The Thursday rant #1

(The first in a weekly open-mic series, trailed here)

This week’s ranter: The Devil’s Kitchen is the lair of a graphic design agency MD, who blogs mainly about politics, economics, and — occasionally — science and computers, in an entirely free-flowing way. Occasionally, he even writes with a degree of informed opinion, rather than his traditional bile and guesswork.

Where does our money go?

We’re all paying more tax and yet services don’t seem to have significantly improved: so, where has all the money gone?

Here’s a little nugget from the NHS (necessarily vague, I’m afraid, to protect my source). A hefty amount was invested in creating a database of ideal projects. The person assessing the projects and compiling the database left before the job was completed. Enough data was collated and evaluated to publish without any problem.

So did it happen?

Several major restructurings later, the project appears to have been lost or forgotten. Then drive-scouring, after two major computer system crashes, threw the database up again; and it is, once more, of interest. So the manager of the department draws the Scottish Executive’s attention to it.

The Scottish Executive remember that they actually spent a rather a large amount of money on the project and are embarrassed that nothing happened. They throw it back, ordering it to be web-published (more cost).

But this is three years later. Some of the project examples, so promising in their infancy, might have subsequently failed. They might have evolved beyond all recognition. The whole database is effectively useless. Updating the contact details is the best that can be done.

By rights, the NHS community that this project was created for should be screaming blue murder. But no one is, and perhaps £100,000 of our money has been pissed up the wall; wasted not by malice, but by the natural incompetence inherent in bureaucracies like the NHS.

Remember, this is not “magic money” that falls from the sky: we earned that money. And it keeps being tossed into a public sector black hole. For how much longer?

44 comments
  1. Paddy Carter said:

    DK, some devil’s advocacy to get thing started.

    How do you know that the NHS has not improved? Or, more accurately, that it has not improved in reasonable proportion to real funding increases? Strikes me that this is a very hard thing to measure. Healthcare is a textbook example of expectations inflation too – so that disatisfaction may increase even though objective improvements have been made.

    You cite data showing NHS funding has broadly doubled but that productivity has not improved. Well doesn’t that mean that output has simply scaled in line with inputs? i.e doubled too? Or have I misunderstood the meaning of productivity in this case?

    You cite data showing that non-clinical operating cancellations has increased – but what if the number of operations being scheduled has increased at a greater rate?

    Did you think that nurses, hospital porters etc. were underpaid in the past? So do you begrudge higher salaries now? Do higher salaries create measurable improvements in the NHS?

    I don’t want to create a comment a mile long, so I won’t paste the whole story, but this article from The Economist paints a more optimistic picture (I suspect it might be available for subscribers only)

    http://www.economist.com/displaystory.cfm?story_id=3892109

    I do not mean to suggest that the NHS is not rife with waste and incompetence, nor that reform, as opposed to more spending, is not needed. I just suspect that some of the money being tossed into the NHS is actually starting to improve things.

  2. Paddy, I take your point. Note, however, that the article points out that simply pouring money into the NHS doesn’t work.

    [Labour] also started to pour cash into the NHS. But by its second term, it realised that reform was needed as well as money, so it reinstated and extended reforms.

    I’m not saying that money wasn’t needed, but money without reforms is not going to work. As for staff (who were, naturally, the first to clamour for their share of the loot), well, they’re not paid so badly, if they turn up. And, unlike us poor private sector wealth generators, they’ll get a pension.

    A junior nurse, for instance, earns about the same, at entry, that it took me 5 years of working (in a supposedly lucrative industry) to achieve. The problem has always been the relatively low wage ceiling if you want to stay as a clinical nurse, rather than a manager. But I digress.

    There is substantial wastage in the NHS: there are far too many managers, and too few frontline staff. There are signs of improvement; however, we are encountering the same old problem.

    Already, the planned extension of payment-by-results this April to other acute-care hospitals has been restricted because of worries that it was going to cost too much money.

    You see? It’s always the money: it would be fine if we had limitless amounts of it, but we don’t. A couple of days ago, The [Scottish] Herald reported that Brown had admitted that his growth forecasts may have to be revised down. Sales are falling at the fastest rate for 22 years, and growth is slowing. That means lower tax receipts; that means more borrowing or higher taxes; higher taxes mean slowing growth, etc. etc. Both as individuals and as a nation, we are surviving on credit: and everyone, including our Cyclopean Chancellor and the government of Great Britain, has a credit limit.

    The point is that we should value every penny that goes into the public services, but much of it is wasted. I know a number of people working for the public sector, and I can give you many more examples of silly amounts of money being used up for no good reason (as a matter of fact, I’m composing a longish post, but didn’t want to steal The Sharpener’s thunder!).

    All I have done here, is to post one example of that wastage: and this is not, in any way, a rare example. Sure, £100,000 isn’t a massive amount in the grand scheme of things, but get 10, 20 of them?

    But that wasn’t even the central point (and I’m sorry if it wasn’t clear): the point is that large bureaucracies do not work. Nobody communicates, between departments, or even in departments: this is the point that keeps coming up, again and again, in conversation with my public sector friends. (The other is, “why the hell are they employing me, I have nothing to do but surf the web most days” (more wastage)). Large bureaucracies do not work, and large state bureaucracies work least of all.

    DK

  3. Andrew said:

    The other problem you tend to find with large bureaucracies, and again I’ll protect my own source by keeping this suitably vague (but it’s another NHS story), is that people’s jobs either massively overlap, or that certain tasks fall between the gaps. My own source does a job that vaguely relates to hospital cleanliness, but there is another team that deals with the hospital environment, another team that manages the cleaners, another team responsible for overall infection control, all of which are essentially managing the same small group of people on any given ward, sometimes with entirely contradictory diktats. Additionally, you find that certain tasks are just not performed, because none of the above teams have overall control. To take a silly example, but a true one, nurses are responsible for cleaning medical equipment, and cleaners are responsible for cleaning ward furniture in this particular trust. But there are certain items that fall between the two, like drip stands, which are neither wholly furniture, nor wholly medical, so these items on certain wards went uncleaned for months and months because none of the ward staff thought it was their responsibility, all initiative had been stifled by endless bureaucracy, and none of the 4 (or maybe more, who knows?) teams responsible in some way for cleanliness had an overall view of the entire process.

