Actually, let's NOT "privatise" the NHS, shall we?

I realise this is probably going to come as a bit of a shock to everyone, given that I hate socialised anything, and my experience of the NHS has been universally depressing and distressing and frustrating.

But I've just realised the outcome of "privatising" the NHS is not going to be loads of independent surgeries and hospitals all competing openly and honestly, driving down costs and improving the experience of healthcare for everyone; it's much more likely to be like public transport, with large, bureaucratic corporate companies gobbling up regions of healthcare and providing de facto (or even worse, de jure) monopolies in each area.

It's a measure of just how useless government is and how reluctant it is to relinquish control of anything that the only model they have for privatisation is to farm the services out to a couple of their mates so that it's easy to "nudge" them in the "right" direction, rather than opening things up to the market and leaving them to sort themselves out. This despite the repeated and rather obvious failure of the model to provide any cost savings or a genuine improvement in service.

We might as well save ourselves the inevitable arse raping (without lube) that is going to happen, since government won't actually privatise the service, but rather just outsource it.

I can't really tell the difference between fascism and modern corporatism.

Can you?

Plus ça change, etc.

Good Lord, it's not the first time I've used that as a blog post title, is it?

Well, here's some good stuff from the Tories:

Diabetes remains one of the largest challenges to our healthcare system, with around 3.7 million sufferers in the UK and almost a million more estimated to have the condition but who do not know it. This is likely to get worse. Unhealthy lifestyles in the UK put a further 7 million people at risk of developing type 2 diabetes and in ten years’ time we may see the number of patients pass the 5 million mark.

All this places a significant burden on the NHS, with an estimated spend of £10 billion per year on diabetes related treatments. A great deal of this spend is unnecessary. Diabetics far too often suffer from late diagnosis, preventable complications and variations in care. They are often overlooked for specialist care when being treated for other conditions, particularly in hospitals, and they can be prevented from accessing treatment by the short term financial ethos embedded in far too many Care Trusts across the country.

Some studies have found that around 80 per cent of the spend on diabetes is avoidable so the main focus the Government needs to take is how to deploy resources effectively to help people manage their diabetes and even more importantly, prevent people from developing type 2 diabetes-the type related to lifestyle-in the first place.

This is being made more challenging by the NHS reforms, which, even if they were perfect, would cause disruption, and the fear that the new commissioners will take something of a short term approach to managing budgets in light of the priority for deficit reduction.

Wow, this is all good stuff, isn't it? Stuff we've been saying all along: you can get the same or better results without spending as much money, too much is wasted. And why is it wasted? Because of insane bureaucratic procedures which explain all too well why visiting a GP in this cuntry feels like you're interacting with a call centre operator in a foreign land who'd like nothing more than to tell you to switch it off, wait five minutes and then switch it on again.

But given that the problem is a massive surfeit of bad guidance that causes people to waste money in a bureaucratic, checkbox manner, guess what the solution proposed to this is?

Go on, guess.

The problem is too much bureaucratic guidance, what solution could you propose that would guaranteed to make me want to strangle myself with my own testicles?

Yes:

The Government can rectify some of these problems through national leadership. The National Service Framework, which has guided diabetes care since 2001 is due for renewal and it is a very appropriate time for Ministers to look at how to spend wisely now, and disseminate best practice across the NHS to reduce long term costs. Achieving this would have the happy coincidence of better patient outcomes; arguably what the priority should always be for Ministers and officials.

Kill me now.

Can't they both lose?

Really, I've got no time at all for the NHS. The doctors are arrogant, hectoring smartarses, the hospitals are awful and I just hate everything to do with it. Simpering twats like Ben Goldacre and the like continually crying about the poor NHS makes me want to perform actual violence.

But then on the other hand, Andrew Lansley is a fucking idiot too, and I'm quite sure his "reforms" are just going to make things worse.

The thing that really cunts me off beyond belief is that if it was, say, Andy Burnham making these exact reforms, Labour would be short-stroking themselves into a coma about modernisation and improvement of the NHS, and that smug bellend would be all in favour of it.

This cuntry is fucked.

In which I say something nice about the NHS

I frequently get my ear bent about my bitter disdain for the NHS and it's certainly true that I have been exceptionally unlucky not to encounter (as a patient) a single one of the caring, helpful staff that the NHS is said to be full of.

