Labour commits to Trident carrying nuclear submarines

Sorry mate there is zero chance of going to a common NHS computer system…the NHS is not an organisation it’s a brand label for a system..that is made of many tens of thousands of different organisations, some public but around 30,000 being private businesses…each of those organisations have different IT requirements, by law have to have their own IT system and be responsible for their own IT system…take it from an expert it is functionally impossible to create a single NHS system….we once tried to make a single patient record that 40-50,000 NHS companies and organisations could access and share…the government gave a number of the largest IT providers in the world 13-20 Billion pounds to do it…after a decade of trying everyone of them failed.

In this case I will use a quote from the Conservative Party

The Conservative shadow health minister Stephen O’Brien said the government’s attempts to “ram through a top-down, centralised, one-size-fits-all central NHS computer system” had come “crashing down around their ears”.

The companies that utterly failed to achieve a single NHS computer system include:

Accenture ( a 70billion Fortune 500 tec company)
CSC (what was the 8th biggest IT provider in the world)
fujitsu
BT

It is an utterly impossible task because contrary to what everyone in this county thinks the NHS is not some monolithic public sector provider is 40,000ish businesses ( some private sector, some charity and some public owned) that all have a contract to provide services and the legal right to use a government owned copyrighted logo “NHS”.

You wrote the same, 5 years back??

Is that now part of the problem?

(Thanks for repeating what you wrote earlier – impossible to find the quote – BUT, common ID from Birth, and thus it begins)

Thank you Jonathan.

I will look out for that one, but if a Labour government try to take that forward they are going to piss away billions…that will never recoup the investment….on the last go the ONS made it clear that in the end it was going to cost far more than it would ever recoup through clinical efficiencies. I don’t believe there is any nation that has done this for that very reason…

to be honest it’s worth the effort to get a single system to have access to a single record..and all systems have already done this…our NHS is divided up into systems that look after a distinct population of between .5 to around 1.5 million..this works really well as most of the population use healthcare within a specific system ( we don’t generally travel across the county to get healthcare, unless it’s very specialist in a tertiary centre)

each system will be made of a commissioner ( the NHS organisation that is given the systems allotment of cash..around £2000 per person per year..the commissioner then decides how much and what type of healthcare it can afford to buy for the population to do the most good based around its specific needs..and contracts out the required activity ( buys it) from the local provider market..usually a couple of hospital trusts, a community provider, ambulance trust ( all businesses owned by the public) then it will also have contracts with few hundred private companies and contractors….whichever national level out of hour and 111 company you have contracts with, one or two companies that providers patient transport, 50-100 gp practices, 100-200 pharmacies 100 or so dental practice practices and a few hundred care homes and dom care providers…this generally county or city level system ( eco system of providers) can generally work together to get its IT systems talking to each other…it’s possible for 500 odd business and organisations to get some harmony of IT systems and compatibility as well as getting all the information governance sharing agreements between the companies so they don’t get fines for breaking the law( for sharing without adequate contracts and information sharing agreements or good IG agreements…Each NHS organisation can be fined 2% of its operational budget if it gets it wrong and is prosecuted by the ICO ( I’ve know hospitals in systems I have worked in fined millions of pounds for something a private contractor did or did not do that they had a contract with).

So doing that at the local level with half a million to am million people and 500ish organisations…you can get some connectivity and sharing….70 million people and tens of thousands of organisations and businesses….that’s just pissing 10s of billions up the wall…

Spoilsport Jonathan!

And yet, Amazon can generate account numbers but subcontract ‘delivery.’

The Army had 155,000 personnel and… ‘managed’

The NHS needs to be sorted from the ground up, one unique number for each new born, and move on from there.

As we have regiments, I see the different Departments in the same way and the RLC for ambulances; stupid? Naivety? I can see the ambulance trusts in the same way.

What I can’t see is the huge and increasing costs of the ‘N’HS being sustainable.

Hi DB I will try to unpack those things for you to try and give some context

first the Amazon thing…so world wide Amazon generate 1.6million parcels per day..each essentially requires a name and address as records..they don’t need to share the record in any complex way…and don’t need to store that record beyond a few months or link it in any complex way with any other record..

