With hindsight, was the politicisation of healthcare in 1948 a good thing or a bad thing?

[Dai Corner]

Moderator note: Split from https://www.railforums.co.uk/threads/clapping-for-the-nhs.203503

Germany's healthcare system is funded by compulsory insurance and provided by either private contractors (like our GPs) or not-for-profit hospitals. As a result it's pretty immune from politics. It seems to have done a better job of dealing with the pandemic than the UK NHS's so far.

With hindsight, was the politicisation of healthcare in 1948 a good thing or a bad thing?

 

[Mojo]

This might be a subject for another thread, but as people have brought up politics already...

Germany's healthcare system is funded by compulsory insurance and provided by either private contractors (like our GPs) or not-for-profit hospitals. As a result it's pretty immune from politics. It seems to have done a better job of dealing with the pandemic than the UK NHS's so far.

With hindsight, was the politicisation of healthcare in 1948 a good thing or a bad thing?

I’m glad someone else has said this. For a number of years now whenever some changes have been suggested or proposed the loudest reaction seems to be case studies, anecdotes, facts and figures from the USA, as if the only two choices are NHS, or USA-style. Of course, there are plenty of other options available (primarily from European countries).

 

[DarloRich]

edit - i cant be bothered.

 

[Meerkat]

They want rid of the NHS

Thats utterly illogical, ideological bias.
The Tory members are old folk - the most attached to the NHS nostalgically, the biggest users, and the ones who know how expensive private health insurance is (it gets ridiculously expensive as you get old, and that’s for ’top up’, not NHS plus top up)

I would also ask experts like you how people will be able to afford the insurance needed

This is a left wing debating trick - that anything that isn’t the current model is private health insurance.
The key bit of the NHS model is universal healthcare cover, funded by the state. You could make a lot of changes to how the services are provided without affecting that principle, without involving individual health insurance.

 

[Mogster]

On the subject of privatisation PHE have been forced into outsourcing a large chunk of work to private healthcare laboratories it seems. No one has mentioned the P word but I can’t see public health testing returning 100% to PHEs private fiefdom after this. The operators of private healthcare laboratories will be rubbing their hands together with glee and checking their bank accounts with abandon...

If we do look at alternative funding models for the NHS (we should) then I’d rather we avoid something that lines the pockets of private healthcare companies and doctors the way the German system seems to.

 

[Dai Corner]

Correct - but you have more faith in Tories that I do. They don't want to "improve" things by looking at systems in other places that might work well and make things better here .They want rid of the NHS. We should be very careful what we wish for.

If we had the German system you wouldn't have to worry about what you imagined the Tories might do. On the other hand you would have one less stick to beat them with.

I'll ask again now. Was the politicisation of healthcare in 1948 a good thing or a bad thing?

 

[Dai Corner]

On the subject of privatisation PHE have been forced into outsourcing a large chunk of work to private healthcare laboratories it seems. No one has mentioned the P word but I can’t see public health testing returning 100% to PHEs private fiefdom after this. The operators of private healthcare laboratories will be rubbing their hands together with glee and checking their bank accounts with abandon...

If we do look at alternative funding models for the NHS (we should) then I’d rather we avoid something that lines the pockets of private healthcare companies and doctors the way the German system seems to.

I believe the German equivalent of GPs are private contractors (same as ours) and the hospitals are ainly not-for-profits.

 

[DarloRich]

I'll ask again now. Was the politicisation of healthcare in 1948 a good thing or a bad thing?

It was fantastic that people could have access to good quality health care without worrying about the cost. That is what matters. Perhaps you would prefer if we didn't have that access.

I'm not saying they're all 'lazy awful'. I'm asking why some Trusts are fine and others apparently aren't. What's your explanation? A doctor has been on telly today asking for Burberry's number to order stuff he needs. Why on earth is he doing that? It's a procurement officer's job.

