[News] Say your goodbyes to free health care...

[Chicken Run]

There’s few things worse than expats droning on about how things are better in their adopted home.

One of the few things being when they pop back to check on their BTL portfolio [emoji23]

 

[Harry Wilson's tackle]

Do you think that an institution such as the NHS would benefit from a shake-up in this respect, the clear out of pointless administrators and alike?

Yes I would, but with several caveats (that can be summarized as 'be careful what you wish for' if you are disinclined to read the rest of my rant, below).

Any restructuring would be led by the administrators. Most of the leading administrators are actually medics and scientists. The system facilitates the rise of a certain phenotype - excellent memories, a joy of detail, a willingness to do anything asked of them, manipulative, devoid of conscience....

Hard as it may seem, the NHS and higher education have regular shake-ups. My department has changed its name at least 10 times in he last 30 years. Even our staff meetings have changed their names (from staff meeting to departmental meeting to departmental teaching committee meeting to departmental education committee meeting; I shit you not) The way we purchase for research and for NHS purposes has changed multiple times, using new forms every year, new platforms every few years, and new process that means I don't buy anything myelf any more because I don't know how - I just ask my lab tech to do it for me. The way research is funded changes again and again (forms, process, funding streams, criteria). The way medicines are discovered and advanced changes year on year (in a bad way, in my view; and I am the owner of a patent on a new drug so have been through the very early stages of the process....it is life-diminishing).

So the problem is internal inertia, coupled with very little scope for access from the outside to identifying what to fix or how to go about fixing.

I'll give you an example the clunkiness at a level of minutia. More than ten years ago I was made chair of training and education for our 'clinical and academic grouping' in my therapeutic area. Because my therapeutic area is run by a reseach focused medic who isn't interested in 'teaching' I have had no support, no staff, no access to process, no invitations to staff meetings and no traction to achieve anything. It suits my head of therapeutic area (I note here that our place separates teaching and research so I am in one department for teaching and another for research).

By now you should be in a deep deep sleep.....

So, to effect real change, a very smart strategy needs to be introduced that operates by slashing and burning rules, paperwork, regulation, elaboration, flying buttressess etc at every level. Unfortunately the minute a boot is put in from outside the whole thing will grind to a halt.

And as an aside, sadly, for those on NSC who wanted to leave the EU to ditch all the red tape, the English are the absolute masters of creating red tape. We create red tape in order to organise a process to reduce red tape. We invent new red tape to monitor how the red tape reduction intiative is performing against a range of performance indicators. We create new red tape to evaluate the fitness of the red tape reduction performance indicators. We all know this

We have only ourselves to blame. My dear colleagues have spent hundreds of man hours on a Covid back-to-work plan. So, to access my office I need to book it, so that it can be assured by monitoring that numbers are regulated on my floor to facilitate social distancing (this is reviewed regularly as the definition of social distance is varied by HMG). My office is too small to have its own process written. So its process has been linked to that of a nearby laboratory. To book access to my office I therefore have to book the lab. I can't book he lab without doing a risk assessment for use of the lab. I have already done that per Covid, but we are in the process now of writing new risk assessments because of Covid. It is my job to obtain the old risk assessment and write a new one. That hen has to be sent to a committee for approval. It is a 30 page document. I also have to take an online Covid awarness training course. I can't do that till I have done the risk assessment. This process is recognised to be suboptimal so it will be reviewed by a subcommittee shortly. And you wonder why I have decided to stay working from home till we have a vaccine?

Are we ****ed? Not yet. Crisis is the best way of yielding disruptive change. I suspect that Dominic Cummings has that written above his desk. With that I would agree. I would much prefer the disruption be different and the objectives different though. No idea what DomCu has in mind for the NHS, o be fair. But you can't have everything....

As for the NHS specifically, I think too many in it are overpaid, and they benefit from the process and obfuscation everywhere, and contribute to the inertia. Attempting to make medics do anything, other than dispense medicine, in the hospital milieu is a fool's errand, though. I can email a consultant about teaching, for example, and 9 times out of 10 will get no reply. The secretaries (some consultants have three!) filter the emails. Those medics who do teach (and they are good people) do so in timetabled blocks so won't even look at a teaching email till the block opens. I have dropped medics from teaching on the courses I run (for science/medic students) because they are institutionally unreliable, don't mark exam papers transparently, go on holoday when they are supposed to be marking exams (because they are allowed) etc. Lovely people but the context and structure of their job means they are as much use to teaching as little Aaron Connolly would be to our back four.

Anyway, I could rant all day....

 

[happypig]

I thinks that things cannot continue as they are, without massive rises in taxation.

When I moved here I was somewhat concerned about healthcare provision. Now I know a little more I am quite comfortable with it. Just like the UK, emergency treatment is free at the point of delivery. In fact most treatment is free at the point of delivery.

