You seem to be saying that in order to be effective (in the supply of public services) we have to be inefficient, I find that appalling. I would have thought that in a population of over 60 million predicting requirements such as medical care, at a city level, would be relatively straightforward for the Office of National Statistics. However given that we struggle to meet supply and demand for schools, with the lead-time involved in rearing children, I am maybe being a bit over optimistic. Maybe we do, as a nation, need to spend more on healthcare but throwing more money at the NHS is not the way to do it, otherwise we might indeed end up like France, who is now considered the new sick man of Europe.
No, it is not appalling at all. It is an absolute and logical necessity, inherent in the whole concept of public services. There will always and necessarily be a tension between the incompatible aims of being efficient and being effective. And so public services can always be subject to ill-informed criticism for not being one or the other.
There might be a rail crash tomorrow, injuring hundreds of people; or there might not. There might be a Flu epidemic this winter, or an Ebola epidemic, with millions needing treatment; or there might not. A dozen expectant mothers in a maternity unit might all start giving birth at the same time today; or there might be none tomorrow. Your supposition that this can be predicted statistically is sheer fantasy.
It can be safely predicted (or rather assumed) that at some point there will be a major accident injuring hundreds of people. But there is no possible way of predicting when, where or how many. It is a matter of putting resources in place in many locations to deal with possible incidents - resources which necessarily go unused and wasted much of the time. It can be predicted that on average (say) 10 babies will be born per day in a certain maternity unit, but that means some days it will be 20 and other days nil. There is no way of predicting this accurately. So again there have to be facilities in place which some days will go unused.
It is not an absolute necessity for public services, in order to be effective, to have: - State monopolisation; other countries (forget the USA) have public health services which do not have such a high proportion of public delivery (although let's not forget that GP practices are in most cases effectively private). The "profit" argument is meaningless - we don't expect NHS suppliers to run as charities or at a loss, and when the state has run industries on a break-even or loss-making basis (think British Leyland) it has not led to cheaper or better output than the private sector would provide. - Zero charging for use of public services. Even when we had publicly owned telephone services, they were not free to use. It is perfectly possible to have some charging built into delivery of public health care and still to protect the poor. - Centralised National negotiation of prices and wages; it is generally believed that the deal done with GPs, which set relatively high rates of remuneration (compared, for instance, to various other European countries where GPs are paid less, meaning that you can have more of them for the same price), and limited the requirement to provide out-of-hours cover, was a bad deal for the tax payer and patient. Public services do not have to involve that sort of inefficiency.
Are "high rates of remuneration" required in order to attract qualified doctors to take up GP posts? I don't know. All I can use as a rough & ready comparison is NHS Dentistry practices. There is a perceived shortage of these nationally - perhaps if GPs weren't "handsomely" rewarded there would also be a shortage of GPs? As it is, there are an enormous number of doctors working in GPs who are from overseas - why is that? Hint: the answer is in two parts and only one half of the answer is "because we pay them so well".
Yes, interesting and well-known. There will always be debates about whether the resources available at a given location are sufficient, excessive, or about right in terms of the risks of those resources being either needed or wasted; just as there are debates about different methods of financing healthcare. None of that affects the fundamental underlying dilemma between effectiveness and efficiency which I have described.
Qualified doctors find it easy to emigrate and immigrate , because they are welcome in almost any country. British doctors often choose to move overseas and vice versa. It would be foolish indeed to underpay GPs if the aim is to provide adequate healthcare in the UK, regardless of how it is organised or financed.
You are correct in saying that public services do not necessarily have to be provided directly by the state, or free at point of use, or centralised in structure. An infinite number of possible models are available, and each country has its own solution. All of that is wholly irrelevant to the basic point I have just made, which is that in any system of delivery (not just our current NHS scheme), efficiency and effectiveness are polar opposites - you can't possibly have both.