    Of course, normally this sort of thing doesn’t matter. It just costs money. Irritating, but that’s life. But with the NHS, people actually die from these day to day screw-ups. That’s why it is urgent that we reform the damn thing.

  4. all initiative had been stifled by endless bureaucracy

    Up to a point, Lord Copper. In this case, there’s also the staff laziness to take into account, in the case of drip stands. If the nurses couldn’t do it – not being the selfless beings that the media like to portray – then they could at least have raised it, loudly, with the management.

    Of course, normally this sort of thing doesn’t matter. It just costs money. Irritating, but that’s life. But with the NHS, people actually die from these day to day screw-ups. That’s why it is urgent that we reform the damn thing.

    Too true. Although, I get extremely cross about the waste of money as well.

    DK

  5. nikolai said:

    We’re all paying more tax and yet services don’t seem to have significantly improved: so, where has all the money gone?

    I think there’s a gap in the logic behind this question. Not all tax revenue is spent on public services. A good portion of it is redistributed from one group of people to another: tax credits, pensions, childcare vouchers, international aid, and so on. Some of these have been at the forefront of New Labour policy, it’s just not the case that people are taxed more in order to provide better services (though that’s often the public justification, saying your raising someone’s taxes so more of their money can be given to someone else wouldn’t work too well in an election broadcast).

  6. Andrew said:

    In this case, there’s also the staff laziness to take into account, in the case of drip stands. If the nurses couldn’t do it – not being the selfless beings that the media like to portray – then they could at least have raised it, loudly, with the management.

    Not entirely true, that. Yes, nurses aren’t the hard-working, underpaid angels that the (print) media often portray them to be, but this particular example was more cock-up than conspiracy. These things do get raised to management as well, but they tend to then find that the management it gets raised to doesn’t have jurisdiction over the particular issue that is being raised, because of further lack of clarity about job descriptions. Bureaucracy stifles innovation and initiative.

    Or, more simply, I don’t think laziness would be an issue if the NHS was run better.

  7. Stuart said:

    Why do you not tend to hear these same arguments applied to, say, the armed forces? Taxes are up again, but damned if I see any significant rise in the corpse count. Huge bureaucracies like the army and the military-industrial complex just don’t work, do they? And the soldiers are all lazy good for nothing shits who lie around in bed all day when they could be out getting killed. When will something be done?

    The idea of deducting a theoretical amount from nominal wages was a stroke of genius on the part of the bourgeoisie. Everyone thinks they now have a stake in the system and a say in how it’s run. You don’t. Just get back to work, you wage-slaves, and stop all this bloody whingeing.

  8. Andrew: yes, I see what you mean. It’s completely insane…

    Nikolai: that was just a preamble, not the whole point of the article. There is an awful lot more that one can say about this, but The Rant is limited to 300 words or so.

    I heard on the radio a few days ago that, whilst public sector spending is about double what it was in 1997, because of inflation and wage increases, the actual increase in funding has only been 16%! Talk about running to stay still!

    Part of the problem is this: every time that you raise public sector wages, you also significantly increase the pension liabilities. The firefighter’s wage rises, for instance, created an instant £76 million pension hole. But try to get public workers to ameliorate their pension plans to something more reasonable, and you get this sort of thing.

    Stupid, stupid, stupid.

    DK

  9. Katherine said:

    Your assumption is that large bureaucracies are inefficient, but there is no necessary correlation between the two. Certainly, it is easier for large organisations to be inefficient, but they don’t have to be. Look at all those mean, lean and huge global companies.

    I’m not quite clear whether you are arguing for more efficiency and better management of the NHS, or for the abolition of the NHS, on the basis that large bureaucracies can never be efficient.

  10. Why is this sort of discussion always carried out in a vacuum, as if were were the only country in the world to have state-funded health care? OK, so we are the only one to do it through a huge command-and-control bureaucracy designed in the 50s (just after the war, when the whole country was centrally planned), but that might be an indication of why we are having problems.

    The US system is a disaster and a good example of why universal free coverage is so important. The French system is a lot better, although more expensive still.

  11. When it comes to efficiency, in international comparisons the NHS is actually pretty good. In any organisation that spends what (£100 bn?), there will be examples of waste, and nobody is saying we shouldn’t have reform if it brings more efficiency. But none of this is an argument for abolition. We still spend less than other countries on our healthcare, the US spends over 15% of GDP for what is a very patchy service, appalling in places, (40 million uninsured, infant mortality higher than India in some districts). We by comparison have gone from 6.6% of GDP to around 7.7%, with a target of the EU average of 9% by 2008. This will still be less than France and Germany spend (12% and 14% respectively).

    The NHS also has a similar percentage of managers as private industry and has a very impressive customer satisfaction audit published each year that private companies would die for.

    Sometimes state provision is more efficient than private. There is evidence worldwide that healthcare is one of these cases.

    There are lots of inefficiencies of private healthcare. There is the extra admin of having to assess each patient individually and determine a premium, the NHS has none of this cost.

    Canada and the UK are good examples of how public provision works better than the private system in the US. I have spoken to South Africans, New Zelanders and Americans who marvel at our system and can’t understand why we are so negative about its cost. In the US, I knew people on quite good salaries who struggled to meet the cost of healthcare, a lot of people just can’t afford it. This may be what DK wants but the majority of us do not.