You are saying they are lazy and awfull and not doing anything. I will pop round and speak to the guy I get the train with and ask him what he thinks about that. He is a project manager for NHS estates. He is currently working 12 hours a day plus as a porter. My colleagues wife has gone back on the ward as an auxiliary carer rather than her secretarial job. My friend who is an NHS accountant is working as domestic. My aunt has gone back to the wards having retired from nursing and taken a back room/training role.

But yeah doing nowt.

I also know how hard and long the logistics and procurement people are working. The government have actually set up the kind of system ( if in a chaotic way) they have been suggesting for a long time! They have even given them some cash!

The key bit of the NHS model is universal healthcare cover, funded by the state. You could make a lot of changes to how the services are provided without affecting that principle, without involving individual health insurance.

Correct - that is what is important and in honesty I have no problem with changing how that is delivered. I just don't want to pay for it by insurance because I worry I wont get any and be forced to fund health care which will be impossible.

I simply do not trust the Tories to deliver free at the point of use universal health care. You are welcome to disagree but you wont persuade me that they give a stuff about normal people. Their hypocrisy about carers and nurses is sickening. They weren't worth a pay rise but now they gush in their tributes. Disgusting.

BTW the Tories I know aren't old. They are young ( ish), anti eu and very right wing in many of their views.

 

[Dai Corner]

It was fantastic that people could have access to good quality health care without worrying about the cost. That is what matters. Perhaps you would prefer if we didn't have that access.

If it had done without the politics would that be better or worse?

You are saying they are lazy and awfull and not doing anything. I will pop round and speak to the guy I get the train with and ask him what he thinks about that. He is a project manager for NHS estates. He is currently working 12 hours a day plus as a porter. My colleagues wife has gone back on the ward as an auxiliary carer rather than her secretarial job. My friend who is an NHS accountant is working as domestic. My aunt has gone back to the wards having retired from nursing and taken a back room/training role.

But yeah doing nowt.

I also know how hard and long the logistics and procurement people are working. The government have actually set up the kind of system ( if in a chaotic way) they have been suggesting for a long time! They have even given them some cash!

You didn't answer my question. What is your explanation for all the NHS staff I know the having the resources they need and your mates working hard but other frontline staff being short?

.

 

[Dai Corner]

I just don't want to pay for it by insurance because I worry I wont get any and be forced to fund health care which will be impossible.

Don't worry. Everyone in Germany gets insurance. Just as here if a company takes out a scheme for all their employees any with particular health problems are still included at the standard cost.

 

[DarloRich]

You didn't answer my question. What is your explanation for all the NHS staff I know the having the resources they need and your mates working hard but other frontline staff being short?

Because the government weren't ready, wasted the preparation time they did have, didn't have the supply, distribution or procurement systems set up to cope in the manner or volume needed or have expedited and prioritised buying up PPE and other goods early enough (when they should have done). They then had mixed messages about PPE which didn't seem to follow best practice from other countries, changed their guidelines half way through and generally messed about. They also didn't take the shackles off early enough or quickly enough and held onto their silly procurement and internal market rules for far too long. My procurement friends say those rules, the lack of money and the lack of staff cause the most problems generally and stopped them getting stuff they wanted when they wanted it at the start of this crisis.

They have got better but not quickly enough and NHS staff have paid for that. People I know in the NHS have said they now have enough PPE, usually. However they have no confidence in the system and worry about replenishment. This week the item of concern is gowns. Last week was masks or visors. Next week will be gloves or something.

Also the government clearly hadn't thought about care homes and that is now the area where things aren't working. That is an absolute horror show. I do have some sympathy with your view there.

Don't worry. Everyone in Germany gets insurance. Just as here if a company takes out a scheme for all their employees any with particular health problems are still included at the standard cost.

Great! That is my big concern in this kind of debate. I will point out I have been refused private health insurance due to family history so I remain unconvinced.

