So reading that am i right to believe that the system is not “free” but rather based on the user taking out insurance? and the care received is determined by the insurance policy in place?

You think the NHS is free? No isnt an insurance system, you pay into your own fund and then you pay for your own treatment out of the fund, topped up by the government for those on low pay. The point isnt the method of funding per say, its the fact that the providers of healthcare are a mix of state and private hospitals and doctors who in effect compete for your attention. Its about YOU THE PATIENT.

But I’m wasting my time. In the UK you cant properly debate the existence of the NHS, you can only have one state provider because somehow the great profit motivated free market cannot play any part.

konabunny, as you say wealthy boss, what happens to those who have less money and are unable to pay a retainer?

I really have no idea. The suggestion someone made above is that the Singaporean scheme is FULLY AWESOME but my understanding is that some people still prefer to pay for private doctors. How common that is – I have no idea – he seemed to suggest that it was something that was quite common but I didn’t really ask for any detail. I’m just chucking it in there. It certainly doesn’t mean that the NHS can’t learn anything from Singapore.

konabunny, as you say wealthy boss, what happens to those who have less money and are unable to pay a retainer?

“Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth”

Hate the target culture of NHS you say? There’s the only stats that matter.

mcboo, the NHS is not perfect and debating is fine. But i only have one simple question, is the treatment available to the company cleaner as good as that available to the MD?

no system is free, it will be paid for through taxes, insurance, etc. but should the poor be denied treatment if they can’t afford it? If a system can guarantee access then good, if it can’t then there should be no discussion it should not exist.

To be fair, mcboo, Iceland only has about 250,000 citizens so that would skew stats like this. Depends on the sample size, innit?

Stoatsbrother – I must take you to task about the role of GPs – yes they have a good perspective on some parts of the NHS – however they simply do not have the expertise or desire to undertake the role the government envisage.

this is deliberate – the GPs will have to contract out much of the role to management companies who will in turn pass juicy contracts to their friends.

Amateurish management is a bane of the NHS – and while some GPs may be good managers many are not and very few indeed have the expertise to do what the government wants – and even fewer wish to take teh role.

Teh only way it can be run is mby professional managers with the necessary expertise

OK….so lets exclude Iceland. There, Singapore you are No 1!

Look, I’m not saying that you dont get a nicer room or better food or even a shorter wait time for an operation if you are wealthy in Singapore. But just because it isnt a completely flat system (like ours) can it offend your sense of fair play so much that it isnt in its entirety an admirable system of universal health provision? As an expat on a short term contract you rely on your work to provide health cover so its slightly different for us but the Singaporeans I know like the system a lot.

As an aside, Singaporeans have a TERRIBLE lifestyle, too much MSG in their food, not enough exercise and everybody chain-smokes. Yet they still have a long life-expectancy?

But I’m wasting my time. In the UK you cant properly debate the existence of the NHS, you can only have one state provider because somehow the great profit motivated free market cannot play any part.

McBoo – the reason for that is that for profit firms provide worse healthcare at greater cost – and a part of their cost is a loss of the cooperative ethic that good healthcare requires. This is ultimately damaging – you cannot consult your colleagues because they have a different employer because sharing best practice is not in your employers interests.

The shareholders can never have the same interest as the patients.

Teh only way it can be run is mby professional managers with the necessary expertise

No, no, no, you’ve got this politics game all wrong, TJ. You’re not supposed to be say “we should pay people who are good at administering healthcare systems to administer healthcare systems and pay people who are good at treating patients to treat patients”. You’re supposed to say, “we’re going to fire all the bureaucrats and bring back ward sisters and there are too many paperpushers and the community should play more of a role instead of LBGT quangocrats”.

More fatuous soundbite nonsense, that’s what you need.

It’s admirable that the results from the Singapore system are so good, but in terms of healthcare, the way it is financed should have little effect on the way it actually works, unless there is some special medical effect that we don’t know about that changes with the source of money.

It is worth looking more closely, and trying to stay apolitical, to see how the system works in terms of primary and secondary care, how long do people wait for appointments, how does the small and therefore centralised care system work in terms of treating people?

Just changing how you fund a healthcare system shouldn’t affect the quality of care delivered, should it?

Mcboo is right though; lets look at it in terms of outcome and see how we can match that rather than defending the NHS at all costs.

mcboo, if someone wants to take out private health insurance, i.e. BUPA i don’t have an issue, as i said more a case that if you need treatment can you get it.

I would not want a system where the treatment you receive could result in your bankruptcy, a system where when your insurance runs out your on your own. If the singapore system is basically the same regardless of income, you just get a few bells and whistles for spending a bit more, fine.

However should a system work where money can buy you faster treatment? where through contacts and money you can gain access ahead of those less fortunate than yourself?

McBoo – the reason for that is that for profit firms provide worse healthcare at greater cost – and a part of their cost is a loss of the cooperative ethic that good healthcare requires. This is ultimately damaging – you cannot consult your colleagues because they have a different employer because sharing best practice is not in your employers interests.

You can ram your co-operative ethic. We all know what that really means. Those ethics very nearly killed my mother 2 years ago.