So, let me say something positive about British healthcare professionals: given the insane bureaucracy and meddling, soundbite-driven, target-oriented micromanagement by the government, given the complete disconnect of normal market self-interest in making medical people care about patient loyalty, it is a remarkable testament to the skill, dedication and commitment of those healthcare staff who do actually care and do actually deliver, that the UK is not at the bottom of the healthcare charts.

It just frustrates me that if there were truly an open market in healthcare, things would be so much better, people wouldn't be beholden to faceless quangocrats for the drugs they need, or have postcode lotteries, or have faceless bureaucrats unaccountably cutting services for everyone but the really rich.

So, here's to the individual nurses, doctors and other people in the NHS who care enough to deliver good health care despite, not because of, the stupid business model that the NHS has.

And could someone please arrange that my local GP practice gets a couple of them? Thanks!

Some random thoughts about the NHS

I am sure that my last couple of tweets about the NHS are going to get me some stick.

But I think it's important to divorce the business of healthcare from the organisational woes of the NHS. People who defend the NHS's virtues are the same people who complain about postcode lotteries or government interference in the niceties of healthcare.Or, indeed, low front-line staffing or excessive bureaucracy.

These really are two sides of the same social healthcare coin. As soon as the state is involved in the provision healthcare, it becomes subject to the decisions made by bureaucrats who are chasing statistics or "The Thick of It" soundbites, rather than caring for patients. If you want the "safety net" idea of a means of providing healthcare for all, free at the point of delivery, which has to be funded out of general taxation, then you have to accept the downsides of this approach, which is that the safety net is under the control of people who have no idea of the issues and consequences of their decisions and initiatives.

I don't think that opening the NHS up into thousands of competing hospitals and small practices, paid for by individual consumers, will have any bad effect that will not be outweighed by lower costs, better service and fewer needless fatalities.

It's not getting any better

Sorry Kingbingo, but whatever you're doing is not fucking working. I just got my local rag through the mailbox and the front page is plastered with how fucking disastrous boozing is and how much it's costing the saintly fucking useless shower of shite that is the NHS.

Not a fucking word on the fact that smoking and drinking are nett contributors to tax. Just more of the same old nannying, hectoring, we-know-better-than-you shit that filled our fucking ears while the cunts who wore red ties were in charge.

To all you authoritarian bastards, gearing up to tell us some more about how wicked and dissolute we are, I have three simple words to share with you:

Just. Fuck. Off.

In simple words (for @joshuwahwah )

This caught my eye on twitter:

RT @joshuwahwah How on earth can Cameron promise to cut paperwork for GP's, when he has put them in charge of budgets? #fail

My response was something disparaging, to which I got an equally disparaging response.

Rather than leading to a typically childish string of insults ("you child" - "you mong" - "imbecile" - "twat" - "fascist" - "cunt" ...) I thought I'd explain to someone who is obviously a bit of a simpleton that it is entirely possible for someone to do less paperwork and take responsibility for budgets, if the budgets require less paperwork than they were doing originally.

Having said all that, I disagree entirely with the NHS and state provision of healthcare and broadly agree with this post from the LPUK if you have to have state provision of healthcare.

Fucking Doctors

I went to see my doctor today. I fully expected to get back needing tranquillisers.

But no: he saw me promptly, listened courteously, sympathised, clearly told me what was going on and how the treatment would carry on. I walked out feeling rather deflated.

I wonder what has changed?

I fail to see the relevance

Spot the entirely irrelevant commonality:

Reforming the NHS

Lansley is, of course, doing nothing useful. Ostensibly taking the levers of power away from the unaccountable managerial twats who control the purse strings in the current version of the NHS, he is instead giving that power to the only people who I would less prefer to have it: GPs.

Now I realise that I alone in this entire country have been unlucky enough to find only useless, incompetent makeweights in GP practices in three different counties, but I'm afraid that it has coloured my perception of them.

Unable to diagnose a splinter without a battery of blood, urine and stool samples, I wouldn't trust a single fucking GP I've met to find their own arsehole with a map, Grey's Anatomy and fucking assistant. How giving them control of what happens to you after you've left their tender and astute care is going to help anybody is fucking entirely beyond me.

The problem isn't the fucking managers or the bureaucracy, the problem is specifically that the cunting GPs are entirely useless. How giving the fuckers the reward of controlling how money is spent is going to suddenly make them better, I don't fucking know.

How a service that is free at the point of delivery is not going to be abused by freeloaders and hypochondriacs, I don't know. How a system which does not reward a doctor for the quality of his work but rather his run rate is ever going to provide decent primary health care, I don't know.

