Saturday, January 08, 2005

Efficiency in the NHS

Andy says I didn't address his point about the efficiency in the NHS. I suppose I didn't, not directly. What I was trying to do in matching his points was express my thoughts on 5 areas that Andy highlighted. A particular point I think I was feeling my way towards, but didn't state explicitly, is that what is the point of being more efficient if you don't have the doctors or nurses to actually treat the patients, or don't actually have the drugs to enable the best healthcare. Another cost of the efficiency is the so-called Postcode Lottery - that is when one is imprisoned by one's place of residence at times to accept inferior healthcare. Now, for me these are inefficiencies.

Andy in his original post does quote some figures to back up his idea that the NHS is more efficient (post here). In particular he compares expenditure per person by year with average life-expetency. Now, I have heard that argument that one reason why the US tops the global healthcare expenditure per person is the greater amount of medical research that goes on in the US. I couldn't find any breakdown on research on the WHO site Andy linked to (though I admit I am not the best person at navigating such sites). If true however there is a gross distortion already in the figures, because it means we in the UK benefit from costs incurred elsewhere. That may make the NHS a more opportunistic and parasiticial system if true, but it does not make the NHS more efficient. I am also just generally wary about the validity of comparing life-expectency because of the many possible factors that influence those numbers beyond the effiency or inefficiency of the local healthcare systems.

So I think that is my most direct answer (since I am not going to answer his more specific points here about healthcare in Taunton, I might in another post). However, this comes with one main caveat. Namely that my experience of the NHS personally is mostly negative, and from accounts of family and friends I have no reason to believe that I am especially unlukcy in that (a mixed bad as I said earlier, some had good luck, others didn't). As with all these things so much depends on from where you stand, and I seem to stand in a very different place from Andy on this.

Which leads to a final thing. In his comment Andy says "We should both be proud that we work for such a value-for-money organisation." Now, leaving aside that I am very unconvinced that the NHS is value-for-money, there is a more basic problem with this. I know many people (presumably Andy included) who are proud to work in the NHS. I am proud to work with some wonderful people, I am proud to (hopefully) help people at difficult times. But I am not proud of working in the NHS. It is probably one of the reason I stand in a different place to Andy on these issues.

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