NHS holds on to top spot in healthcare survey

I don't think anyone is saying we don't try and improve outcomes. It's also to put it in perspective that the UK is being compared to developed nations.

I disagree it makes everything else irrelevant.

It's worth going through the data below, the charts are interactive:

http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/

Populatiuon health is okay. The outcomes is a bit lower than other countries which are actually quite homogeneous for a lot of measures. Breast cancer reversal rate 81% in UK vs 85-89% for others. Colon cancer reversal rate of 56% vs 63-69% for others.

The UK has also seen the greatest improvement in improvement in mortality amenable to healthcare in the last 10 years. Although does still lag behind on strokes but not heart attacks.
 
Last edited:
RDM said:
Surely outcomes is one of the most important measures?
Click to expand...

Surely if 33% (US) of your population don't have access to cancer treatment that is also equally important (using cost related problems for access to medical care as proxy). Doesn't matter if your breast cancer survival rate is 89% vs the 81% in the UK.

Admittedly it isn't as high in European countries, but it is only 7% in the UK. Only 1% in UK had problems paying any medical bills, 4% in Germany and 23% in France.

We also pay less for healthcare than a lot of countries.

Its worth noting the UK does suffer on some of the Timeliness measures.
 
Last edited:
Well clearly that 20% is useless to the betterment of everyone else. Regardless if the NHS is going to go down the path it's on, the likelihood is that it wont be servicing anyone soon enough.

Are we just supposed to ignore depressed nurses and doctors, the quality of care can't possibly improve if everyone is overworked and underpaid.
 
StriderX said:
Well clearly that 20% is useless to the betterment of everyone else. Regardless if the NHS is going to go down the path it's on, the likelihood is that it wont be servicing anyone soon enough.

Are we just supposed to ignore depressed nurses and doctors, the quality of care can't possibly improve if everyone is overworked and underpaid.
Click to expand...

I'm not sure what you are getting at here. What do you propose? Which country's system of healthcare would you rather have. Do you think any are flawless?

Increase funding for the NHS? Sure I'd go with that, let's increase taxes.
 
muon said:
Surely if 33% (US) of your population don't have access to cancer treatment that is also equally important (using cost related problems for access to medical care as proxy). Doesn't matter if your breast cancer survival rate is 89% vs the 81% in the UK.

Admittedly it isn't as high in European countries, but it is only 7% in the UK. Only 1% in UK had problems paying any medical bills, 4% in Germany and 23% in France.

We also pay less for healthcare than a lot of countries.

Its worth noting the UK does suffer on some of the Timeliness measures.
Click to expand...

Outcomes are the key measure against which all other factors should be considered in a good statistical analysis, as outcomes are the key purpose of healthcare.

You should then start looking at both access factors and influencing factors to rank the systems accordingly.

Having a system that everyone can access but performs poorly doesn't result in better outcomes for the individual, just similarly poor ones.

You may be happy with mediocre but accessible, I would much prefer better outcomes with more accessibility limits, of there is no option to increase both outcomes and accessibility.
 
Cool, so reduce accessibility for a marginal increase in survival rates (assuming it is a trade off).

I most certainly wouldn't be okay with that.

I'm happy to increase outcomes via greater spending to avoid the rationing the NHS must ultimately do, by increasing mine and your taxes.
 
muon said:
Cool, so reduce accessibility for a marginal increase in survival rates (assuming it is a trade off).

I most certainly wouldn't be okay with that.

I'm happy to increase outcomes via greater spending to avoid the rationing the NHS must ultimately do, by increasing mine and your taxes.
Click to expand...

It must also spend the money better. We have a full experiment of pouring money into the NHS, but it didn't really produce a statistically significant increase in outcomes (outcomes did improve, but not over and above what was measured elsewhere without huge increases in money).

Perhaps the best solution would be to look at what better systems do and learn from them, rather than treating the NHS as a sacred cow.
 
Dolph said:
Perhaps the best solution would be to look at what better systems do and learn from them, rather than treating the NHS as a sacred cow.
Click to expand...

Who's treating the NHS as a sacred cow? People treat certain principles as immutable. The civil service would be happy to hear how you can improve the NHS (call it something else if you like) which satisfies those principles whilst also making outcomes better.

As for spending money better, it is already the most efficient provider in the developed world. That's an easy claim to make, "spend money better".