We are truly uniquely blessed in the UK: we pay through our nose for health care service that needlessly kills more people that pretty much all the things they pronounce upon with such disdain and we have absolutely no fucking control over how any of that money gets spent. The worst incompetent cuntish fuckwits in the entire system are being rewarded with control over the money.

Oh yeah, and that bonfire of the quangos has yet another new "commissioning board" to add to its list of amazing accomplishments.

So: more money being wasted on the NHS, more quangos, taxpayers getting raped, patients getting killed, lectures from doctors about how sinful we are.

Meet the new politics, completely different from the old politics.

Oh yes.

What is the NHS for?

I think it's time somebody asked the question. And it's not an easy one.

My take on this is that anything outside A&E can't really be a "common good".

You could argue that care for chronic (i.e., long-term) illnesses should be nationalised because of the potential of financially ruinous bills. I wouldn't argue that, but it could be argued.

So, would you support the NHS providing for chronic illnesses and what else would you want the state to provide in healthcare? (Or not, as the case might be!)

The envy of the world

We are the three in four
Just numbers on a list
We are the three in four
Death panels "don't exist"
Nobody knows us
But we're always there
A statistical reminder
The NHS just doesn`t care

Queues longer than the dole queue
Malnutrition dulls our hair
Our eyes are black and lifeless
With appalling patient care
We're patients in the corridors
Fatcat managers on our dime
I'm the MSRA victim
'Cause no-one cared 'bout grime

We are the three in four
Just numbers on a list
We are the three in four
Death panels don't exist
Nobody knows us
But we're always there
A statistical reminder
The NHS just doesn`t care

We're the doctor and his victim
Why not just use a gun?
We're a sad and bruised old lady
Ward looks just like a slum
We're a middle aged businessman
With chronic heart disease
We may as well commit suicide
Than face post code lotteries

We are the three in four
Just numbers on a list
We are the three in four
Death panels don't exist
Nobody knows us
But we're always there
A statistical reminder
The NHS just doesn't care

We're a starving UK pensioner
Can't afford private care home
We're all hooked on Seroxat
Committing suicide alone
We're evil smokers, fatties
Taxed to fucking death
NHS wants our money
Doesn't care about our health


We are the three in four
Just numbers on a list
We are the three in four
Death panels don't exist
Nobody knows us
But we're always there
A statistical reminder
The NHS just doesn't care

We are the three in four
Just numbers on a list
We are the three in four
Death panels don't exist
Nobody knows us
But we're always there
A statistical reminder
The NHS just doesn't care

Fucking NHS CUNTS!

WHAT THE FUCK ARE YOU DOING?

Patients’ confidential medical records are being placed on a controversial NHS database without their knowledge, doctors’ leaders have warned.

Those who do not wish to have their details on the £11 billion computer system are supposed to be able to opt out by informing health authorities.

But doctors have accused the Government of rushing the project through, meaning that patients have had their details uploaded to the database before they have had a chance to object.

What fresh cuntery is this, then? The government is dead keen to get our fucking medical records online for what possible reason?

Whatever it is, you just fucking know it's not going to end well for us, don't you?

Joined up government ...

The (excellent!) UK Libertarian has drawn my attention to this story:

Visitors to the UK could be required to hold health insurance before they can enter the country, the government says.

The move is an attempt to crack down on “health tourists” who come for treatment but fail to pay for it.

Ah yes, let's make it even less attractive for those damn foreigners to come here and spend money. After all, which Daily Mail reader doesn't instinctively know that darkies come here and drain our hospitals?

But serendipitously, Timmy has an interesting factoid:

The Department of Health is trying to recover £22 million from foreign nationals who have had NHS treatment in the past two years and not paid their bills.

At one level it’s a significant sum. £ 10 million or so spondoolicks a year is real money.

At another level it ain’t. At something like £100 billion a year spent on the NHS £10 million is, umm, let’s see if I can get the right number of zeroes here…..0.001% of the system cost.

Why are we even discussing this?

Must be an election coming or something.

Cunts.

Too good not to share!

Dear Ms Raccoon,

Thank you for your enquiry.

You appear to be under some misapprehensions about the purpose of the NHS. You believe that it’s supposed to cure people, or something. Things have moved on since that philosophy was in operation, many decades ago. No, these days, the new thinking is that the real purpose of the NHS is to kill people, in as large as numbers as possible.

