals providing loans ?
Presumably this might result in board members selling bad debt onto financial recovery firms ?
The mind boggles at the issues this throws up, for example, would families by penalised if they needed subsequent services having failed to cough up in the past [god, forbid if a second child, or demented elderly relative became unwell].

I comment on the latent masochistic tendencies of the general public simply because they have the means [at least in statistical terms] to do so much for themselves before they finally become dependent on prescriptions for endless statins, puffers, antihypertensives, and so on - but perhaps the health fascists are pissing in the wind given the inexorable rise in lardy and computer addicted kids.

But every man for himself [if that, in fact, is that what you are suggesting] then no, I don't agree, no matter how beguiling your arguments are.

lost_nurse said...

"...chooses whichever hospital wastes least on bureaucracy and spends most on actual care and treatment."

The much-bandied about notion of "competition" doesn't count for much in high-risk paediatric surgery. Hospitals such as Great Ormond Street function, more-or-less, as charities. Bring in insurance-dominated systems, gift the public infrastructure to Kaiser et al (as is happening), and watch as we re-invent the wheel.

IMO, the NHS might be far from perfect, but in the context of a big teaching hospital, yer average joe still gets pretty good bang for his bucks - especially in an emergency. The Devil might have had minimal cause to visit. He's lucky. In resus or recovery, I've yet to hear somebody "come round", and then complain about their tax burden.

"Effectively, the NHS only worked based on the (partially enforced) charity of its staff."

Not necessarily a bad thing, if one tries to quantify it. Does A+E C/N ever get angry? I would imagine he does - if he reflects on how politicos have wasted that kind of goodwill. Divert PFI, ISTC and spurious consultancy costs to existing capacity, and let's call public healthcare what it is - and not pretend it's gonna be a consumer paradise.

Besides, I'm not sure you can ever separate healthcare from the wider social milieu. Aetiology often collides hard with lifestyle. Easy to theorise about systems, if you don't have to personally kick patients out the door. But I guess libertarians have to square that particular circle all on their lonesome...

the A&E Charge Nurse said...

lost-nurse - your point about Great Ormond Street hits the nail on the head.

What constitutes "competition" in this instance, given that there is no other centre of paediatric excellence within a 100mile radius [in fact there is probably no comparable service in the UK].

Is the answer to build a multi-million pound rival [PFI funded, of course] across the street ?

Mark Wadsworth said...

A&E Is the answer to build a multi-million pound rival [PFI funded, of course] across the street?

*yawns* No, of course it isn't, who ever said that? Hospitals belong to The People, legally owned by the State as guardian/trustee.

Those hospitals plus kit are worth a shed-load. So local council says to people or groups who'd like to run it, you pay us £x million a year in rent/lease payments, and whatever you make from treatment (i.e. taxpayer-funded health vouchers) is yours to keep.

In the particular case of GtOSCH, I am sure that GOSH would jump at the chance to take over, sack a load of managers and pen-pushers and employ more nurses etc.

lost_nurse said...

*yawns* No, of course it isn't, who ever said that?

Funny - what happened to the all-singing, all-dancing "market" we keep on hearing about. Surely, those slack-jawed PICU staff just need a healthy dose of competition? That would soon whip them into shape, etc etc (have I got this right?)

Nurse Anne said...

Whoa there Anonymous. I have to respond to your comments about nurses. To be honest you sound like you are totally retarded and I feel like I should try and help you.

Nurses are working harder than ever but there are too few of us around. One nurse with 25 patients will not be effective. It is impossible. This is what has happened to nursing care.

People don't realise that there are hardly any nurses left because they see care assistants all over the place and think that they are nurses. Real nurses cannot get jobs at the bedside.

If the airlines decided to cull back 1/3 of their airline pilots and tried to continue to operate all flights as normal what would happen? Would the planes get off the ground? If not than why not? Is it because the pilots are lazy and disorganised? Think about that one for awhile and hopefully you can start connecting the dots.

I tried to use a very simple analogy and small words to avoid confusing you too much anonymous. Hopefully I have cleared a few things up sweetheart.

If you need any further help understanding the situation with nurses in the UK, why nurses have the responsibility they have, why they need to be university educated, or if you just need help tying your shoelaces because you outgrew your velcro shoes than please just let me know. I will be happy to assist you.

Love From,
Anne

Mark Wadsworth said...

Lost Nurse Funny - what happened to the all-singing, all-dancing "market" we keep on hearing about?.

*yawn* not from me love, having given this a lot of thought, I have explained exactly how it could and should work. Once again: Taxpayer funded vouchers; Competing providers; Less managers and admin and faff; More nurses and doctors *yawn*.