The NHS on the other hand sees 1.6 million patients per day..now each of these contacts will generate a complex record that at its most basic would run to a couple of pages of heathcare date for a GP visit..to a hospital stay that could generate a whole book of highly complex clinical inform generates by 30-40 healthcare professionals ( running to hundreds of pages)..that set of data will need to be tied to all the other data generated by that patient and update key things..it will need to be shared with maybe 30-50 other organisations and companies but only specific bits can be legally shared ( you cannot just share the whole record, you have to have a specific reason for sharing each and every bit….if you share a bit without a specific reason you have broken the law)…this data will be matched with all the other sets of data and information and kept for decades..with different bits of data have specific laws on how long you have to keep it and how it can be stored…remembering in a persons life they will literally generate many thousands of records each that need to be tied up together and if shared with another company or business in the NHS reviewed for legality of sharing…some people will have records that could fill a shower room…in one of my roles I had to gather and share patient records…sometimes I had to go through hard copies that needed a forklift to move around would take me weeks to check to ensure it was all safe and legal to share…( that’s not the NHS being beurocratic, that’s the law of the land)…so essentially managing records in the NHS involves many thousands of times the data that Amazon will ever collect, which is thousands of times more complex and if it’s processed wrongly can kill people ( yes I have investigated cases where incorrect data management has killed people)….that data needs to be tied in and is essentially a serial record with many thousands of entries over what could be 100 years..provide by many different companies over the lifetime of that person and involve a small roomful of data per person that if not accurate could cause a death….essentially Amazon and every logistics companies records in the world put together is child’s play compared to NHS data and records requirement….let’s put it this way the data and records that the NHS collects each year is so complex and large that if it pulled it together and sold on the open market each years data and records would have a value of around 10 billion pounds…that’s how complex and how much data it has to hold and collect in its 40,000 different companies IT systems.

around the whole one number thing…I will tell you a secret…there alreay is one and every person that has had contact with the NHS ( and when you are born you have contact) has a single unique NHS number…you have one I have one we all have one…also you basic demographic data is on the nhs spine that every nhs organisation has access to ( Your name, age, data of birth, address, any recorded allergic reactions)…basic demographics is piss easy….we have more and better organised demographics for our population than any other organisation on the planet…I bet the police don’t know were you live…the NHS does. It’s the clinical information that is impossibly complex to manage across 40k organisations for 70 million people over their entire lifetime.

As for regiments and the structure of the army…the army is a single organisation legally speaking..it’s regiments are simply parts of that organisation…there is simply no such organisation as the NHS…it’s a national lie it does not exist. If we take an ambulance trust..an Ambulance trust is a singular organisation..it’s owned by the public and can put the NHS log on its signs because it has contracts with a number of NHS systems to provide ambulance services…so say you have south east ambulance service..it’s a publicly owned company that will hold and bid for contracts to provide ambulance services to a number of different NHS systems..these contracts will say how many and what type of activity will be expected of it ( how many cat 1-2-3 calls ect that specific system will expect it to answer..what benchmarks around delivery how much it will get paid for that activity..what happens if there are more calls than expected..less calls or it fails it’s benchmarking…it can loss that contract and if it so wishes a system ( so a county ) could offer that contact to another ambulance provider…

so in reality is the NHS is not a large public sector organisation like the army or navy…it’s a set of systems more like our food supply system..made of lots of farmers, food producers, logistics companies, warehouse, small shops and supermarkets…but healthcare systems are profoundly more complex than any othe systems and the most complex systems ever created by humanity and our food distribution systems are profoundly simple compared to healthcare systems..

re cost..I’m afraid the debate around healthcare costs in this country is essentially a standing joke across the rest of the western world ( I talk to a lot of international leaders in healthcare)…the Uk PLC has essentially been ripping off and steeling from its heathcare providers for years…we pay vastly less for our healthcare than any comparable nation…I will give a few examples.

the UK pays its healthcare system around £3000 per year per person..this is essentially the public shoplifting healthcare…the British public are essentially walking into a supermarket..filling their trollies full of £100 of food at cost price and essentially saying they will only pay £75 and walking out the store..then after all doing that for 75 years wondering why the store is now closed..