 

[Jozhua]

The UK appears to be the first country in the world attempting to run a health system entirely off goodwill and food Bank style donations

Saw a sign in wilkos asking for hair clips and shampoo, etc, seems like a charity drive vs a well equipt health system.

Can't believe that London Bridge thing last night, literally the opposite of helping the health service!!!

I feel like all I've seen since the outbreak began is a bunch of empty virtue signalling.

I must say I noticed people looking around in my street last night as if to notice and show disapproval at those who were not stood out on their doorsteps.

I do worry as if we as a nation are reaffirming the cult of the NHS as if it is our new national religion, making any sort of meaningful reform or criticism of the NHS something akin to hate speech.

Totally agree, I love having the NHS and believe it should have more funding, but it all seems to have gone a tad crazy!

I was having a conversation on Twitter, about Piccadilly 15/16 and someone said any money on infrastructure is a waste and should go to the NHS!

I'm pleased also that there are people on the forum with similar views to mine on this issue. As a former NHS Nurse with over 35 years experience and a partner who is still practising (and working extra to cover for staff who are off) we both feel that, while welcoming the support for the NHS in general it really is a bit rich for those who have consistently voted for deep cuts in our Health service to clap for those currently working in extreme conditions caused by those cuts.
My partner is working nights at the moment (and extra shifts on days to provide cover ) and we have had some harrowing debriefs in the morning when she gets home, trying to live separately isn't easy either!

Yeah, I don't think Goodwill helps solve poor working conditions. When working in healthcare is no longer seen as a sacrifice or 'vocation' for the love of it, and a proper career path (especially for nurses), then more people will take it and stay with the health service.

I’m glad someone else has said this. For a number of years now whenever some changes have been suggested or proposed the loudest reaction seems to be case studies, anecdotes, facts and figures from the USA, as if the only two choices are NHS, or USA-style. Of course, there are plenty of other options available (primarily from European countries).

Yeah, I know Spain has an inexplicably efficient health system.

I've also seen some people note that improvements in efficiency seem to be aimed at cost not patient care quality/outcomes. I think having a given budget and saying "allocate this the best way to get the best outcomes for patients possible", vs "reduce costs where possible" would probably result in a more efficient health system. This means no cuts and an element of per-patient funding (with adjustments depending on the area), so NHS departments can adjust with rises/falls in demand.

I don't know if market forces are the golden ticket to efficiency, so unsure about privatisation. In fact, most kind of franchising setups tend to suck a lot of resources in just making work, especially if you're a government body that must be transparent and accountable for decisions made.

 

[Dai Corner]

Because the government weren't ready, wasted the preparation time they did have, didn't have the supply, distribution or procurement systems set up to cope in the manner or volume needed or have expedited and prioritised buying up PPE and other goods early enough (when they should have done). They then had mixed messages about PPE which didn't seem to follow best practice from other countries, changed their guidelines half way through and generally messed about. They also didn't take the shackles off early enough or quickly enough and held onto their silly procurement and internal market rules for far too long. My procurement friends say those rules, the lack of money and the lack of staff cause the most problems generally and stopped them getting stuff they wanted when they wanted it at the start of this crisis.

They have got better but not quickly enough and NHS staff have paid for that. People I know in the NHS have said they now have enough PPE, usually. However they have no confidence in the system and worry about replenishment. This week the item of concern is gowns. Last week was masks or visors. Next week will be gloves or something.

Also the government clearly hadn't thought about care homes and that is now the area where things aren't working. That is an absolute horror show. I do have some sympathy with your view there.




Great! That is my big concern in this kind of debate. I will point out I have been refused private health insurance due to family history so I remain unconvinced.

Why is it the Government's fault that (parts of) the NHS and (some) care homes weren't prepared? Surely ministers aren't supposed to go round storerooms and warehouses stocktaking?

 

[Islineclear3_1]

You mean like how the labour government of 1997-2010 signed up to many poorly written and costly PFI deals for the NHS, as well as starting to privatise it?