You should see how poorly private companies which are driven by profit can poorly spend money. Why do they not remedy it? It is easier said than done and there sometimes is no alternative or the alternative carries significant risk.
 
Well it has been falling since austerity kicked in. But Dolph is happy with that as you should be able to make the most efficient healthcare service in the world even more efficient (which true may be possible to an extent) but at some point you have to consider how much you are actually spending.

Interesting to see the regional split in that above link though.
 
muon said:
Who's treating the NHS as a sacred cow? People treat certain principles as immutable. The civil service would be happy to hear how you can improve the NHS (call it something else if you like) which satisfies those principles whilst also making outcomes better.

As for spending money better, it is already the most efficient provider in the developed world. That's an easy claim to make, "spend money better".
Click to expand...

Treating certain principles as immutable is treating it like a sacred cow. You have to be able to justify principles evidentially as being relevant and beneficial, not take them as absolute.

Also, the claim the NHS is the most efficient comes once again from the commonwealth trust, and once again ignores outcomes.

Here's a couple of links from opposite ends of the political spectrum that reach similar conclusions.

https://www.adamsmith.org/blog/healthcare/myth-busting-nhs-not-efficient-after-all/
https://www.sochealth.co.uk/2015/01/18/international-comparisons-say-nhs/
 
Minstadave said:
Are we pouring money into the NHS? Our spending per capita is substantially less than many European countries and our healthcare spending has been pretty static for 8 years, if not falling:

https://www.nuffieldtrust.org.uk/resource/nhs-in-numbers#finance

https://www.kingsfund.org.uk/blog/2...nding-compare-health-spending-internationally
Click to expand...

NHS spending doubled in real terms under labour, that was the experiment. If the problem was purely monetary, this should have resulted in substantial improvements above and beyond what was seen elsewhere, but it did not.

http://www.lse.ac.uk/website-archive/newsAndMedia/news/archives/2011/03/nhsreport.aspx
 
There were areas of substantial improvement:

"Waiting lists have halved and people wait less time for treatment. The 1.3 million people on NHS waiting lists in 1998 fell to under 600,000 in 2008. Median average waiting times for elective treatment (e.g. hip replacements, heart surgery) fell from 12.7 weeks in 2002 to 4.3 weeks in 2010. There is also evidence that, for example, stroke care improved between 2000 and 2009, with a 25% improvement in mortality rates following admission to hospital."

Now spending is flat, we're looking at scrapping the 4hr A&E wait along with the 18 week target. Back we go to the 90s.

Even with the rise in NHS spending under labour we're still sub many European countries.
 
Dolph said:
NHS spending doubled in real terms under labour, that was the experiment. If the problem was purely monetary, this should have resulted in substantial improvements above and beyond what was seen elsewhere, but it did not.

http://www.lse.ac.uk/website-archive/newsAndMedia/news/archives/2011/03/nhsreport.aspx
Click to expand...


This topic is far too complicated for a 2 sentence reply and a link to a very short article. You'll also note the per capita cost has not doubled. Next time you state this (and you say it a lot), please can you itemise what the NHS does differently now compared to 1997? Think about services that directly benefit healthcare (the use of radiography) and those that do not (IVF). The article states a lot of money went on pay rises, were these justified then? Should nurses and other NHS staff receive more pay now after 7 years of stagnation to pay bands? They also state more staff are employed. Nursing ratios have been introduced and boosted. What about back office? IT was much smaller then compared to now. Has patient record keeping improved in that time needing more admin staff? Where else has had an increase in staffing numbers. Are these justified to bring it to the level we expect in the 21st century?
 
Minstadave said:
There were areas of substantial improvement:

"Waiting lists have halved and people wait less time for treatment. The 1.3 million people on NHS waiting lists in 1998 fell to under 600,000 in 2008. Median average waiting times for elective treatment (e.g. hip replacements, heart surgery) fell from 12.7 weeks in 2002 to 4.3 weeks in 2010. There is also evidence that, for example, stroke care improved between 2000 and 2009, with a 25% improvement in mortality rates following admission to hospital."

Now spending is flat, we're looking at scrapping the 4hr A&E wait along with the 18 week target. Back we go to the 90s.

Even with the rise in NHS spending under labour we're still sub many European countries.
Click to expand...

How does that change in stroke mortality rate compare with other countries over the same period?