basic economics of healthcare costs…if you went to a private hospital in the Uk and paid for a knee replacement it would cost you around £16,000-18,000 pounds..the British public pay the NHS £4500 pounds per knee replacement the US public and government will pay a U.S. hospital £25,000 for the same surgery…the reality is it actually costs around £6000-8000 to do a knee replacement in the Uk and every time an NHS contracted hospital does one it’s in the red for around £1500…that’s why it will take you about 4 years to get a knee replacement on the NHS…the NHS system cannot afford to do the surgery on what it’s paid so it manages demand…what happens is the system finds the money lost in other ways…not recruiting staff..not repairing buildings…not treating other people..

so national healthcare costs…the UK pays £3000 pounds per person Germany pays around £5000 per person…which actually represents the true cost of a health system in Europe ( Germany has the same sort of costs as we do..for staff,drugs and equipment)…the difference is in the UK the government decide how much the NHS gets per person from general tax and in Germany it’s the Healthcare system that’s decides how much Germany will have to pay per person for healthcare via a mandatory heath insurance policy.

The U.S. system is even better they have a full market driven system…the beauty of a market driven health system is that it can charge what the hell it wants…after all if you don’t pay up you die…or suffer hideous pain and disability….Market for ces in healthcare are great…as a health system/ health care provider we to take everything you own and you will be great full …so in the US the county and citizens pay around £15,000 per year for healthcare each…just over half of that’s is payed by the state from tax ( it supports old, young and vets from that money ) and the other half is paid by the public generally an average family will have an insurance of £7000 per person and the if they are sick they will need to pay co-payments on top..

so if we reform the NHS to a German social security system we can expect our heathcare cost to go from 190billion to around 270billion ( although Germany actually pays 470billion euros vs our £190billion).

If we went all in with a private market driven health system like the US we would looking for around a cool trillion pounds mark…the US pays its healthcare system a funky 4.4 trillion dollars a year…

or we go with a Spanish system…which actually costs less than the UK system at around £2500 per person per year…but that Spanish system simply does not provide the same healthcare as the UK…Spanish hospitals don’t provide nursing care…if you want your loved one washed, feed, dressed or got out of bed…If you are sick in a Spanish hospital it expected that relatives will stay with and care for the patient 24/7..this is because every nurse in a Spanish hospital will be looking after 12-13 patients and they don’t ache care assistance..in a UK hospitals you will have a nurse for every 8 patients as well as a supporting care assistant…bizzarly the more expensive German system actually has a worse nurse to patient ratio than NHS hospitals at 10 patients per nurse….( but Germany has about twice as many hospital beds per 1000 patients than the NHS so their patients tent to be less sick..we have so few beds hat every bed is taken up by an acutely I’ll person..in Germany you get to rest and recuperative in a hospital bed after the acute phase)…

So all in all the NHS is cheap as chips..if you want a good social Austen like Germany we need to give the NHS 40% more..if we went to a private sayten like the US we would be paying 500% more….

You are not describing a uniquely complex problem for a computer system to manage, and you are also misrepresenting Amazon. They may not strictly need to do anything other than correctly store a user’s credentials and basic address information, but they actually devote a lot of resource to building alarmingly detailed profiles of their millions of customers despite the added hardship of having to harvest the data indirectly.

Agreed, and I say that as someone who also works in IT and also worked for 2 of the IT companies you listed, BT and Accenture.

We have similar problems in defence digital services, with the added complication of security classifications on top of the usual data protection issues. We nonetheless achieve much better interconnectedness and smoother data flows than the NHS does, particularly since we started accepting cloud-hosted systems that only need a modern browser to access them. It is not as difficult as you are suggesting if you take a rational approach to designing the system.

But the issue is that your not 40,000 different companies all with their own it systems. If you had contracts with 40,000 companies and had to get them to change up their IT systems to all use the same cloud hosted service..how long would it take you and how much money would it cost…considering many of the records you would have to put on the cloud will date back to the 1930s and be stuffed in warehouses full of boxes or if your lucky on microfiche and all be completely different formate from each other…each of which need very specific permissions….take it from me the best IT minds on the planet had a decade and well over 12billion pounds to sort this and they failed…it was not the NHS that said it could not be done, it was not the NHS that could not do it, it was the biggest players in the IT industry…health records are a killer.

“Crackdown on gender transition etc, being paid for by the NHS”

Did you honestly just recommend cutting people off from healthcare to save money?