  12. Pingback: Tim Worstall

  13. The NHS also has a similar percentage of managers as private industry and has a very impressive customer satisfaction audit published each year that private companies would die for.

    Neil, what country are you living in? This simply isn’t true.

    This story sums it up. I was also in the pub yesterday, with my friend who gave me the info for this rant. She has been working in the NHS for a month, and has identified reams of wastage. She is incandescent, and bent my ear for a couple of hours on the subject.

    Just as an example: she was taken on as a temp in order to cover for another worker who was on holiday. The worker (I use the term loosely because she is, apparently, the laziest shit in a massive office of lazy shits) has now returned, and yet my friend’s contract has been extended to the end of October. Why? My friend is chewing off her own arms with boredom; there’s no work for her to do and, if there is, it takes no time at all (she was, at one point, given 4 days to create a 20-card database. It took her 2 hours). Her department has, in the last year, increased from 160 staff to 240, and yet their output in no different. Furthermore, that report that the Rant was about is one of three similar situations discovered in the last year alone.

    Sometimes state provision is more efficient than private. There is evidence worldwide that healthcare is one of these cases.

    Name one instance. Give me hard figures, Neil, I beg of you. If you look at Scullion’s figures (linked to in the Rant), you’ll see that, despite massive spending increases, productivity is actually down. How is that efficient? Massive bureaucracies are never efficient, and nor are state-run services. They may work, yes, but they never work efficiently (mainly because no one is able to see a relationship between the work that they do, and the end results).

    DK

  14. Aidan said:

    I agree with a lot of what you are saying – putting money into the NHS seems to be a case of rapidly diminishing returns, however, what is the alternative?

    PFI or similar seems a particularly poor solution – the energies of the private company are going to go towards increasing profits. As it’s almost impossible to measure benefit to patients in an accurate way, and patients have no meaningful way to exercise their consumer choice, the best way of doing maximising profit is for the private company to reduce its costs – often at the expense of quality of service, and to concentrate on wringing cash out of any loopholes.

    If your supermarket sells you lousy food, you are going to take it back or shop elsewhere. The supermarket will soon be on the receiving end of your consumer choice. If you go into hospital and get lousy food, you eat it or go without. If you are feeling energetic, you or a relative might kick up a fuss until you are worn down. The company keeps churning out the nutritionless and disgusting meals, the public purse keeps paying them.

    The hospital has to balance its budget so it keeps employing them, and after a few days you get back to your life and forget about it, because you don’t have the time or patience to tilt at windmills.

  15. DK, I can give you loads of examples of private companies where workers are doing diddly squat! Giving a few examples of waste in the NHS is a Daily Mail tactic and utterly meaningless. Look at the satisfaction ratios of NHS patients, look at the rise in the number of operations and the drop in waiting lists. If you want proof of how the health service is doing, look at the worried faces of directors at BUPA and others, who can’t sell health insurance for love or money now their chief selling point is being eroded by falling waiting lists.

    I’ll get back to you on the managers ratio stats, but I can assure you I have read an article on the net that quoted the NHS managers ratio as similar to large private companies, I’ve just got to re-locate it. When I do, I will post the link.

    I’m not against private provision in the NHS, as long as it helps deliver more cost efficient service and no drop in quality and as long as it stays free at the point of use for the patient, paid for by taxpayers.

    When it comes to health, private provision is inefficient because of the wastage on admin determining premiums, assessing risk and the cost of advertising. It also has a terrible record of the quality of delivery.

    This is why a publicly funded health service is better. You don’t dispute we spend half what the US does on health, and look what they get for it. Good service for the few, and very poor service for the rest. The US has far bigger problems with inefficient and poor quality of service, infant mortality, MRSA etc than us.

  16. DK, Ive checked out your link. All of the figures there are misleading and don’t mean what you state. I’ll take a few to demonstrate.

    He quotes rising cancellations of operations, but neglects to mention that operations overall have risen massively so the ratio of cancellations have fallen.

    Productivity increase of 0% means exactly that, productivity has not increased. This means the extra money put in has achieved improvements in service at the same rate as the original budget. It doesn’t mean that that output has fallen as you try to imply.

    I could go on and rubbish all the stats there but I think people get the point.

  17. DK here is the link I promised on NHS managers.

    They make up 2.8% of the NHS workforce. The private sector by comparison has 2.9 times the number of managers that the NHS has.

  18. Andrew said:

    Neil: That link contains no data on the actual numbers. It just states the percentage as a given, with no definition of what they are counting as management and what they are not, and how they have calculated the ratio. Verdict: Must try harder.

    Sometimes state provision is more efficient than private. There is evidence worldwide that healthcare is one of these cases.

    Yes? Then cite it.

    Look at the satisfaction ratios of NHS patients

    This is a very bad measure of healthcare efficiency, because these stats are necessarily survivor-biased. Dead men tell no tales.

    look at the rise in the number of operations and the drop in waiting lists

    and the rise in hidden waiting lists, as patients have their operations or scans booked at impossible times, and enforced cancellations push them to the back of the queue.

    If you want proof of how the health service is doing, look at the worried faces of directors at BUPA and others, who can’t sell health insurance for love or money now their chief selling point is being eroded by falling waiting lists.

    BUPA is a provident organisation, not a for-profit company. Why would the directors be worried about waiting lists? The reason that most people cite nowadays for taking out private medical insurance is hospital hygiene and MRSA, which tend to become worse as the NHS increases throughput. The insurers are on to a win-win here. Despite your claim that they can’t sell health insurance for love or money, our own national statistics show steadily rising subscriber numbers to private health insurance (at least to 2000, when available figures end). And to use a New Labour rhetorical trick, the year 2000 showed the highest number of subscribers since records began.

