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The Johnson Quandary

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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 you’ve 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?

I’d 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:
I’d 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.

 
suze
1391580.  Fri Oct 01, 2021 4:46 pm Reply with quote

A bit earlier I stumbled across this article, which compares the Johnson regime in Britain to the Orbán regime in Hungary.

The author is best known as a novelist, and also writes for The Guardian. He identifies as a socialist but not a supporter of the Labour Party, so he is not grinding that particular axe.

 
Brock
1391589.  Sat Oct 02, 2021 2:49 am Reply with quote

suze wrote:
A bit earlier I stumbled across this article, which compares the Johnson regime in Britain to the Orbán regime in Hungary.

The author is best known as a novelist


Is he? He writes thrillers under the pseudonym Sam Bourne, but I would have thought that he's better known as the presenter of Radio 4's The Long View, a series comparing current events to historical ones.

Quote:
and also writes for The Guardian.


I know. He published exactly the same article in the paper yesterday!

https://www.theguardian.com/commentisfree/2021/oct/01/boris-johnson-rigging-the-system-power-courts-protest-elections

 
barbados
1391592.  Sat Oct 02, 2021 4:15 am Reply with quote

suze wrote:
A bit earlier I stumbled across this article, which compares the Johnson regime in Britain to the Orbán regime in Hungary.

The author is best known as a novelist, and also writes for The Guardian. He identifies as a socialist but not a supporter of the Labour Party, so he is not grinding that particular axe.


I wonder what particular axe he might be grinding?

 
Brock
1391593.  Sat Oct 02, 2021 4:25 am Reply with quote

barbados wrote:

I wonder what particular axe he might be grinding?


If you want to get an idea of Jonathan Freedland's political perspective, here are some of his recent articles and podcasts for the Guardian:

https://www.theguardian.com/profile/jonathanfreedland

He's undoubtedly on the left. I enjoy reading and listening to his stuff.

 
PDR
1391597.  Sat Oct 02, 2021 4:33 am Reply with quote

barbados wrote:

I wonder what particular axe he might be grinding?


Attempts to discredit the author rather than commenting on the content of the article.

I wonder what particular axe you might be grinding?

PDR

 
barbados
1391600.  Sat Oct 02, 2021 4:45 am Reply with quote

Hear we go again……
I read the article, I even noticed that it was the same article from the Guardian, swept up in Yahoo’s trip around the papers.
However, the lack of an axe to grind was brought up in the initial post.

If you have nothing to say, I suggest sit down and focus. FOCUS!

 

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