Does it follow the general trend of failure to do anything other than improve at the same rate as general mortality amenable to healthcare?

http://www.standard.co.uk/news/the-...ome-a-vast-bureaucratic-monolith-6669513.html
 
Trifid said:
This topic is far too complicated for a 2 sentence reply and a link to a very short article. You'll also note the per capita cost has not doubled. Next time you state this (and you say it a lot), please can you itemise what the NHS does differently now compared to 1997? Think about services that directly benefit healthcare (the use of radiography) and those that do not (IVF). The article states a lot of money went on pay rises, were these justified then? Should nurses and other NHS staff receive more pay now after 7 years of stagnation to pay bands? They also state more staff are employed. Nursing ratios have been introduced and boosted. What about back office? IT was much smaller then compared to now. Has patient record keeping improved in that time needing more admin staff? Where else has had an increase in staffing numbers. Are these justified to bring it to the level we expect in the 21st century?
Click to expand...

The details are not really that relevant, unless you are trying to justify poor outcomes. Outcomes should be the focus of everything that is done.

There are two key questions that should be considered separately.
1) would we benefit from spending more money on healthcare?
2) would we benefit from spending more money on the NHS?

I do believe we could benefit from spending more money on healthcare overall. What I don't believe, based on what happened when we did it before, is that we would benefit by simply throwing money at the NHS.

Reforming the NHS would allow us to spend more on healthcare and improve outcomes, simply spending more on the NHS as is will not.
 
[/quote]
Dolph said:
NHS spending doubled in real terms under labour, that was the experiment. If the problem was purely monetary, this should have resulted in substantial improvements above and beyond what was seen elsewhere, but it did not.

http://www.lse.ac.uk/website-archive/newsAndMedia/news/archives/2011/03/nhsreport.aspx
Click to expand...

Whilst it is fair to point that out. Healthcare spending has increased significantly across the developed world.

Two reasons:

- Healthcare inflation has been significant across the world because of a greater number of treatments and expensive treatments.
- Life expectancy combined with increased mortality means greater spending per capita is required over time.

Evidence of this is in charts below although they are intended for a different purpose.

In your own link you will see that waiting times improved significantly, which is something people care about even if for most things (e.g. not cancer etc.) it has no beneficial outcome as far as things like life expectancy and mortality is concerned. You do that through having a lot more staff.

In you previous Adam Smith Institute link, I do not disagree that the definition of efficiency should look at outcomes. Ultimately spending half the amount to get outcomes which are 20% worse may not be an acceptable trade-off, but they don't provide any clear argument to come to the conclusion that the NHS isn't getting value for money.

Accessibility also matters though as you can't ignore the outcomes of people who don't get the benefit of the better healthcare you want.

THe OECD have published a paper which the institute have effectively quoted a single paragraph out of.

http://www.oecd.org/eco/growth/46508904.pdf

The conclusions of efficiency they come up with can be summarised by the following charts:

1z1tjdk.jpg


Above the line you are more efficient on a life expectancy basis and below the line you are less efficient.

Note they use PPP $.

Note that the line is very shallow because life expectancy is actually quite homogeneous across countries. Anyway, they use this data to create an efficient frontier to look at holding spending constant (in PPP $), what improvements in life expectancy are feasible (their model tries to control for lifestyle factors).

This where where the leap of logic occurs. The OECD look at the improvement from 1997 to 2007 that occurred as a result of increased spending in your country (average of ~50% looking at the chart and I'd argue causally weak) and then estimate what the equivalent benefit is from hitting the efficient frontier (is it the correct frontier?). Then you can monetise that suppose efficiency gain. This approach says even Japan can make reasonable efficiency gains.

Nice analysis but I fundamentally disagree with the approach. PPP $ I don't think fairly reflects spending and secondly life expectancy is just too homogeneous to be a reasonable response variable to use.

2uo5mjq.jpg
 
Last edited:
sure the nhs might have its problems, but considering what it has to deal with it's amazing how good it really is.

for sure there's issues in the higher levels of the organisation, and there's issues with waiting times in a&e if you're only there because little johnny's got the sniffles, but for people in genuine need for healthcare the nhs does the job.

i think people are confusing the idea that because you can go to the doctor any time for any reason and get free prescriptions, doesn't mean that you should in all cases.

the problem lies in that wether it's managerial inadequacy or a downright lack of funding, they have to focus on a scale of needs, this is why for example the coverage of mental health is so poor by comparison to the rest.
 
You must log in or register to reply here.
Back
Top Bottom