Let me explain. In the past, people were understood to have become ill as a result of bacterial or viral infection, largely through no fault of their own. But now we know that most disease is caused by ‘lifestyle’ factors. Smoking cigarettes, for example, causes all forms of lung disease, every kind of cancer (and not just lung cancer), all variants of heart disease, and more or less every other disease as well. And if cigarettes don’t cause these diseases, then drinking alcohol does so instead. Or eating meat. Or not getting enough exercise. And these lifestyles are what people have freely chosen to adopt. And so, it’s their own fault if they contract these diseases. And given there’s next to nothing that the NHS can do to cure them, the only option is to assist them to a premature death, which is where they were all heading anyway.

In modern NHS hospitals, doctors all know that anyone who has been wheeled through the front door is someone who has been trying to kill themselves all their lives with smoking, drinking, overeating, sex, lack of exercise, and so on. We simply try our best to help them on their way to the early grave they quite obviously seek.

I agree we’re not very efficient about it. MRSA is a nasty way to die. We’re hoping that new legislation on assisted suicide will allow us to open some assisted suicide facilities in our hospitals. Some people call them ‘gas chambers’, but these have some unfortunate resonances, and so we’re looking for another name for them. But, once the new facilities come online, we’re hoping to boost the NHS deathrate from its current figure of about 70,000 a year to something more like 1,000,000 a year. Patients with ‘lifestyle’ diseases will be able to look forward to rapid and immediate treatment in these new facilities, with waiting times of only minutes or hours.

We will, of course, retain the treatment centres for the old-style bacterial and virally-transmitted diseases. So if you get malaria, we’ll still prescribe drugs for its treatment. However, there is a strong argument that even malaria is a ‘lifestyle’ disease. You get it by going to West Africa. And anyone who gets malaria has only themselves to blame, and must have had a death wish of some sort, which we at the NHS will be more than happy to fulfil.

I’m sure you’ll agree that the new model NHS will be far more efficient than the old one. Hospitals will be much smaller. Wards will be small and very private. Patients will be treated immediately. Much of the old bureaucracy will vanish. Furthermore, the health of the remaining population of Britain will be greatly improved as unhealthy people are removed, and the population of Britain will fall towards sustainable levels. We’re hoping to bring the population down to 5 million or so by the end of the century.

Please don’t hesitate to contact me again if you have any further questions.

Yours faithfully,

Josef Mengele, M.D.

From the comments here.

Ah, the wonders of the NHS

An old acquaintance of mine was born in Essex, but emigrated to one of the colonies when he was young. A long time ago. He grew up in the colonies, lived there, worked there but on his retirement, he hankered to return to the land of his birth.

The fool.

So, he called me the other day to say he was going back to the colonies for some pre-Christmas sun. It was a Sunday, I think. On the Wednesday, I got a phone call from him to say he was in hospital. I found this rather odd, although he had mentioned going to the NHS doctors a couple of times (fruitlessly, of course) before his trip. He had called his old colonial GP on the Monday morning and arranged to see him on the Tuesday. After a very thorough examination, the colonial GP decided that he had a hernia. So he booked him in for some new surgical technique on the Wednesday, the operation was done immediately and by the Thursday, he was out shopping and enjoying his holiday.

And I have to say, it sounded wonderful.

Imagine phoning up your GP and being able to arrange to see the doctor you want to see at a time you want to see them. The doctor then spends a whole fucking hour checking you up because you "feel a bit out of sorts" and actually finds something. You know, doing actual diagnosis and stuff. You are then wheeled into a (clean) hospital of your choice within 24 hours for what is, frankly, not exactly a life-threatening condition and operated upon immediately. You leave the hospital better than you entered it and without a dose of MSRA.

Or, of course, he could have gone to a hospital in Essex.

I can't see why more countries don't emulate us

Yes, we all love socialised medicine. It's all free*, don't ya know? Lovely. Mind you, there are one or two minor issues:

Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors.

But the real decider is the market. And until doctors feel financial pain as a consequence of their incompetence, it will never get better. And the guys who do know what they're doing will never stand out.

Because it's all "free".*

*I know it's not fucking free. But there are actual dimwits out there who think that the fact that they don't need to take their wallet with them is a fucking good thing.

Cunts.

A false dichotomy

I can't understand why all these people who bang on about the NHS being great make it sound like the American system is the only alternative. The litigious American health care system is better than ours, but is more expensive per capita. But there are many other systems out there, and some Tories have actually suggested something which sounds fairly similar to my own thinking.