True. Using Sunak mathematics, the pace at which it will arrive, all backloaded, requires only about £9bn extra to be found over the next five years to take us to April 2029 and to 2.44% of a by then £3.2tr economy. Then there’ll be another election.

If UK is spending 2.3% GDP already then it has not much to show for it.

We include extras in the budget like the servicemen’s pension and the nuclear deterrent. Both should be totally excluded from the calculation.

The pension should be covered under Welfare/Benefits.

The nuclear deterrent should be considered a national insurance policy and, thus, completely separate from any other budget grouping.

Just wondering – and to take just one example – do ex-teachers pensions come out of the Education budget or from some random Welfare/Benefits budget?

The Education budget does not concern me. This is a defence news platform.

In this discussion, I consider it totally irrelevant.

You don’t get my point – I was using a simile. If all public sector workers have their pensions paid from relevant Departmental budgets, then it is surely not wrong or strange for military veterans to have pensions met from the Defence budget.

Again, government budget calculations outside of defence really don’t concern me. I understand where you are coming from, but they don’t matter to my issue.

Including pension costs in our supposed NATO “contribution” buffs the value without providing any additional capability or strength, and it is totally misleading. The 2% minimum expectation should be costs directly associated with the defence of the nation and our NATO partners, not former servicemen and unrelated costs.

Whether it is strange is immaterial – “this is the way we’ve always done it” is not an excuse when it comes to our obligations and our capabilities.

It comes out of the education budget and the present teachers pay..the employing school pays 23% of the wage to the pension scheme and the teachers pays around 8-11% of their pay..

the NHS pension uses the same principle…although the nhs employer pays slightly less 20% and the employee pays a bit more ( up to 14%). The NHS pension scheme also only costs about 90% of what it charges the employer and staff..so 10% tGets paid to the treasury at the end of the year to go into general taxation..( essentially you could say nhs staff pay an extra 10% income tax for the pleasure of the pension..or NHS providers paying twice what it should so the treasury can take a 10% NHS pension tax off the providers) the state pays around 40% of the cost of the NHS pension and the staff pay around 60%)….

basically the staff and employing organisations pay for both NHS and education pensions.

Thanks Jonathan, so it is logical (from HMG point of view) that veterans pensions come out of the defence budget, even if that is not what many people want to hear.

Indeed, essentially pretty much every public and private sector organisation are responsible for paying for their own occupational pension schemes if they offer them…the army, navy and airforce should be no different….the only big difference between the forces pensions any say the NHS or teachers pension is that there is no individual contribution.

Yes. I am sure you are aware that the non-contributory nature of a service pension is deemed to be a significant perk and it is considered by the Armed Forces Pay Review Body when assessing the annual pay award for serving personnel ergo the pay is reduced accordingly below civilian comparators, which is one reason that service personnel quite understandably consider that they are underpaid.

Thus that non-contributory pension does not end up by being much of a perk in reality. When I was a serving Major responsible for 120 soldiers I was paid less than a train driver or experienced plumber and had to buy a more modest house than I would have wished – far more importantly, there were some junior soldiers with a family who were on supplementary State benefits. I recall that it was a point often made that Privates risking life and limb on operations were paid far less than newly trained police officers.

I know that most service folk grumble about pay today, as evidenced in the annual Continuous Attitude Survey.

Indeed, to be honest it’s not really fair, yes for instance I have 12.5% removed from my salary for my pension..but I do get to choose to be a member or not. So I have colleagues who stepped out of the pension when they needed their full salary to live.

wages wise, unfortunately even when there is wage competition the government purposefully subdue public sector wages ( I’m sure they use it as a way to manage inflation)…like you when I was more senior I ran a large team with life and death as an outcome and for that got 40k…interestingly as a comparison of wages…when I was very young I sold kitchens earning 16k a year ..then I joined the NHS went of and trained for 3 years to qualify as a nurse..earning £1800 a year working on wards as a student..then after 3 years qualified and got a job in an ED as a staff nurse..earning the grand total of £11,500 a year…at that point my old sales colleagues were all on £18,000….( how we laughed at the fact I had worked hard as a student nurse got a degree, now worked in ED, was saving lives, dealing with horror every day, got assaulted on a regular basis and was earning 60% of someone sitting in a showroom selling kitchens).

