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Monday, January 03, 2005

The NHS

Andy has replied to my post on the NHS below. He makes five points about why the NHS might be more efficient than a fully privatised health system over here. For all I know he might be right, but I've listed my replies to his five specific points below.

Now, with the proviso that I don't have a clear idea in my head about what I'd prefer (since it is wishing after moonbeams) here are my problems with some of those ideas. I'll title the points the same as Andy has done:

1) Advertising - Well, we don't have advertising because the various Trusts are all little monopolies, more or less. But is that a good thing? In the long-run, I'd have to say no. People should not have to accept substandard healthcare in one region if they are willing to make the journey into a Trust that offers better. It's called the postcode lottery, and people are not allowed to vote with their feet. If choice is properly introduced to the NHS as Tony Blair seems to propose some sort of advertising will begin anyway as Trusts start to compete. Personally, I look forward to it.

2) Invoicing - I honestly don't know much about this on the big scene, but I know that for the basic stationary and what have you in my office half the time it would be cheaper if we just walked down the road to Tescos or what have you to fill our needs.

3) Litigation - I don't actually think that has anything to do with the sort of health system, and more to do with societies. We are becoming a more litigious society over here (or given how litigious people were in mediaeval times, returning to a more litigious society?). Walking the line on medical litigation is a difficult one - and it is a line that we will have to draw somewhere. However, since we don't have punitive damages over here I think this is a lesser problem anyway, and not directly related to a nationalised or privatised system.

4) Drugs. The old conundrum: cheaper, but less effective healthcare; or more expensive, but more effective healthcare. NICE is the arbiter of that. While it does keep prices down, there is a cost. It comes down to what you are prepared to pay. But alas, as I said in my earlier post, the whole rhetoric of the NHS is that it is "free". From a practical position however the role of NICE doesn't have to be torn down in a partly or wholly privatised system.

5) Single-Employer. On the specific issue, yes nurses and consultants are paid less. As far as consultants are concerned this is definitely one reason why there are not enough of them. I think the same is probably true of nurses. Cost again, and the lie of the free NHS. Should people pay more? Well, I'd say that it is quite possible that to have the kind of health service the politicians keep offering us then perhaps we need to pay more. There is also one counter-problem though that I wrote about previously, and which I will throw Andy's way, since I am honsetly interested in seeing what he thinks about it.

The Treasury: The home of the control-freaks, headed by chief control himself Gordon Brown. This is the part of whitehall that makes, among others, the MoD pay £75 for a £5 padlock. The history of centralised government in Britain has come down to the Treasury and its forebears. The development of our governmental structures was nearly entirely the result of taxing more efficiently and perniciously. And the Treasury is wroth to return any of its power or privileges. The Foundation Trusts are a case in point - they were complaining of Treasury red-tape. Now, if some way were found to deal with the Treasury (and I think it is the Treasury, not Gordon Brown that is responsible) then perhaps real change for the better could result. I am, however, not holding my breath.

As a side-note, I keep harping on about this business of a free NHS. One reason why I'd like a more privatised system is so that people would be able to see what it costs them, and then they would be able to make a decisino whether it was worht it. This already works, more or less, for eyes and teeth. Of course, you do that and there are some people who will not invest in their health, and who will then suffer for that down the line. Just the same as some people do not save enough for old age. It's personal responsibility, and that is something that I do not think this government, or most other parties, want us to retain. The NHS teaches dependency, and that I think is extremely unhealthy.

Of course, I must admit that I personally have had two very unsatisfactory experiences with the NHS (one of which is continuing), and the experience of my family as a whole is a very mixed bag. I am prejudiced against the institution as a whole. Saying that, and since I've been generally negative let me say loud and clear one programme of the NHS that has my full support: NHS Direct. I've used the service once, and it was a very positive experience. The same is true of others I know that know about it - it's surprising still how many people don't know of its existence.

Sorry for being typically roundabout.

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