But really, don't pretend there's only the NHS way or the US way - there are better options out there!

Emotive bollocks

The Indy wanks itself into a coma:

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury.

Er, hello? Are you implying that the NHS is free? By my very rough, back of the envelope calculations, every taxpayer in the UK pays an average of £3200 per annum for the NHS. I can get the very highest level of private insurance cover for about a sixth of that. Chuck in the same again for paying directly for primary health care visits to the GP and prescriptions, and the average taxpayer is paying about 3 times as much as I should for health care. Now, I know that I can't really generalise like I have, but really, how does it make sense to pay £3200 for £1300's worth of service and then still fucking claim to like it because you see it as "free". (And would that I, personally, was only paying £3200 into this cuntish system. I pay a lot more than £3200 in, but I reckon I still only get about £600's worth out of it.)

For fuck's sake, by all means, defend this shitty system, it is your right to hold that opinion, but please just be fucking honest about the costs.

An idiot writes

Stick to dispensing the drugs:

The healthcare will be as expensive as you make it. If you are paying for it you will start to scrutinize your therapeutic interventions more closely. You will have to eliminate waste. Ask your healthcare professionals. They know where the wastes are in the system. They will save you money without compromising your quality of health. With strong leadership, you can start to spend your healthcare budget on interventions that makes real difference to people's lives.

Doesn't that make your soul wither? Let's start with the "if you are paying for it": we are paying for it, but there's no connection between what you pay and what you get. The NHS, by making things free at the point of delivery is actually the worst possible mechanism for pricing. There is no incentive (or even possibility) of you shopping around to get the combination of price and service that suits you best. Your service provider has no incentive to innovate or differentiate or improve anything, because he has complete monopoly. So, you're paying a set amount irrespective of your personal health, your risk appetite, your desires, etc. and in exchange for that you get whatever health care a committee feels they can afford or, even better, whatever health care the government dictates you can get.

I'm sure that Americans scrutinize their therapeutic interventions much more closely than we do, already. I mean, right now, who cares if we do an operation or not? Apart from the guy getting operated on. Who hasn't heard of operations being rescheduled at the last minute because of some bogus issue which hides either incompetence or the fact that the trust needs to save the money for the operation this month so that they can operate within their budget?

And isn't it amusing that there is a presumption of significant waste within the system? I mean, any business has waste, which is why redundancies are a feature of modern business life. Redundancies are a way of allowing a business to re-optimise itself and do more (or the same) with fewer people (and fewer assets, as a consequence.) When was the last time you heard of a program of redundancies in the NHS? Does that make you wonder how much inefficiency is in the NHS?

And strong leadership? Is that what you really, really want? I mean, Mao, Franco, Stalin, Hitler and Mussolini were all strong leaders, but they didn't really do much for their countries, did they?

And it gets even better:

I am personally encouraged by what is coming out of the big pharmaceutical companies. They are beginning to understand that they have a social responsibility. It is not all about profits to shareholders. A number of them are now consolidating their positions. They want to be part of the solution not the problem. They now know what they have to do. And if they want to innovate and they ask you for help, it is within your rights (and power) to develop a system which will provide the pharmaceutical companies with opportunities to innovate. It can be done and it is being done. What will you rather have your pharmaceutical companies doing? Supplying drugs to you on the strength of an effective marketing campaign or on the strength of a great product? It is in everyone's interest for the pharmaceutical companies to develop new innovative drugs.

Oh dear. I think your faith in big pharma is entirely charming, but oh so very misguided. What has happened is that big pharma has decided that rent-seeking, by sucking up to government, is easier than doing what they used to do. Why bother going through all that fol-de-rol of creating new drugs when you can make as much money or more for your shareholders by sucking up taxpayer money?

Given the amount of drug regulation that goes on, is this man really saying to us that we buy drugs because they're well-marketed rather than because they work? Isn't that a rather damning indictment of drug regulation, which is, let's remember, an adjunct of the wonderful NHS? Or is he perhaps just talking out of his arse? I couldn't say, but either way it's not a ringing endorsement of statist health care, is it?

I'm fucking amused by the shameless hypocrisy of this Labourite, economically illiterate cock-sucker at the end of all this, endorsing The One's principles of health care. Because the very first of these is:

1. Guarantee Choice

The NHS offers the population of the UK a fantastic choice: take it or leave it, but you're fucking paying for it either way. If you want lubrication with that, you're going to have to buy it yourself - sucker!