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The Johnson Quandary

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PDR
1389643.  Mon Sep 13, 2021 1:40 am Reply with quote

What we were discussing was this:

barbados wrote:
Jenny wrote:

And in the instance you cite, is it true that the five managers out of 14 did nothing else but manage the other 9 members of the department? Were they all of equal standing, so that each of the five managed specific individuals while doing no other form of work?

Yes.


But in subsequent posts it seems that managing the IT department involved rather more than just managing/supervising the other 9 members of the department. That's where the inconsistency seems to lie.

PDR

 
barbados
1389653.  Mon Sep 13, 2021 4:58 am Reply with quote

There was no mention of bloat in other organisations from anyone other than you

 
PDR
1389655.  Mon Sep 13, 2021 5:07 am Reply with quote

Strangely short memory (my emphasis)

Alexander Howard wrote:
Personally, I think it's a cussedly awful decision that might even reduce the tax take, and if it increases it, the money will be spaffed up the wall by inefficient bureaucracy and not reach the project it is intended to do. They could trim rolls of fat off the bloated state, if it were not so engorged that no one can see any shape to it, let alone where to stick the knife.


barbados wrote:
I can see a little of where AH is coming from.
The NHS isnít funded adequately, and it never will be. So there is some merit in looking to reduce the bloat before giving additional money.


Ho hum...

PDR

 
Alexander Howard
1389656.  Mon Sep 13, 2021 5:48 am Reply with quote

I suppose imitation is the greatest form of flattery, but even I cannot claim originality for that one - nor 'spaff up the wall': the latter was from Boris. For some reason the word 'bloat' comes to mind when Boris is in a sentence.

 
barbados
1389658.  Mon Sep 13, 2021 6:21 am Reply with quote

PDR wrote:
Strangely short memory (my emphasis)

Alexander Howard wrote:
Personally, I think it's a cussedly awful decision that might even reduce the tax take, and if it increases it, the money will be spaffed up the wall by inefficient bureaucracy and not reach the project it is intended to do. They could trim rolls of fat off the bloated state, if it were not so engorged that no one can see any shape to it, let alone where to stick the knife.


barbados wrote:
I can see a little of where AH is coming from.
The NHS isnít funded adequately, and it never will be. So there is some merit in looking to reduce the bloat before giving additional money.


Ho hum...

PDR

You appear to have overlooked the immediate posts following the second of those quoted. You remember the ones where you asked me to justify the hyperbole, which - although clearly hyperbole I did provide details of when I was employed in the NHS, you then referred to my comparison with the private sector, with another question about my role in the NHS - although this time after I had answered it you referred it to my private sector roles - to which I duly responded.
Are you now saying the points you raised about budget responsibility etc do actually refer to the NHS role?

 
Alexander Howard
1389662.  Mon Sep 13, 2021 7:21 am Reply with quote

I'd love it if they could take a scalpel to waste in the NHS, but don't ask me: I have no idea where that waste is.

There is little political motive to reform, and plenty favouring throwing money at the NHS willy-nilly. If the concern really were for health outcomes, politicians would universally vote to abolish the NHS and go over to a system that works better, like Germany's or Singapore's.

 
dr.bob
1389731.  Tue Sep 14, 2021 3:52 am Reply with quote

Alexander Howard wrote:
I'd love it if they could take a scalpel to waste in the NHS, but don't ask me: I have no idea where that waste is.


Surely this is the problem: in order to reduce waste in a large organisation you first have to start by identifying where that waste is. To do this will require time and staff effort. This will, therefore, require money.

Can you be sure that the money spent on identifying and reducing waste in the system will not be more than the amount of waste you manage to reduce?

Alexander Howard wrote:
If the concern really were for health outcomes, politicians would universally vote to abolish the NHS and go over to a system that works better, like Germany's or Singapore's.


I know nothing about Germany's or Singapore's healthcare systems, so I'm genuinely interested to know by what metric they "work better" than the NHS.

 
crissdee
1389733.  Tue Sep 14, 2021 3:55 am Reply with quote

Me too....

Given that the NHS has saved my life a number of times for absolutely no (extra) personal cost to me, I am keen to know how anyone could do it "better".

 
CB27
1389747.  Tue Sep 14, 2021 6:27 am Reply with quote

To give Singapore their dues, they're often ranked as having amongst the best health care in the world, but that doesn't take into account how it's financed. Yes, there is a financed universal health care, but it's structured in a way that you get penalised for using it too much. Also there is a very large private health sector in Singapore that you don't see similar levels in the UK. Lastly, there is the Geography, demographics and culture in Singapore that make it slightly different to the UK.

Having said that, let's have a look at the "we waste too much money" idea.

The WHO did a comparison of costs for 2002, 2010, 2018, all adjusted for inflation. The idea is not to take a single year, but to look at a possible trend and average.

The UK figures for these 3 years are $2,338, $3,645, $4,620.

The Germany figures are $2,973.$4,321, $6,098.

Singapore figures (and these have been rising because private health is being used more and more for public treatment) are $1,465, $2,268, $4,439.