    I could go on and rubbish all the stats there but I think people get the point.

    What do you mean, ‘go on and rubbish all the stats’? You haven’t started yet. Try posting some data that contradicts DK first. That’s what rubbishing stats is all about.

    When it comes to health, private provision is inefficient because of the wastage on admin determining premiums, assessing risk and the cost of advertising. It also has a terrible record of the quality of delivery.

    Same comment really – have you got any evidence to back that up?

    I can give you loads of examples of private companies where workers are doing diddly squat.

    Me too, but the difference is that I don’t pay their wages.

  19. I’m afraid we DO pay private companies wages? I pay for Sky TV and ITV etc, even though I don’t subscribe because everytime I buy a product that is advertised there I pay, its just more hidden than a licence fee. For example the average person pays £340 a year to ITV.

    Isn’t the fact that the US spends twice the amount as us for worse results proof enough of the inefficiencies of private healthcare.

    I have done research for private health companies and believe me they are very worried. Only last week there was a report that suggested private healthcare might disappear in the next few years. BUPA may be a provident organisation but that doesn’t stop there directors worrying about their well paid jobs.

    What people forget is that when there is a cancellation of an non urgent operation it is because there is an emergency operation to perform.

    You can’t dispute that the number of operations has increased and productivity has not dropped. Any organisation that goes through a massive expansion and maintains productivity is doing well.

    This fear of MRSA is conveniently hyped by the press, probably at the behest of private health companies. The US is worse, they even have flesh eating MRSA that kills in a day over there.

    You disagree with the link but it seems pretty conclusive to me, 2.8% in NHS, 8.1% in private firms. Its taken from the Labour Force survey figures, that seems pretty impartial. Its certainly better than the dodgy stats DK came up with to back up his case.

    Anyway, its easy to criticise, what are your solutions for the NHS? Remember I have nothing against private provision in the NHS as long as it remains free at point of use and the quality of service is maintained.

  20. Andrew said:

    Isn’t the fact that the US spends twice the amount as us for worse results proof enough of the inefficiencies of private healthcare.

    Not unless you cite some data, no. I also don’t think the US system is a wonderful example of private healthcare – I certainly wouldn’t set up something similar in the UK. The stranglehold of the insurer’s is just as bad as the monopoly of the public sector over here. Nonetheless, they have a lot of shiny new equipment and drugs, and we don’t. Funny, that.

    I pay for Sky TV and ITV etc, even though I don’t subscribe because everytime I buy a product that is advertised there I pay, its just more hidden than a licence fee.

    I’ve dealt with this before. The vast majority of Sky’s revenue comes from subscription money, not advertising. And if you don’t like it, don’t buy products that buy advertising. You have a choice over where your money goes.

    For example the average person pays £340 a year to ITV.

    Once again, you state data without a reference. Any chance of a link when you do that? Like when you say this:

    I have done research for private health companies and believe me they are very worried. Only last week there was a report that suggested private healthcare might disappear in the next few years.

    Believe you? No chance, Neil. You are partisan. State your source and link to it.

    This fear of MRSA is conveniently hyped by the press, probably at the behest of private health companies. The US is worse, they even have flesh eating MRSA that kills in a day over there.

    You are blustering to the wrong man on this, Neil. My wife works in the field, and MRSA isn’t conveniently hyped by the press at all. If anything, a cover-up exists, given the scale of the problem, and the under-reporting that goes on. It is an increasing problem, made worse by the lack of development of new antibiotics, the centralised target culture that means priorities are distorted away from patient care, and of course the ongoing evolution of resistance by bacteria. MRSA isn’t even the most dangerous ‘superbug’ out there, by a long way. It’s just the one that gets the most press. And ‘flesh eating MRSA’ in the US? I assume your source for that is this, from the BBC, which relates to community-acquired MRSA – i.e. MRSA acquired outside of a healthcare environment. And it doesn’t kill in a day. All of the victims recovered in hospital, although some required reconstructive surgery. And the HPA over here said that we had experienced some cases as well. So now who’s hyping? You ought to go to the badscience blog to get the lowdown on how badly news organisations report science, particularly when they copy-and-paste directly from press releases written by idiots in the University PR department.

    You disagree with the link but it seems pretty conclusive to me, 2.8% in NHS, 8.1% in private firms.

    It isn’t conclusive, because it doesn’t state the basis of collection or calculation, or the underlying figures. It is meaningless.

    Anyway, its easy to criticise, what are your solutions for the NHS?

    Vouchers. An end to public monopoly provision. Co-payment. Breaking the stranglehold of the healthcare unions. An arbitrary lottery to sack half of the NHS management, who are as lazy as they are incompetent as they are overpaid. Public funding, but not public provision. No limits on private provision. Things like that. But this isn’t about me, it’s about your casual use of data. You’ve spectacularly failed so far to back up any of your assertions. Want to try again?

  21. Its pretty obvious you don’t care about the 40 million uninsured in the US, or the fact even the most wealthy can’t afford cancer treatment. Yes ‘some’ hospitals reserved for the wealthy do have shiny new equipment but as they pay twice as much as us as a percentage of their GDP, and have scandalous infant mortality… I could go on but…this is obviously something you don’t find a problem.

    You think you are reasonable when you argue for hanging, banning abortion and a flat tax and now you argue that the amount of money you have should determine your healthcare. You are on the extreme right of even the Tory party. How reasonable is that? Vouchers were rejected at the last election I think you will recall.

    I have read that a superbug killed people in New York last year in less than a day and it was hospital born. I will search for the link, fair enough I was being a bit lazy, I will come back to you on this one…

    However big MRSA is in the UK (and we all know how underfunding and contracting out made it much worse in the 1980s), give me some international comparisons? You do some research by providing ME with links.