NHS Dentistry and the NHS GP service are very different. On the whole, I think dental practices are private businesses (like GP Practices), and I'm not sure the NHS directly runs any of them, but many of them take on a proportion of NHS work, which in the case of my current dentist means that they will treat the children as NHS patients, and me only as a private patient. I don't think there is a real shortage of dentists, just of those who want to work on NHS terms. I'd be much happier if the NHS allowed me a "voucher" in respect of a basic service, allowing me to top up, rather than pay all over again, which I have to do (I've had several dentists treat me as on NHS terms before, and they have all gone on to explain that this was no longer something they were prepared to do, due to the nature of the contract they were offered). There are a lot more than two parts to answer the question as to why we have overseas GPs, including: - Increased workload, admin, targets etc. This may have strengthened incentives to leave UK General Practice, for some British doctors. A proportion of that workload may be down to "frequent fliers" (as distinct from the chronically ill) and patient population increase and age profile have also had a significant effect. - Lots more British GPs now work part-time than was the case in the past (you can earn enough to support a family without having to be full-time - I don't criticise this, but it must be an effect of relatively high pay). - Punitive taxation of income between £100 and £120K under our tax system (approx 62% if you include NI and personal allowance withdrawal, vs 42% for income under £100K or 47% on marginal income above £150K !); another incentive perhaps to work part-time. We can blame Brown/Darling for this crazy system, and Osborne for doing no more than tinker with it. - Even though not direct NHS public-sector employees, GPs have access to a state-backed DB pension scheme (Final Salary is a bit too simple to describe it) which led to the major pay rise of some years ago giving an instant boost to pensions, which apparently encouraged a fair bit of early-retirement.
That isn't how statistics works, but I suspect you know this. Precisely when a single radioactive atom will decay is unknowable, but put sufficient radioactive atoms together and the rate of decay can be predicted with a high level of certainty. It is all about probabilities. There will always be outlier events that any system will struggle to cope with. One example of how statistics is used within the NHS is to preposition ambulances at known accident hotspots under certain weather conditions, time of day etc. Defeatist tosh.
Which bit do you disagree with Loz; how statistics works or defeatist tosh ? I have replaced produced with predicted, which is what I meant to write.
Put sufficient local population and a sufficiently large hospital together, you will begin to be able to do the same. Say, several tens of billions of potential patients and several million doctors/nurses etc. Oh. Not very practical, is it. In any event, by saying that as a country, we need X amount of doctors for Y amount of cases, that include large incident spikes, you fall foul of granularity. Regional variations will occur, the country is not one homogenous "meta-hospital". Thus you have accepted the "effectiveness" argument. Fair enough LOL. "The War will be over soon, we'll be home by Christmas!".
So, Debenhams can predict, within 2%, how many red sweaters in Necombe High St they can sell, but the might of the Govt billions in data analytics cant work out we'll need 3 schools, 2 hospitals and a pear tree for a single partidge in Croydon? Efficiency and effectiveness go hand in hand. Depending on what efficiency is measured at....95% utilisation or 30%...
are we skirting around the issues here?whats pissing people off regarding the nhs.? the staff are possibly pissed of because they get pushed from piller to post while probably being forced to do a days graft for a days wage. is that a new thing for a council worker.? how dare i. people (customers) being unrealistic when it comes to services offered? possibly more to do with who is receiving treatment. that covers every one from turning up at A+E with a stubbed toe to migration issues. grannies left at hospitals because we wont do the work ourselves. on the whole i bet the nhs is doing ok. it's a massive organization with a lot of power mixed with politicians rubbing salt in to the wounds for a bit of point scoring.
Customers?! You mean pateints, the infirm, the ill. Theres fuck all in there to do with customers And there lays a large issue for both users, who think they are, and the reforming knobs who think thats what we want to be. I want a Dr when I feel ill. A hospital bed when I need it. Nurses who will take 'care' of me while I'm there. And no one kicking me out until I'm healed. I want to live in a carry on movie...