Or are you one of those labour supporters who have carefully removed that government from your memory as being "New Labour"?

But the earliest form of privatisation, or de-nationalising of industries started with Thatcher's Conservative government in the late 1970s.

PFIs was started by John Major's Conservative government in 1992

 

[Dai Corner]

The UK appears to be the first country in the world attempting to run a health system entirely off goodwill and food Bank style donations

Saw a sign in wilkos asking for hair clips and shampoo, etc, seems like a charity drive vs a well equipt health system.

They're for patients. Normally visitors bring them in but most (all?) hospitals aren't allowing any at the moment.

 

[Islineclear3_1]

Why is it the Government's fault that (parts of) the NHS and (some) care homes weren't prepared? Surely ministers aren't supposed to go round storerooms and warehouses stocktaking?

Probably because the NHS is funded by general taxation which is collected by... the Government

But yes, care homes are a different story. They are run for profit

 

[Dai Corner]

Probably because the NHS is funded by general taxation which is collected by... the Government

But yes, care homes are a different story. They are run for profit

I think you'd agree with me that it was a mistake to found the NHS in the way it was and that it would be better if funding and delivery was independent of politics then?

 

[Darandio]

Why is it the Government's fault that (parts of) the NHS and (some) care homes weren't prepared? Surely ministers aren't supposed to go round storerooms and warehouses stocktaking?

Care homes aside it's because it's the government and at the end of the day, they are accountable. It's the government that decided to procure equipment too late. It's the government shouting out large numbers and making false promises. It's the government that set a target of 25,000 tests per day, when it turned out they couldn't achieve that they decided to shout a bigger number of 100,000 instead, yet they cannot even get near the original figure.

They seem to think big promises and shouty numbers appease and please people but it doesn't wash for many. How anyone can defend them is beyond me.

 

[Dai Corner]

But the earliest form of privatisation, or de-nationalising of industries started with Thatcher's Conservative government in the late 1970s.

PFIs was started by John Major's Conservative government in 1992

Imagine if telecoms, electricity and gas had been subject to the whims of politicians over the last thirty years!

 

[Dai Corner]

Care homes aside it's because it's the government and at the end of the day, they are accountable. It's the government that decided to procure equipment too late. It's the government shouting out large numbers and making false promises. It's the government that set a target of 25,000 tests per day, when it turned out they couldn't achieve that they decided to shout a bigger number of 100,000 instead, yet they cannot even get near the original figure.

They seem to think big promises and shouty numbers appease and please people but it doesn't wash for many. How anyone can defend them is beyond me.

I'm not defending the politicians, I'm suggesting it would be better if they were as involved as little as possible.

 

[Islineclear3_1]

If it had done without the politics would that be better or worse?

There has been too much meddling by Whitehall over the years and the tip-toe to privatisation is proof that the state want to wash their hands off the NHS. But privatisation does not work, it reduces patient choice (and care) and some private companies have had to hand back services to the state as the cases are too complex

 

[Dai Corner]

There has been too much meddling by Whitehall over the years and the tip-toe to privatisation is proof that the state want to wash their hands off the NHS. But privatisation does not work, it reduces patient choice (and care) and some private companies have had to hand back services to the state as the cases are too complex

That's why I like the German system, with its universal insurance and not-for-profit hospitals.

 

[Islineclear3_1]

I think you'd agree with me that it was a mistake to found the NHS in the way it was and that it would be better if funding and delivery was independent of politics then?

I don't disagree with how the NHS is funded however, a government is elected by its people (i.e. the taxpayers) and it should be "the people" who have a say in how funding and delivery of services are done. The government becomes the guardian of the taxpayers money

However, I do think this clapping is getting overrated now; I think we have all got the message now...