Other countries of note:

US - $5,332, $7,930, $10,624
France - $2,876, $4,061, $5,250
Ireland - $2,370, $4,561, $5,897
Canada - $2,758, $4,257, $5,200
Australia - $2,438, $3,587, $5,005

And it's not just the values, it's also about expenditure as share of GDP. UK (9.8%) is lower than the US, Germany, France, Japan, Canada, and several other countries. Singapore is an outlier here in that the share of GDP is very low because they're counting strictly medical care and not social care, which is usually included in the figures for other countries.

 
barbados
1389755.  Tue Sep 14, 2021 7:21 am Reply with quote

They are very interesting figures and points CB, I recall from when the hospital I worked at were looking to close the A&E department, and replace it with an Urgent Care Centre. There was consultation upon consultation where concerns were raised over the extended time it would take to get to the nearest A&E, and it was pointed out that the life saving work is usually done by the paramedics, and the best pathway would be to go to a unit better suited rather than closest to the patient.
It was also pointed out that no A&E would also improve care removing the trips to A&E because youíve got a hangnail, because gp appointments would free up as there is no pathway from ambulance to bed.
It seemed to make sense at the time so who knows?

Iíd also say that the Singapore approach of fining for misuse sounds like a great way to improve the finances of the NHS

 
Jenny
1389779.  Tue Sep 14, 2021 8:57 am Reply with quote

In this country people without good health insurance (and even people with cheap and dodgy health insurance) sometimes die because they are terrified of using the health service and going bankrupt in consequence.

I watched an advert last night for a drug that improves the prospects of people with MS, that only requires being used twice a year. Out of curiosity I looked up the cost of said drug, and the yearly cost is over $68,000. I doubt very much whether any insurance company is going to pony up the full amount for that.

 
dr.bob
1389928.  Wed Sep 15, 2021 9:25 am Reply with quote

barbados wrote:
Iíd also say that the Singapore approach of fining for misuse sounds like a great way to improve the finances of the NHS


CB27 actually said people were penalised for "using it too much". Viewed one way, that implies penalising people who are misusing the system. Viewed a different way, it implies penalising people who are unfortunate enough to require lots of healthcare.

I'm not sure which one CB27 meant, and I don't know enough about Sinagpore's healthcare system to know which one is right. Maybe someone can clarify.

 
suze
1389954.  Wed Sep 15, 2021 11:20 am Reply with quote

In other news, El Thicko has gone!

That Gavin Williamson would be fired as soon as there was a Cabinet reshuffle was pretty much a given; the only surprise is that it didn't happen a year ago.

I'd been hoping that his replacement in the Education chair might be Liz Truss, although it never seemed likely. She is on her way to the Foreign Office, while the new man at Education will be Nadhim Zahawi.

Mr Zahawi is one of the richest men in Parliament, and for some reason felt it appropriate for the taxpayer to pay the electricity bill for the riding stables he owns near Stratford upon Avon.

He has been a junior minister at Education before, so he must know something about state schools. He didn't go to one or send his children to one, but these things are pretty standard in the Conservative Party. All new Ed Secs get a little time to prove themselves before teachers decide that they don't like them, but I cannot say that the appointment fills me with joy.

 
CB27
1389967.  Wed Sep 15, 2021 1:01 pm Reply with quote

To be fair to all the new and reshuffled cabinet members, I suspect they're all as equally incompetent and wasteful, I don't think any of them stand out more than the others :p

Back to Singapore, I'm going by what I've been told by a friend who moved out there for some work, and trying to understand something I read about their system, which seem convoluted.

From what I understood it works similar to car insurance in that you have a certain number of treatments and emergencies up to a certain level which won't affect your basic contribution, but after that it can forces you to either contribute more in taxes or pay towards part of your treatment. I don't know if this counts towards GP visits, though I'd like to think it doesn't.

 
Alexander Howard
1389981.  Wed Sep 15, 2021 2:59 pm Reply with quote

There is a new Lord Chancellor.

It is a fascinating position, possibly one of the few offices pre-dating the Norman Conquest. Technically, in terms of the Order of Precedence, the Lord Chancellor is senior to the Prime Minister. (I reminded a Lord Chancellor of this once: he said he would not mention it to the PM.)

In the Middle Ages the Chancery issued all public documents, so the Chancellor had his hands on all levers of administration and became often effectively a prime minister.

(The Lord Chancellor of Great Britain is the Chancellor, by the way. The minister the press insist on calling 'the Chancellor' is chancellor only of the Exchequer.)

In the early modern period the Lord Chancellor became known primarily as a judge, running his own court, the Court of Chancery; often well but sometimes notoriously. He therefore had to be a learned barrister.

(The Offices of Lord Chancellor of Scotland and Lord Chancellor of England were merged just after the Union. The Lord Chancellor of Ireland stayed separate and only vanished when the Free State was booted out of the kingdom.)

After the Victorian reform of the courts (reshaping the system sensibly on the Scottish model), the Lord Chancellor was still presiding over the House of Lords and frequently acted as a judge in the House of Lords, so it was understood that he had to be a QC and senior enough that he could be a judge. There were Chancellors famed as judges who delivered leading judgments, like Lord Hailsham. Margaret Thatcher in fact appointed a 'Lord of Appeal in Ordinary' (a Law Lord) as Lord Chancellor (Lord Mackay of Clashfern).

By Lord Mackay's time though the Lord Chancellor's Department had taken over responsibility for funding and administering Legal Aid, so it became political.

Tony Blair turned it all on its head when he did an overnight rationalisation of a festering constitutional mess. He tried to abolish the post entirely but was told it would require an Act of Parliament. Instead the Chancellorship was turned into a normal ministerial position. Since then, it has gone all sorts once even to a non-lawyer.

Robert Buckland was a barrister, not a high-flyer but a down-to-earth court lawyer. Dominic Raab is a high-flying lawyer with some glittering prizes to his legal career. However, and this is a shock to all traditionalists, he is not a barrister but a solicitor.

 

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