As I intimated, a problem with military salaries being suppressed because we had a non-contrib pension and because HMG could suppress the pay award as an anti-inflation measure is that you were only offered a lower amount of mortgage.

Yes that’s a really good point around mortgages…when I and my NHS colleagues apply for mortgages our full pay is used..even though we then loss that 10-12% for pension…you guys never had it on your gross pay…

Seem to me that they maybe need to think about paying forces Staff the full wage and then allowing them to enter the pension scheme and taking the deduction…would give them better mortgage options..and if they are in need of the money drop out of the scheme for a bit….war pensions and pension for those wounded should really be completely separate anyways..

So the 2.3% are not really 2,3% which explain the ever reduced army, RAF, RN.

I wonder how many Tempest UK will have, it is reportedly a large aircraft with 2 engines, and for that matter Italians and Japan.

The 2.3% is clever mythology (to be fair to us, a lot of countries play the same game), hence I think it is completely misleading to claim that we are spending a lot on defence.

A former serviceman living on his pension is not defending the nation any more and, therefore, should not be calculated as part of the defence budget.

Take it up literally with Nato.

https://www.nato.int/cps/en/natohq/topics_49198.htm

100% agree the Nuc Deterrent and Pensions should both be separate. Actually funds are paid into the pension fund so were does that go? Pensions already paid for and therefore are separate to the MOD Budget. Fudged figures as always and of course that £22k!for that new toilet seat etc etc. We should have top kit and the right amount, but we don’t. We get our crappy low quality uniforms from China and they are certainly not fit for purpose but some idiot ordered them just the same and that is but one factor.
Note the RM’s do not either use the kit of the Army or the weapons as they go kit that is durable and works.

I recall that years ago we got some clothing from China – I think it might have been DPM pattern waterproof jackets and trousers. China still supplying uniforms? Crikey!

Hi Angus,
Pension fund? You think that MoD works the same way as everyone else. I very much doubt that MoD operate a pension fund in the same way as private companies do. They will have a sub-Vote for pensions but that’s for billing attribution, so is a very different thing to a company pension fund.

Certainly Equiniti are contracted to do the admin and pay the pensions out (including mine), but that doesn’t mean they control a pension fund.

What funds are paid into this pension fund? Service personnel (if they qualify) have a non-contributory pension – service pay is set (low) to reflect and offset the ‘pension perk’!

MoD does things very differently – for instance I don’t believe anything is insured for fire, theft, damage – if a barracks burns down then the rebuild cost and cost of replacing written off kit comes out of the Defence vote. MoD could not afford conventional insurance premiums.

Nato defence spending includes the spending on pensions etc. From Nato and how it’s calculated.

“Retirement pensions made directly by the government to retired military and civilian employees of military departments and for active personnel is included in the NATO defence expenditure definition.”

https://www.nato.int/cps/en/natohq/topics_49198.htm

I don’t particularly care that it’s part of the NATO definition, it’s a fundamentally flawed way of calculating it.

It is not productive investment in our armed forces and everyone should recalculate it with that nonsense excluded. No pensioner will be deployed on PoW, no pensioner will be doing exercises in Bahrain, no pensioner will be doing training in Kenya. Hence, it should be completely ignored.

The point is if we’d choose labour Starmer would have made the same choices. In fact, with JC at the helm, it nay have been even worse. I’ll take the insult as a complement.

I think you were right. this site is riddled with people who should as m.p in their areas , they are self appointed idiots.this not a political site and some rabid anti Tories should remember it😡😞

labour performance in opposition was dire.how would the likes of boy band millibandand and Corbyn fare? the Tories kept winning elections because there was no alternatives.

So your suggesting if we had 10% vacant capacity which Labour would have built in preparation for a pandemic lockdowns on the kevel we had could have been avoided?

Sorry but I refuse to believe Labour would have built a 10% buffer, that would mean 10% extra spend YoY just in case. That’s what 14b just incase money approximately 30% of the defence budget.

Everyone knew a pandemic will hit but when is the question 1 year 10 years 100 years. Spending 14b and climbing just in case for any period of time is big commitment. We’d be better off looking at why our health service is so stretched, the reality is we have first world problems like obesity and a political system that has gradually revoked personal responsibility. It seems im in the minority that believes im responsible for my own wellbeing and its not ok to be overweight.