Good God, you're as bad as Neil Harding at deliberately misunderstanding what somebody is trying to say.

lost_nurse said...

Good God, you're as bad as Neil Harding at deliberately misunderstanding what somebody is trying to say.

Actually, I'm not disputing the general standard of healthcare available on the continent (esp regarding treatment waits), nor the mechanisms by which such outcomes are achieved - all of which seem to inform your ideas. Though, like A+E C/N, I'm interested as to why people belittle the NHS (in certain respects), given the comparable % of GDP spend - not to mention all that lovely Alpine fresh air and general exercising. Gosh, I even grasp the distinction between provision and funding, though I promise I'll be careful not to think too hard about it.

And throwing provision open to competing providers (themselves consisting of moonlighting clinical staff) does not entirely iron out the problems of complex caseloads - the kind of stuff that (in a different context) ISTCs tend to leave at the door of yer long-suffering infirmary. Germany has its own - well-documented -problems, too. Infact, the whole goddamn developed world is facing up to the same thorny issues. But it makes for a nice global labour market, I guess.

I suspect we agree on the need for greater local "say" (versus top down politico diktat) - but that doesn't remove from the fact that many of these debates (and much tinternet rhetoric) are characterised by unthinking & dribbling paeans to "The Market", whilst bashing the pinkos. And I'm not alone in finding it to be rather crass.

Interesting use of the word 'love', by the way - do you usually patronise men like this? As a modern bloke, I'm all for equality of opportunity...

Mark Wadsworth said...

Lost nurse I'm interested as to why people belittle the NHS.

Y'see, chuck, there we go again, I am not attacking a vague concept like "the NHS", I am being quite specific about the best way to wring value for money from the system.

At whatever level of spending, it strikes me that one nurse is better value for money than one pen-pusher and one doctor is better value for money than one Quangocrat or Person in Whitehall who has never dressed so much as a single wound in his or her whole life, and one ambulance plus medic is better value for money than one chauffeur driven limousine for said Quangocrat.

And competing providers (whoever they are) will, as a rule, prefer to employ nurses, docors and medics to actually do stuff that makes people better, because that provider gets paid for every operation, every treatment, every late night admission to A&E, and has no interest in having three layers of unqualified twats at the front desk asking you whether your sick child is White, Afro-Caribbean, Asian, Mixed-race or Other.

Is that clear, darling?

lost_nurse said...

Is that clear, darling?

Ha - regardless of the issue at hand, I would imagine the new chancellor has gone right off Blackadder.

Anonymous said...

well said mark wadsworth to all of the above

all of these apologists for the shit nhs are fuckwits who cannot see past the end of their nose

the nhs is a dismal failure, if it had been a success and the rest of the world was copying it, then maybe, just maybe that would be one thing

as it is everyone from Gordon Brown down knows its a complete and utter profound national failure of the highest order

the only way ahead is to learn from organisational models that work, and self improve, and dynamically self adjust to changing circumstances from the bottom up

and that for me means end consumers, ie the patients, having real day to day control of theri health spend

lets see how long obviously dirty wards stay open when patients really can get in a taxi and go to another hopsital like they cannot in the nhs

lets see how long GPs surgeries take to answer the phone when the patients can go to another GP without having to move address

lets the people who earn the money keep more of it

let the crap nhs sites close, through good old fashioned consumer dynamics

no one

Anonymous said...

Nurse Anne:

Teachers decided discipline was below them, so the Goverment brought in useless "teaching assistants".

Coppers decided the beat was below them, so the Government brought in useless "community support officers".

Now you complain that the people we mistake for nurses are just common "nursing assistants". Jesus, just listen to yourself, no wonder the NHS is so fucked.

Nurse Anne said...

Anonymous,

Basic nursing care should be done by nurses NOT nursing assistants.

Research has shown that having more registered nurses on the ward allows them to take better care of their patients and decreases risk of mortality. If a nurse has too many patients than she has to delegate the basic care stuff to the assistants and that increases the risk of infections, failure to rescue etc etc. It's proven fact.

Nurse Anne said...

These "assistants" have not been brought in because nurses, teachers, and coppers think that certain elements of their job was "below them". They were brought in by the government to save money. But the amount of complications that arise costs us more money. There are very few nurses around in the hospital anymore.

lost_nurse said...

"all of these apologists for the shit nhs are fuckwits who cannot see past the end of their nose"

On most days, no one, I tolerate your contributions with good humour - partly because you wind up doctors, and partly because you (occasionally) speak for those who feel powerless. But not today. Wind yer neck in.