    You and I both know, it is impossible to have a choice about advertising and other excess costs in this increasingly monopolised world, not unless I go self sufficient or something and grow my own food. Its effectively a tax on us.

    Finally if you are not going to believe the Labour Force Survey, you are obviously going to pick flies at every statistic I find, so what is the point? You were arguing that the NHS was over-managed and I provide stats to show you the ratio is 2.9 times higher in the private sector, but you refuse to believe it. phew! I will try and find more stats on this I suppose…

    Ok I admit I have got the ITV average spend figure wrong, I apologise, it was a lazy off the top of my head figure that you were right to challenge, it is actually the total UK spend on advertising which stood at £345 per head in 2004, £20.4bn total, its not totally clear from this link but I’ve multiplied the UK internet advertising total (£510m) by 40, as it states that it is 2.5% of the UK total (then divided by 59 million to get the per head figure). I know this is a bit convoluted but its obviously going to be correct.

    Of course advertising is not the only way we pay private companies wages, there are excess profits due to monopoly control and excess director salaries etc etc.

    Im sure you will gloat over this mistake, but at least I admit when I get something wrong. The stats DK provides are deliberately misleading. Productivity is not the same as output as he claims. The number of cancellations are meaningless without it being put as a ratio of the total number of operations which have vastly increased. Quoting the number of heart disease etc says more about our diet and nothing about the NHS. Saying we have the highest number of infections in Europe doesn’t take into account the starting point or the population size of other countries. This is all deliberately misleading.

    I agree with you that the private sector and even competing hospitals should be involved if it can be used in such a way to increase efficiency, but vouchers are just bureaucratic nonsense that help the wealthy go private, David Cameron said as much today. I have big hopes that this guy could change your party into something more ‘on the same planet’ as the electorate. You are comedy fascists at the moment.

    I’m tired now, so I’m off to the pub.

  22. This fear of MRSA is conveniently hyped by the press, probably at the behest of private health companies. The US is worse, they even have flesh eating MRSA that kills in a day over there.

    Methicillin Resistant Staphylococcus Aureus is just one of the so-called “superbugs”: and, as Andrew said, they are not over-hyped (“at the behest of private health companies”? Where’s my tinfoil hat gone?). As for flesheating bugs, you might remember the necrotising faciitis that our hospitals suffered a few years back.

    As we are well-aware, the waiting list drops have been very well-managed; mainly by the introduction of a waiting list to get on a waiting list.

    You seem to have missed the point of my wee rant, Neil. I was highlighting just one part example of waste in the NHS; furthermore, this waste was in an area that should not even concern the NHS. It was one small example of the kind of waste of my money that happens in every way and in every day and in every one of the hundreds of NHS departments. It is an example of money that should be going to treat patients being pissed up the wall rather than being spent where it’s needed. If this wastage was stopped, if all of these unnecessary workers were sacked, how many more frontline staff could we hire? Or how much less,/i> money would we have to pay in for the same results?

    I was deliberately not making comparisons to any other country’s health provision because it doesn’t concern me at present. No one really seems to be—to use a wanky phrase beloved of marketing companies—”thinking outside the box” on health. I was saying: “Look! Here is an example of why the NHS is consuming vast amounts of money for less benefit than we might expect”.

    DK

  23. You and I both know, it is impossible to have a choice about advertising and other excess costs in this increasingly monopolised world, not unless I go self sufficient or something and grow my own food. Its effectively a tax on us.

    Neil, there is competition between private companies; Tesco is cheaper than Sainsbury’s and you can choose to shop at whichever you choose.

    We are forced to pay for the NHS annd other government organisations: there is no element of choice. If we feel, as many do, that the NHS provision is not good enough, then we have to pay again to go somewhere else. Especially, when they find that they have had their operation cancelled, or just been removed from the waiting list entirely. Some might feel that they are waiting too long simply for diagnostic tests.

    Neil, your Labour Force only measures managers. It does not measure managerial support staff, research clinitians, administration staff and agency staff. I think that you wil find that, when you include all of those—many extraneous—personnel, that your figures do not look so impressive. People do seem to be complaining about stifling bureaucracy.

    DK

  24. Andrew said:

    You think you are reasonable when you argue for hanging, banning abortion and a flat tax and now you argue that the amount of money you have should determine your healthcare.

    You might find it easier to argue against the caricature of a right-winger that exists in your head, but it shows you aren’t capable of holding your own in a forum for mature debate. Come back when you have grown up, Neil. All I asked you to do was to provide references to back up your unsupported assertions, something which you have so far spectacularly failed to do. That proves my point far better than any petty gloating about a minor mistake you made might do.

  25. Blimpish said:

    Ah, Mr Harding…

    Its pretty obvious you don’t care about the 40 million uninsured in the US, or the fact even the most wealthy can’t afford cancer treatment.

    Well known canard. That ’40 million’ includes anybody who is without insurance at any point during the year. So, if you leave one job with insurance and wait a week before the next, you count. Also, it includes rich people who effectively self-insure. It includes young people who choose not to insure because they bank on being reasonably healthy. There is a huge problem with people not being adequately covered in the US system, but discussion of it hindered by throwing around a hugely inflated number.

    You are on the extreme right of even the Tory party. How reasonable is that?

    Very.

  26. DK there is the small matter of charity status to avoid taxation, and the fact that private health companies have all their staff trained at NHS expense.

    Andrew, I’m going to deluge this site with links to back up my case. Watch this space…Thank you for not gloating about my error.

    Blimpish, good point about the 40 milion uninsured, but would you prefer the US system to what we have?

    If you see nothing wrong in being on the extreme right of the Tory party, I think it demonstrates how representative you are of the public, who do think there is something wrong in this.

  27. Andrew said:

    Neil: Fine, just don’t argue against something I don’t say. It is very tiring to constantly correct your misconceptions about my opinions instead of addressing the issues.