Switch our migration system to encourage high net worth individuals who tend not to use the NHS but pay millions in tax. This could give a huge boost to.public finances with nearly zero need to provide additional public services for these individuals.

I refuse to believe Labour would have shortened lockdowns even with hospital capacity there was a massive unknown if someone caught covid to what level they would be effected. So a huge risk to say hospitalisation could adequately deal with the disease. Especially in the early days when little was know of the disease.

Italian research showed population density played a huge part in transmission, London had a very high population density during the day with a commuting population bigger than the Aukland. So surely a better way to tackle pandemics is lower population density. Surely better to tackle how it may spread rather the spending billions of just in case money.

And on the debt Labour called for more money to be handed out so even with shorter lockdowns, it doesn’t mean less debt.

I don’t see that 14 years of Labour would have made the country any better off. Ive watched on several news channels Labour MPs saying Labour changed and is now fiscally responsible so essentially confession that had they won before they would not have had the same kevel of control.

Evidence us heavily stacked against Labour being any better than the Tories maybe on par at best,but there own confessions that they’ve changed are very telling about the party we could have elected. The public aren’t fools with most just wanting a change rather than a Labour government, it’s another least worse option election. Which is very sad tbh.

Hi expat, it’s a little known fact that almost the most effective western healthcare systems work with around at least a 10% buffer on hospital beds…you should never really go above 90% occupancy rate in a hospital..it’s sort of managing a healthcare system 101. If you do go above 90% you end up harming people because..you will be putting surgical patients in medical wards..and medical patients in surgical wards etc…it would essentially be like the navy under crewing with engineers and sending some of the bridge crew down to the machine space and getting them to run it.

Essentially all health systems that are not planning on a lot of unnecessary deaths aim for their hospitals to never go above 90%…so the average occupancy is well below that.

look at any other healthcare system…German hospitals just before the pandemic hit had a 69% occupancy rate..because almost all well run systems only ever surge up to 90% of their bed capacity even in the hight of a bad flu winter…so Germany has around 650,000 hospital beds…and on average it has 30% spare capacity…or 200,000 empty bed at anyone time…more in summer less in winter..the NHS England runs an average of 96.7% with hospitals in winter effectively having to run at at up to 110% in the worst winters ( people on corridors and makeshift wards)..this is because the NHS England is now working with an acute and general hospital bed base of around 97,000 for the 55 million residents of England..compared to the 650,000 beds for 83million in Germany)…yes Germany has around 650% more hospital bed than England.

As for where we were…before 2010/11 it was an average of 85%…bed occupancy in England so way away from what was good but even in winter hospitals stayed within their bed capacity and did not need to turn random rooms into makeshift wards or use theatre recovery spaces.

so the context of the nhs England bed numbers..in 2010 we had 180,000 by the early 2020s we had 95,000…when I started my career we had a bed base of 250,000… in reality we got to 180,000 by being just about the most innovative healthcare system in the western world ( the NHS wrote the book on how to manage without beds)..and 180,000 was a manageable stretch without becoming unsafe in a bad flu year…

Now we go onto staff…first the German health system they have:
421,000 doctors or 4.5 per 1000 people ( that’s not the highest density..many EU nations have 5-6 DR per 1000 people)
1.1million registered nurses or around 14.5 per 1000 people)

total healthcare workforce 5.5 million

now we look at NHs England around 2022

130,000 doctors or 2.9 per person
300,000 registered nurses 7.7 per 1000 people

total healthcare workforce 1.5 million.

As I noted demographics and geography did make a difference in R0..very rural low density counties with healthy populations had a lower R0..but that does not remove the fact that of all western health systems the NHS is profoundly precarious….simply we refuse to pay what a decent robust system costs…Germany pays £5000 per person we pay £3000)…Germany spends 400billion pounds for 85 million people in a generally healthy population we spend 150 billion pounds for 55 million people who are one of the most unhealthy population that are addicted to things that give them long term conditions.

Simply our health system is no so fragile without the lock downs our system would have collapsed if we had not locked down…and I can assure you it would have killed huge numbers of people. We would always have needed to lock down due to our population density and the maths of the R0 but if the NHS had the correct level of bed capacity and the same staffing as most other European nations it would have been a shorter lock down…and it could have been managed by fire breaks.