You can choose which GP surgery you wish to be registered at, one that operates ‘free’, or if you want a more personal, tailored service you may well need to pay. Non emergency but necessary procedures are probably carried out more quickly than in the UK and again are free of charge. The difference is elective surgery/treatments, these are not freely available to most. You can either take out low level insurance, which you will probably need to pay excesses upon, or have full private healthcare. The trick here is to start it young, as premiums are surcharged the later you leave it. With low level insurance you do get generous allowances on dental, optical and other medical needs to a point. I get free dental check ups and hygienist cover twice a year, and it covers maybe 60% of all dental treatment costs. I also get to have ‘free’ specs up to about £175 every year (I can top up further). I can also claim for a certain amount of massage, acupuncture, and other treatments on an annual basis. This costa about £40 monthly.

The downside? Prescriptions from your GP cost a lot more than the £8ish fee charged in the UK. My monthly asthma preventative treatment costs me about £25, on the other hand a Ventolin inhaler costs about £4 as it is on a list of drugs that are seen as being important to be easily accessible, you can just walk in and buy one. Annoyingly, a tiny tube of Betnovate is also priced at about £25, this figure is important as below that price you cannot claim from your insurance.

Overall, a number of minor annoyances, but overall OK. Those in real need get necessary treatment, those who are savvy do OK. Taxation is higher here to pay for public services, but by bringing in private companies it does introduce competition which eliminates a lot of waste. I am fortunate enough to be able to put money away for a rainy day, but feel comfortable enough that a mix of public and private healthcare will be up to my expectations. As I said earlier, the trick is to get onto full private healthcare before you are 30 years old, many youngsters choose not to.

Personally I'm quite happy with the UK system and don't give a carp what Australia does as I have no desire whatsoever to move to that ghastly country.
I do, however, know someone in Australia who has worn-out knees and cannot get them fixed due to not having proper insurance; in the UK he'd be up and running without having to worry about the cost.

 

[GOM]

[tweet]1285471489945411584[/tweet]

900,000 public sector workers are getting a pay rise, but not nurses.

Nurses negotiated a 3 year deal in 2018 and are receiving a 5% rise this year

 

[Thunder Bolt]

Nurses negotiated a 3 year deal in 2018 and are receiving a 5% rise this year

From the link

Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing said: “Nursing staff have witnessed great public support and now need to feel the same from government. Telling them to wait until next year is not acceptable – nursing staff deserve a fair pay rise now.

“The RCN, along with 13 other health unions, wrote to ministers several weeks ago asking for discussions on a fully-funded pay rise for NHS staff. The government needs to initiate that conversation without delay and conduct it on the basis of facts.

“In this year, of all years, it is time to value these professionals and begin to fill the tens of thousands of vacant posts.”

There are tens of thousands vacant posts as nursing staff are leaving in droves and not being replaced. Don't forget student nurses have to pay their own fees now.
I'm sure they appreciated the applause.

 

[Yoda]

Nurses negotiated a 3 year deal in 2018 and are receiving a 5% rise this year

Not if you were already at the top step of the pay scale. The whole 3 year deal worked out to be about 3.5% in total, so just over 1% on average per year. Austerity ended my arse!!!

 

[Pretty pink fairy]

Free at the point of treatment. As well you know. What do you think of the legislation?

Maybe the EU will be interested as a large amount of EU residents came across to abuse it
Regards
DF

 

[GOM]

From the link

Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing said: “Nursing staff have witnessed great public support and now need to feel the same from government. Telling them to wait until next year is not acceptable – nursing staff deserve a fair pay rise now.

“The RCN, along with 13 other health unions, wrote to ministers several weeks ago asking for discussions on a fully-funded pay rise for NHS staff. The government needs to initiate that conversation without delay and conduct it on the basis of facts.

“In this year, of all years, it is time to value these professionals and begin to fill the tens of thousands of vacant posts.”

There are tens of thousands vacant posts as nursing staff are leaving in droves and not being replaced. Don't forget student nurses have to pay their own fees now.
I'm sure they appreciated the applause.

So they agreed a 3 year deal in 2018 giving them a rise this year but it's 'unacceptable' for them to honour that deal and wait until next year to negotiate a new deal after this current one expires. Well why bother with a deal in the first place then.

 

[Harry Wilson's tackle]

So please detail how you think these organisations would get this 'control' ?

I can tell you. It boils down to money and the amount a company can charge for medicines, machines, services and, in the end, staff.

There are purchasing frameworks in the UK. Giving the US 'access' would mean arrangements to give US companies preference and even monopoly of supply of medicines, equipment, services and, later on staff.

It is exactly the same as the chlorinated chicken situation, something simpler to follow. If laws are changed so that a chicken can be sold in the UK, that is labled 'British chicken' (because it was defrosted in Port Sunlight) and 'fresh chicken' (because the animal was frozen within 2 hours of slaughter), without any requirement that it also says 'chlorinated', and with a very generous zero import tariff, in a deregulated market where a massive loss leader campaign is permitted, undercutting the domestic market, putting British chicken farmers out of business (unable to compete with US high intensity battery farming which wouldn't be legal in the UK) eventually resulting in a virtual monopoly of chicken supply from Uncle Sam (whereupon prices would rise and rise, making out chicken supply not only tasteless but also bloody expensive, then you may start to see the picture. And I haven't even mentioned atrificially increasing muscle bulk by administering high doses of antibiotic in the feed, have I? And with changes in the labeling laws, with chickens still appearing in 'Tesco own, golden fresh chicken' wrapping, we will all be none the wiser.