    On the US system, I specifically said above:

    I also don’t think the US system is a wonderful example of private healthcare – I certainly wouldn’t set up something similar in the UK.

    Which part of this wasn’t absolutely clear?

  28. DK interesting quote from one of the links you provided.

    “There are just over 26,000 managers in the NHS, many of them doctors and nurses, each one providing vital support so that front-line staff can get on with focusing on patient care.”

    Considering there are 1.3 million staff in the NHS this seems a low number.

    Heres some quotes for you to chew over;

    “An ICM poll in September 2004 revealed that the public estimated 48% of NHS staff were not involved directly in patient care – the actual figure published in the official statistics today is 16% which means that 84% of NHS staff are directly involved in looking after patients.”

    “13% of NHS staff provide ‘infrastructure support’ which means they are responsible for key services including cleaning, catering, laundry and IT ”

    “Respondents were asked how they rated the ‘quality of senior management leadership’ on a scale of 1 to 5, ranging from ‘very poor’ to ‘excellent’ – the average score was 4
    60% of respondents said senior managers in their organisation were ‘focused on meeting patients’ needs’ – just 14% said they were not
    54% of respondents said senior managers in their organisation ‘support new ideas for improving services for patients’ – just 15% said they didn’t”

    Contrast that with this-

    More managers than skilled workers

    “A new analysis of figures from the latest Labour Force Survey show a sharp rise in the number of senior managers and officials employed in the UK economy.

    According to the analysis, conducted by the general workers’ union GMB, some 4.085 million workers are senior managers or officials, accounting for one in six (14.9%) of all employees in Britain. In the City of London, this figure is much higher, with one in three of workers claiming to be a senior manager.

    In contrast, the number of skilled workers stands at 3.1million or one in nine (11.3%) of all UK employees.

    The analysis says that the number of senior managers has risen inexorably. In 1981, the number of managers stood at 2.7 million or 11.8% of the workforce, compared to the 3.998 million skilled workers who constituted 17.5% of the workforce.”

  29. Andrew the comment was directed at Blimpish not you. Read what I put.

  30. Andrew said:

    I was responding to this:

    Its pretty obvious you don’t care about the 40 million uninsured in the US, or the fact even the most wealthy can’t afford cancer treatment… I could go on but…this is obviously something you don’t find a problem.

    …now you argue that the amount of money you have should determine your healthcare.

    I have never said that the amount of money you have should determine your healthcare, and I specifically said above that I didn’t think the US system was very good, which was why your reply that I have quoted here bemused me somewhat.

  31. Unlike in the UK, where Labour made it mandatory for hospitals to publish records of superbug cases in 2001, the private health companies in the US have successfully lobied the Bush administration to keep them secret. Consequently it is very difficult to get hold of figures.

    According to an Institute of Medicine report last year, 2 MILLION Americans are infected and 80,000 people die each year in the United States from hospital-acquired infections. As there are 36 Million patients treated in the US, this is 1 in 400 of every patient admitted who die in this way.

    Lets compare this to the NHS over here;

    number of infections are 7212and the number of deaths are according to National Statistics as 1400. There are aproximately 11 million admitted patients each year in the NHS. This means MRSA deaths account for 1 in 7857 of patients admitted in the UK compared to 1 in 400 in the US.

    The next quote also demonstrates how reporting in the press has been misleading. The age of the person has a big effect on your chance of dying from MRSA.

    “Age-standardised rates for deaths involving S.aureus and MRSA were highest in males The rates for both males and females increased over the period 1993 to 2003. The age-standardised rate for deaths involving MRSA in males increased from 14.8 per million population in 2002 to 16.3 per million in 2003. In females the rate increased from 7.0 to 8.5 per million population over the same period.

    Most of the deaths involving S.aureus or MRSA were in the older age groups. In 2003 mortality rates for deaths involving MRSA – in the 85 and over age group – were 437.1 and 220.8 deaths per million of the population for males and females respectively. In the under 45 age group there were 0.9 deaths per million among males, and 0.6 deaths per million population for females.”

  32. Andrew by supporting vouchers and ‘co-payment’ you are supporting the amount of money you earn determining healthcare.

    The main objective for you, DK and Blimpish is to reduce taxes and reduce state funding of health. Increasing the amount we spend on state health from 6% to 9% seems reasonable to me (especially as other countries spend much more, e.g the US who waste 15% of their GDP on inefficient private provision), and despite all the myths and scare stories of the right wing, healthcare is vastly improving here.

    Of course efficiency could be better, of course reform is needed, private company involvement ‘might’ help in this and this govt is proposing these changes, but the NHS should remain ‘free at the point of use’, to change this is to benefit the rich over the poor which seems to me to be your objective.

  33. “There are just over 26,000 managers in the NHS, many of them doctors and nurses, each one providing vital support so that front-line staff can get on with focusing on patient care.”

    *sighs*

    Yes, Neil, that’s right. Instead of treating patients, those doctors and nurses are shiffling paper around. Why do nurses, in particular, go into management? Because there is a (roughly) £33,000 ceiling on ward care. If you want more, you have to go into management.

    Considering there are 1.3 million staff in the NHS this seems a low number.

    Yup. Do the figures, in reference to your quotes below. Do you see? They don’t even vaguely correlate, so someone’s telling porkie-pies.

    “An ICM poll in September 2004 revealed that the public estimated 48% of NHS staff were not involved directly in patient care – the actual figure published in the official statistics today is 16% which means that 84% of NHS staff are directly involved in looking after patients.”

    No it doesn’t: see below.

    “13% of NHS staff provide ‘infrastructure support’ which means they are responsible for key services including cleaning, catering, laundry and IT ”

    13% + 16% = 29%.