In reality you cannot have endemically underpaid a system for 70 odd years to the tune of many many hundreds of billions of pounds and expect it to function properly…it’s insanity… if we told Tesco how much we were paying for each shopping trolly of food..no matter it actually cost more for Tesco to buy it than we paid..Tesco would soon go out of the food providing business…that’s what we have done with the NHS…

The big difference between the NHS and German health system is that the German health system sets how much it gets paid from the working German population in a direct tax that it sets…the NHS gets told by the treasury how much it can have….

Took me a while to get back to this
So Germany pays 66% more per head but gets way more than 66% more beds!! It also get more than double number of nurses. Even If we increase our taxation to accommodate 5000 per head it looks like we won’t get the same service as the average German from your numbers. One finer point is of course raising taxes will mean actually the top 10% who pay over 60% of tax will be paying huge sums for health. Because Germany pay via insurance which whilst linked to income it’s capped it’s a more level system unlike ours where the bulk of the cost is born by a quite a small % of the population. A huge and growing number of people in the UK actually have no skin in the game when it comes to cost if their health.
German health care was originally private health care which has been made mandatory so it’s roots are very different to the UK.

Hi expat. The Germans have around 33% more drs per 1000 people…for 40% more…around the beds it’s a bit distorted as 30% of the German beds are always empty..were as every NHS bed is always hot with a very sick person in it.. So each German bed is cheaper than each NHS bed..a bed with empty air or someone recovering and resting costs a lot less than a bed with a very sick person in it.

The NHS was built from exactly the same private care system as the German system was…and as I said 90% of all NHS organisations are still privately owned.

the UK just has to get over itself it’s simple statistical truth for the last 75 years we have paid 20-40% less every year than comparable European systems…if we decided to pay Tesco 20-40% less for our food for 75 years what would have happened to Tesco…this underpayment, which equates to many many 100s of billions of pounds has lead to a national healthcare debt that needs paying and that debt is: £11 billion pounds backlog in repairs to present building..the need build a load of new estate ( 20billion ish), around 200,000 healthcare professionals that need to be trained, 7.7 million waiting list, a very sick population due to poor primary care and lack of upstream care that will take a generation to shake out.

Im all in for going to a French or german system..but if anyone thinks you can have a French or German system without paying the same costs ( £3700 to £5000 per person ) and also gradually paying the health debt from that 75 years of massive underpayment they are delusional. personally I think the UK will live in its dream world that you can spend £3000 per person on healthcare until the system collapses and the only recourse will be to go to a fully market lead system ( as it will be the only way to get the investment levels needed to rebuild ) and a market forces driven system will cost each family around £20,000 a year.

Underpayment us exactly why we should switch to a similar insurance based scheme to Germany. When bury the cost and lump it in with other government spend which it needs to fight for of course you won’t get what’s needed. It’s predicted to collapse anyway it’s just when.

My experience of day to day health insurance is much lower, in the low hundreds per month. And while if you get a chronic condition you may loose you house odds on within the next 10 years the government will be helping themselves to a high % of it anyway.

The point about the beds still doesn’t make sense to me. If there cheaper because they’re constantly empty then why have them at all or at least that volume. And whilst they have so many extra beds the would surely struggle to staff them if they filled them. And yes there cheaper but a hospital bed isn’t cheap, you have gas systems, to up keep as well as keeping any mothballed wards it fut condition should they need to be used.

I have actually been to hospital this morning, yes i wrote my previous comments while sat for 2 hours in an NHS waiting room for a routine appointment. Over tge past couple of months I been going in regularly. Couple if things struck me. 1st was I was given a bag of stuff to do treatment at home. I was given more each visit Even after the treatment finished I still have too much stuff that they won’t accept back. I even did a stock take for them and put a list together of what I needed to complete the treatment, but still, I was handed bags of stuff. Using your Tesco example its like giving away free food. This is not isolated when my father died we had to dispose of a wardrobe full of stuff oversupplied by the health service. I was also given meds which had short shelf life on 2 occasions they gave me meds for 4 days that expired within 3 so one went in the bin. These are made up meds in solution. On another occasion they didn’t have the meds ready so had to taxi them to me later.