 

[Dai Corner]

I don't disagree with how the NHS is funded however, a government is elected by its people (i.e. the taxpayers) and it should be "the people" who have a say in how funding and delivery of services are done. The government becomes the guardian of the taxpayers money

We get our say at each election when the Parties put forward their proposals and we vote.

 

[yorksrob]

I read recently that Germany spend about 2 percent more of their GDP on health than we do. That has to have an effect on outcomes.

If you ringfenced a proportion of national taxation for healthcare, it would effectively become "universal insurance" anyway.

 

[Dai Corner]

I read recently that Germany spend about 2 percent more of their GDP on health than we do. That has to have an effect on outcomes.

If you ringfenced a proportion of national taxation for healthcare, it would effectively become "universal insurance" anyway.

A proportion, as in x% of the amount raised each year?

 

[Busaholic]

I reject the implication of the question. The Beveridge Report of 1942 was completed and published under the direction of the coalition government that existed for much of WW2 and the proposal by the Labour Party to implement it at the 1945 General Election saw a great divide within the party, with the more right wing Ernest Bevin, a darling of the unions, losing out to the left wing firebrand Aneurin Bevan, with Atlee siding with Bevan. The Labour Party's stunning victory in 1945 against the Conservative Party of Winston Churchill, despite the latter's acknowledgly crucial role in securing victory in WW2, was on the back of creating a new society to face the grave problems that would last for so many years after 1945, and the creation of the NHS was the centrepiece.

 

[yorksrob]

A proportion, as in x% of the amount raised each year?

Yes, it was an annual amount. I can't remember the article, but it talked in terms of the European average.

 

[Dai Corner]

I reject the implication of the question. The Beveridge Report of 1942 was completed and published under the direction of the coalition government that existed for much of WW2 and the proposal by the Labour Party to implement it at the 1945 General Election saw a great divide within the party, with the more right wing Ernest Bevin, a darling of the unions, losing out to the left wing firebrand Aneurin Bevan, with Atlee siding with Bevan. The Labour Party's stunning victory in 1945 against the Conservative Party of Winston Churchill, despite the latter's acknowledgly crucial role in securing victory in WW2, was on the back of creating a new society to face the grave problems that would last for so many years after 1945, and the creation of the NHS was the centrepiece.

Do you think it would have made a difference to the outcome of the 1945 election if the proposal had been for a service funded and provided like the German model instead of a 'free' one?

 

[DarloRich]

Why is it the Government's fault that (parts of) the NHS and (some) care homes weren't prepared? Surely ministers aren't supposed to go round storerooms and warehouses stocktaking?

They are accountable and they are, frankly, responsible for this shambles. I actually agree that GENERALLY care homes being (mainly but not entirely) private businesses should be responsible for preparing suitable stores. However I have spoken to a former school mate who runs a number of homes and he tells me they prepared according the the advice given by the government in the early stages. When the advice changed the equipment was not available. They even turned down supplies they now need because they were told they didn't need them and they should let the NHS have them. He has even had some PPE supplies created and dispatched by teachers at my old school!

Luckily he is quite a prepared chap so he had in place plans to deal with an outbreak of contagious illness in their homes ( isolation rooms, changes to family access, cleaning regimes, staff moving on site, changed rotas, altered responsibilities, reduced menus, stores of PPE generally required etc) as part of their business continuity planning which he implemented early so they have been able to reduce but not eliminate the impact of the virus on their residents and staff. They have lost people and expect to lose more.

The issue now is that PPE is needed more widely and in greater volume than individual businesses can procure. Only the government can buy in the bulk with the cash required and get that to people who need it quickly. They have not thought about care homes quickly enough or provided PPE quickly enough which means the numbers of infections and deaths in most homes is very awful. I am sure they will improve but it is already too late for many. It is also horrific families cant be together at the end.

Do you think it would have made a difference to the outcome of the 1945 election if the proposal had been for a service funded and provided like the German model instead of a 'free' one?

No idea. What do you think? What was the Germans health system like at the time?