    1,300,000 x 0.29 = 377,000 people not directly involved in actually curing people.

    “Respondents were asked how they rated the ‘quality of senior management leadership’ on a scale of 1 to 5, ranging from ‘very poor’ to ‘excellent’ – the average score was 4
    60% of respondents said senior managers in their organisation were ‘focused on meeting patients’ needs’ – just 14% said they were not.

    60% + 14% = 74%. What were the other 26% saying? They didn’t know?

    54% of respondents said senior managers in their organisation ‘support new ideas for improving services for patients’ – just 15% said they didn’t.”

    54% + 15% = 69%. So, what were the other 31% saying?

    “A new analysis of figures from the latest Labour Force Survey show a sharp rise in the number of senior managers and officials employed in the UK economy… blah… The analysis says that the number of senior managers has risen inexorably. In 1981, the number of managers stood at 2.7 million or 11.8% of the workforce, compared to the 3.998 million skilled workers who constituted 17.5% of the workforce.”

    Mmmm. Ever wondered why? That’s right, Neil; because we are a service economy. For good or ill, the focus of our economy is not on “skilled” workers. And, really, how many people working in the City are “skilled” workers? How many are going to describe themselves as managers (of other people’s money, if nothing else)?

    Furthermore, you are not comparing like-for-like. Show me manager statistics for a private hospital and similarly sized NHS hospital. Now, I seem to remember reading that there are 4 times the numbers of managers in the NHS hospital as in the private. Now, that was in hard copy, and I can’t find a link (sorry) so this may well be wrong. If you can find hospital figures, rather than general economy, I’d be very interested.

    Andrew by supporting vouchers and ‘co-payment’ you are supporting the amount of money you earn determining healthcare.

    The main objective for you, DK and Blimpish is to reduce taxes and reduce state funding of health.

    Yes, Neil. I’m incredibly poor at the moment, and I still support that. Why? Because I object to having to pay for someone else. You know my stance on humanity from the abortion debate. I want to keep as much of the money that I earn as possible.

    However, if healthcare is to be funded through my taxes, and I’m going to shout here in the hopes that you might understand what the hell I am talking about, I WANT THAT MONEY TO BE SPENT CURING PATIENTS NOT PISSED AWAY ON BEST PRACTICE REPORTS THAT DON’T GET PUBLISHED UNTIL THEY ARE THREE YEARS OUT OF DATE. Have you got that yet? I don’t want it wasted on agency staff who aren’t needed. I don’t want it poured down the drain on a quality department who only publish reports, not analyse them. I don’t want the NHS to publish anything that isn’t absolutely and totally relevent to patient care. I don’t want the ridiculous hangers-on, and wastes of space that the service is full of right now. OK? Clear yet?

    DK

  34. Andrew said:

    I’m not sure what the point of your comparison of infection rates between the UK and US is, because I haven’t mentioned the MRSA situation in other countries. You have also managed to compare two things which are not the same. Hospital acquired infection (HAI) is a generic term, which covers all infections that a patient acquires whilst in hospital. It includes MRSA. Comparing the US rates of HAI with the UK rates of MRSA bacteraemias is grossly misleading, as the MRSA bacteraemia rates are a subset of the total MRSA rates, which are in turn a subset of the HAI rates, and a very small subset at that. MRSA is not particularly common, in the grand scheme of HAI – you’re far more likely to get a minor and treatable infection than a ‘superbug’, but both count once as a HAI. If you’re going to cite statistics to back up your case, it might help if you managed to cite comparable figures. Otherwise, when you meet someone who knows even vaguely what they are talking about (in this case, me), you are going to come unstuck.

    This is also misleading:

    Labour made it mandatory for hospitals to publish records of superbug cases in 2001

    Actually, they only made it mandatory to report MRSA bloodstream cases. Bloodstream infection with MRSA is relatively rare – it most usually infects open wounds after surgery. So not the same thing at all. There is no other mandatory reporting for HAI in the UK at all.

    Conclusive proof, I fear, that your grasp of statistics is as tenuous as your grasp of microbiology.

    Anyway, I’m not sure how many times I’m going to have to type this until you’ll understand it, so let me dumb it down a touch:

    I don’t want the US system over here. It isn’t very good.

    The main objective for you, DK and Blimpish is to reduce taxes and reduce state funding of health.

    Not true. I have no problems with state financing of healthcare. I have a problem with state provision of healthcare, particularly when it is a monopoly provider. Once again, you lapse into arguing against the caricature in your head, so I’ll repeat myself again:

    …just don’t argue against something I don’t say. It is very tiring to constantly correct your misconceptions about my opinions instead of addressing the issues.

    Andrew by supporting vouchers and ‘co-payment’ you are supporting the amount of money you earn determining healthcare.

    Erm, what? Vouchers would give power to the very poorest. Co-payment can be means-tested. If anything, it would open up the (better) healthcare in the private sector to the least well-off in society.

    And to throw in a Neil-esque conspiracy theory, backed up with no logic or data, but with a crude guess at political motives, and a stereotyped view of a less-than-brilliant left-winger: The only reason you want to maintain the NHS in its current form is because you can guarantee that the unions will deliver a big chunk of votes for Labour if you maintain the structure as is, despite what that means for healthcare, particularly for the poorest in society. It doesn’t matter how many people on council estates don’t get the cancer medicine they desparately need, as long as there’s a social democratic government in power, eh, Neil?

    That bit was fun. I should try arguing like a moron more often.

  35. *standing ovation for the future minister of Health*

    *reminds himself that he must publish his manifesto soon*

    DK

  36. DK I have already provided a link earlier on comparing private hospitals and NHS, if you look you will find private hospitals have more managers.