I will say the staff and nurses were excellent and friendly but as a process person I could see there’s scope for improvement

What I also noticed is the number of younger people who are unwell, chatting to a couple of them one chap had his leg amputated due to the diabetes, another chap in his early 40s had had a stroke again due over indulging.

The other thing is the testing on the NHS is strung out you gave to go back several times which means a massive admin overhead. I’ve had private treatment where all the tests are done in one visit production line like then straight into see the consultant. OK so the consultant could have concluded from one test what’s needed but if not he gas the results for the following tests as well. No need to book the consultant again and no need to consume admin time booking in for 4 other tests.

I know people don’t like using production line and patient in the same sentence but why not if the end result is faster cost effective treatment. Perhaps the health service needs a bit of Poka Yoka, genchi genbutsu, mudi muri mura, genba erc

Indeed; just us and the US. I think the French refer to it as the Anglo- Saxon agony. Maybe the WASP agony would be a better name. Not that France is a paragon of virtue 🙂

Hi Alex, the BoE is of course independent of HMG in pulling the lever of monetary policy ie setting BoE base interest rate which knocks onto the mortgage rate. But mortgage interest rate is of course only part of the story. A buyer has to be able to both put up a deposit and then afford the repayments long-term – where the US went wrong was in lenders offering sub-prime mortgages to people who had no real ability to meet the payments long-term.
Our lenders were somewhat more repsponsible than UKLS lenders particularly after self-certified mortgages were dropped.

I am sure that other factors are at play in dramatic house price rises than low interest rates. The law of supply and demand also figures – far too few houses being built for market needs. Scarce housing is expensive housing.

BoE is part of same political culture that is enforced by the media – media which are who legitimates from political disgrace to political violence- BoE know very well to not be the enemy of the people more than they are already are. Which in this case was the Gov and political class wanting lots of taxes being paid, the banks(same culture of BoE) wanting to make lots of business and the common people wanting low rates – No BoE independence would survive if they are going against that coalition, so to preserve their status, lets say benevolently they were flexible…
Where US, UK and everyone went wrong is that the dose was too much, a big part of the growth was artificial because there was no wealth being printed that could paid by production. This did not only affected the real estate market but also all those derivatives made adjacent to it and lots of business and banks dependent on return from real estate market.

Lots of constructions companies went down, In my country – Portugal- large swaths of buildings were not finished. Only now almost 20 years later we are seeing a picking up of those, but not even for all abandoned sites. I would say 60-70% are now being finished.

Hi, I didn’t know Government meddled in this, setting lending ratios for mortgages – thought that was the business of lenders who had to bear the risk.
Not sure – you may be right.

I think that ‘supply and demand’ has got a lot to answer for. Demand for houses went up and supply did not ever keep pace.

The financial melt down of 2007-2009 was of course a global thing and largely intitiated by the US and the awful sub-prime mortgage business executed by their mortgage providers.
Later stuff – definitely the fault of our Government.

Demand for houses went up and supply did not ever keep pace.

Thankfully, if it keep pace the disaster would have been bigger.

Yes and we have been stagnated ever since.
There are more aspects to it like a negative culture evolution but essentially everyone from people to companies expect the state to give and pay them jobs and works. We have several highways where in middle of the day you see barely a car for km’s.

GDP seems to have have trebled until 2009 when you have had almost a lost decade unto now.Life expectancy is nearly 83 years as well. not all bad

Interesting point. What would wake up the political classes?

Perhaps one of the following:
-Loss of a RN warship with loss of life, to Houthi fire.
-Use of tactical nukes or other WMD by Russia in Ukraine.
-Total defeat of Ukraine by Russia.
-Any proof that Iran is embarked on producing nuclear weapons.
-Detection of preparations by China to invade Taiwan imminently.
-Serious efforts by Argentina to re-build their armed forces, beyond the F-16 purchase, to enable expeditionary operations.
-Russian machinations to invade another European country, whether they be a NATO member or not.
-Very low RN fleet availability and inability to meet standing tasks.
-Penetration of UK airspace by a Russian strategic bomber.
-Mass exodus from the army leaving it just 60,000-70,000 strong.

Hopefully of course none of the above will happen……

It was the same crap as Covid, very dangerous , terrible, Suddenly George Floyd occurs and could be useful to push Trump out so public protests are okay…

Nero looking after London burning?