 

[Westdene Seagull]

If one‘s insurance policy dictates the quality of treatment, people will die.

You've clearly lost your marbles. Don't worry though, you can get free treatment in the NHS now, as before and as will always be.

 

[The Clamp]

If you think the Tories are only to blame for the NHS’s plight, I think it’s you that’s being naive.

Anyway, MODs, pop this into the bear pit where it belongs.

No of course not, they could be the government that finally kill it off though.

I don’t see that this belongs in the bear pit. Nobody is being abusive and those that are trying to derail it are being roundly ignored.

It’s a legitimate discussion and an important one.

 

[wellquickwoody]

Does this come under Victoria State or the Federal Government? I have studied Welfare Economics, which included the history of the NHS (might sound sad, but it was part of my BA degree). When the NHS was set up, there was a mighty battle in government between centrist Labour politicians, such as Gaitskell and Morrison, who favoured it being run by City Corporations and County Councils and the Left, especially Bevan and Benn, who insisted that it should be run centrally from Whitehall (Bevan is quoted as saying that if a scalpel was dropped in Merthyr Tydfil, the man in Whitehall would hear about it).

To me, that is no way to run a service as massive as the NHS. You will always get those who scream about postcode lotteries, but the priorities for the service in Newquay are not the same as those in Newcastle, nor those in Brighton the same as those in Barrow. Most other countries run health at a regional, or even local level (in Switzerland it is run by the Cantons). Also, as far as I know, Spain is the only other country where the service is totally free at the point of use, though even here it's Catalonia, Galicia, etc, that run health services, not the government in Madrid.

I am not arguing for a charged-for service, and I would never want us to take on the American system. However, those who claim that we spend less than France or Germany should remember that their services are not free at the point of use (funding comes at least partially from insurance). I do think, though, that decentralisation is necessary, provided there is still some kind of national standard that providers have to keep to. This has been done partially in Greater Manchester, where Mayor Andy Burnham has some control of Health and Social Care, and outcomes are improving, but it is not proposed anywhere else. We have seen the effect of centralisation with COVID-19, Public Health England insisted at first on only using their own laboratories for carrying out testing, which added to the problems of lack of capacity.

My comments relate exclusively to Victoria as that is where I live and have experience of.

 

[GOM]

Not if you were already at the top step of the pay scale. The whole 3 year deal worked out to be about 3.5% in total, so just over 1% on average per year. Austerity ended my arse!!!

The pay increase for those on the top points of their pay bands is only 6.5% over three years,

This is from the GMB pay settlement doc of 2018 https://www.gmb.org.uk/sites/default/files/NHS-FAQs.pdf

 

[The Clamp]

You've clearly lost your marbles. Don't worry though, you can get free treatment in the NHS now, as before and as will always be.

Well, let’s try not to descend into abuse. However, I hope you’re right. I really do.

 

[Thunder Bolt]

So they agreed a 3 year deal in 2018 giving them a rise this year but it's 'unacceptable' for them to honour that deal and wait until next year to negotiate a new deal after this current one expires. Well why bother with a deal in the first place then.

You don't think the work withCV19 is worth anything extra? Workers should get rewarded for going above and beyond the call of duty.
Remember over 500 healthworkers died in this crisis.

 

[drew]

Do you think that an institution such as the NHS would benefit from a shake-up in this respect, the clear out of pointless administrators and alike?

Out of interest, who do you consider to be pointless administrators and how many of them are in the NHS?

 

[beorhthelm]

I can tell you. It boils down to money and the amount a company can charge for medicines, machines, services and, in the end, staff.

There are purchasing frameworks in the UK. Giving the US 'access' would mean arrangements to give US companies preference and even monopoly of supply of medicines, equipment, services and, later on staff.

US companies have access, even monoply of supply for patented or approved treatments and equipments. they dont get into services because the major competitor is offering for free and other competitors are not-for-profit. i dont see much changing until the payer model changes, which isnt likely and isnt going to change in a trade negotiation.

 

[wellquickwoody]

Nah.

 

[happypig]

There are tens of thousands vacant posts as nursing staff are leaving in droves and not being replaced. Don't forget student nurses have to pay their own fees now.
I'm sure they appreciated the applause.

Those people that voted for Brexit because they didn't like Polish and Spanish nurses are going to be apoplectic when they see all the Pakistanis who come in to replace them on the cheap.

 

[Yoda]

The pay increase for those on the top points of their pay bands is only 6.5% over three years,

This is from the GMB pay settlement doc of 2018 https://www.gmb.org.uk/sites/default/files/NHS-FAQs.pdf

Ah! Was just going from memory in knowing that every year still worked out to be below inflation at the time. Was just basing my figures based on the current rate of inflation.