    DK, none of us want money wasted, but the NHS is actually pretty good, and in 2008 you can choose between private and public provision which hopefully will improve efficiency. I have never used the NHS, apart from when I was a kid, but I am more than willing to pay for it. I haven’t got any kids yet but I appreciate paying for their education is in my interests. Stop thinking about your own selfish short term needs and start thinking a bit more about living in a decent society.

  37. Andrew, At least we agree the private provision in the US is rubbish. The main point about MRSA is that it is far worse over in the US, I suppose thats all that needs to be said.

    I don’t think the childish insults do you any favours but that is up to you I suppose. Let’s try and get back to the debate if we can.

    The vouchers idea doesn’t help the poor at all, to pretend otherwise is stupid.

    If you support private provision in health, what do you think of the fact from 2008 we will have a choice of private or public hospital on the NHS. I think it will increase competition and hopefully efficiency, so I support it.

    As for unions, i think the ‘luddite’ attitude of some british unions has not helped the left’s cause. I don’t agree with ideology, no matter where it comes from.

  38. NHS threatening private sector.

    I think this article demonstrates the NHS is heading in the right direction.

    If the private healthcare companies are worried about falling waiting times in the NHS and predicting a fall in the numbers taking out private healthcare insurance there must be something good happening to the NHS.

  39. Andrew said:

    The main point about MRSA is that it is far worse over in the US, I suppose thats all that needs to be said.

    You haven’t shown that at all Neil. You don’t know what the MRSA rate in either the UK or the US is. Try re-reading my last comment.

    If you support private provision in health, what do you think of the fact from 2008 we will have a choice of private or public hospital on the NHS. I think it will increase competition and hopefully efficiency, so I support it.

    I like it, but it doesn’t go far enough. There are still restrictions on where you can choose to be treated, as I understand the proposals. It should be completely open. And while we’re on the subject, how is this any different to a voucher scheme, which is just a way to allocate public spending to a multitude of suppliers?

    The vouchers idea doesn’t help the poor at all, to pretend otherwise is stupid.

    Why the hell are Labour doing it then?

    The article you linked is a classic example of the BBC putting a misleading headline to a sensible article. Let me quote from it to show you why:

    Laing and Buisson, independent healthcare analysts, found the number of people with personal or work private health insurance rose slightly in 2004.

    But report author economist Philip Blackburn warned reduced waits and more choice in free NHS services could cut demand for private care in the future.

    Right, so the number of people with private insurance has gone up, but the report author is speculating that demand could drop in the future, unless the industry adapts through innovation.

    Well, that’s a description of every business in every industry I know. If you don’t innovate, demand drops as your product becomes outdated and less useful. It’s a description of competition, and that’s a good thing.

  40. I have never used the NHS, apart from when I was a kid, but I am more than willing to pay for it. I haven’t got any kids yet but I appreciate paying for their education is in my interests. Stop thinking about your own selfish short term needs and start thinking a bit more about living in a decent society.

    Neil, I appreciate that. The the nth time, what I disagree with is that so much of the money that we all donate is not going to health provision. How difficult is that concept to grasp? You say the NHS is “pretty good”, and I say it’s not nearly good enough. What I provided in the rant was just one example of wastage.

    I don’t agree with ideology, no matter where it comes from.

    Oh, for fuck’s sake.

    DK

  41. DK, Of course NHS efficiency can be improved, we all agree on that, but the thrust of your argument seemed to me to be that the NHS was a bad thing. Can we clear up EXACTLY what you are proposing?

    Andrew, we both agree that the US system is crap, and the US system is based on a ‘free market’ of private provision- it has failed. I can’t be bothered to argue any more about the MRSA stats, as far as I am concerned I have shown they are far worse in the US. Show me proof it is worse here than there if you can?

    The vouchers idea IS totally different to what Labour is doing because it was only 50% of NHS cost being funded. If it had been 100% then it would be similar to what Labour is doing. Even David Cameron (maybe your next leader) accepts he was wrong on this, because it is a bureaucratic system that effectively funded ‘those who could already afford to go private’ with taxpayers money.

    The opening up of the NHS to a ‘sort of’ private competition in each area is very radical and dangerous because it might mean inefficient hospitals closing. This limitation to a choice of local hospital, is a way of gradually introducing this reform without some areas losing all their hospitals. Although I think Labour is right to open the NHS up to competition, it is risky and could backfire when hospitals close. I just hope Labour is not trying to rush this through, that is my main worry.

  42. DK, Of course NHS efficiency can be improved, we all agree on that, but the thrust of your argument seemed to me to be that the NHS was a bad thing. Can we clear up EXACTLY what you are proposing?

    I wasn’t proposing anything as such. However, since you ask, I am pretty much with Andrew here.

    I can’t be bothered to argue any more about the MRSA stats, as far as I am concerned I have shown they are far worse in the US.

    Neil, all hospital acquired infections are not MRSA. It’s quite simple: Andrew is saying that you are not comparing like with like. Read his reply; it’s not complicated.

    Even David Cameron (maybe your next leader) accepts he was wrong on this, because it is a bureaucratic system that effectively funded ‘those who could already afford to go private’ with taxpayers money.

    This is why I won’t vote for Cameron and his “compassionate Conservatism”. You see that taxpayers’ money? Who exactly are the taxpayers? Those who pay tax: those who pay the most should benefit the most. That’s fair, isn’t it?

    DK

  43. Andrew said:

    The vouchers idea IS totally different to what Labour is doing because it was only 50% of NHS cost being funded.

    Where did I say I wanted to introduce the (crap) Conservative voucher scheme from the last election, Neil?

  44. Don’t be so silly, Andrew; you don’t expect him to have actually read your posts, do you?

    And, naturally, we are evil Tories; what could be more natural that we wish to implement Tory policies that failed to even set the party faithful alight? Heaven forbid that we think for ourselves rather than trot out socialist dogma…

    DK