No, no, no, you’ve got this politics game all wrong, TJ. You’re not supposed to be say “we should pay people who are good at administering healthcare systems to administer healthcare systems and pay people who are good at treating patients to treat patients”. You’re supposed to say, “we’re going to fire all the bureaucrats and bring back ward sisters and there are too many paperpushers and the community should play more of a role instead of LBGT quangocrats”.

Lol, the bigger and more complex a system gets, the more it needs managers. Otherwise you get people like me who is good at nursing doing a crap job of managing things…

So you want to introduce private companies despite their care they give being worse and the cost higher?

Singaporeans have a TERRIBLE lifestyle, too much MSG in their food, not enough exercise and everybody chain-smokes. Yet they still have a long life-expectancy?

Yeah, but on the other hand, practically everyone takes public transport or walks to work, so people are walking every day, they’re not huge boozers, there are quite a few Chinese oldies that are into tai chi, and there’s still quite a strong cook food from scratch culture. ‘course, they do like six or seven sugars in their kopi…

Oh yeh when you put it like that, I forgot you are a nurse and are therefore entirely impartial.

Thats the point you see, I WANT NHS staff to be uncomfortable with the new regime.

mcboo,

So how would you set up a system so that everybody got their operation immediately?

I would really buy into that system but can’t see how it would work.

Does everyone under the Singapore system get their operation within a day or two of diagnosis? If so, then hell yes we need their methodolgy and I don’t care if its private or otherwise.

Hah Kona knows it…..they do like a home cooked meal thats true, am sure thats part of it.

Mee-goreng aaaaaaaaaah……..Malaysian food is the absolute berries of world cuisene. Monster hangover cure.

Is berries supposed to be good or bad? Got to say that I really dislike Indo/Malaysian food – does nothing for me.

I’m not impartial, but I’m trying to be, because I know that the healthcare system will end up treating me at some stage and I’d like it to be as good as it can be.

Thats the point you see, I WANT NHS staff to be uncomfortable with the new regime.

To what end? for ‘revenge’?

Like it or not, the NHS is the main healthcare provider in the UK, so lets try to make it as good as it can be, rather than making political points or profit from it.

McBoo I actually like evidence based practice – and the evidence is the way the NHS does things produces better outcomes cheaper than other systems.

Like Dangerous beans – show me a better way of doing it and I will leap at it. Show me an expensive inefficient method and try to tell me its better and I will laugh in your face.

About 1/3 of it is already privatised – just a matter of time till its 100% outsourced quango 😥

Ah, its getting a bit clearer now I’ve looked on the Singapore Minitry of Health site, it’s tiered system where some is state funded and some via medical insurance.

From the listings they provide it seems that if you had lung cancer with complications then your pot of money would provide 7.7 days of hospital care before it ran out, or use 2/3rds of your allocated pot of money for a 6 day stay for a stroke.

Not sure what happens once this pot of money has gone though.

An interesting debate and lots of valid points. I don’t have the energy to add to such a complex debate here other than to hope that no-one starts by assuming that the current (Holy Grail) that is the NHS works either as a system for allocating scarce resources or for delivering a service to the sick – other than in the generally excellent provision of emergency services.

I do have to pick up on esselgruntfuttock’s comments though. I see the winking smily, but is there a serious side to this post? Seems rather harsh?!?

TJ, my wife is a nurse in a LARGE Leeds hospital & am concerned about the OP. However I am also very concerned about why you aways seem to mis-spell ‘the’ IE, you almost always type ‘teh’ (or a derivative). Are you dylsexic, is your keyboard on the blink, or don’t you read what youv’e typed?
I know It’s trivial raelly but, you know….

If so, can I suggest less abuse and a little more self reflection?

don’t you read what youv’e typed?

…what you’ve typed (or better still what you have)!!

I know It’s trivial raelly but, you know

…it’s….really…. 😉

Teamhurtmore. Esselgruntfuttok and I have debated many times over years. I am sure no offence was intended and certainly none was taken

teamhurtmore did you join the debate just to write that, because you forgot this bit.

esselgruntfuttock – Member

Thanks for that TJ, I won’t roll my eyes now every time i see it.

Can’t believe I typed I know It’s trivial raelly but, you know

Must be the Botanist gin thats affecting me!
🙄

Thanks for putting me in my place!! Read first post and felt it was a bit unnecessary and harsh. Good to see that I was mistaken here and that no-one has taken offence.

After posting actually wondered if it was all a joke anyway – it seemed too ironic otherwise.

TJ – so much to add here, but hard to be concise or to avoid offending others with differing views on what is always a very emotive subject. Plus tired from hard day!! 😉

Add it then. 🙂

show me a better way of doing it and I will leap at it.

You see thats what I’d say, and I’d really mean it. Lets be honest, you think you have all the answers already and anyone that disagrees with you is either an idiot or plain evil.

Have a look at the German system. Social democratic in so many ways, their healthcare system is based around health insurance. Want to see a GP? Hand over the money first. I personally dont like the sound of that last bit but each to their own.

Now, remind me…..who are the 3 largest employers in the world?

a little more self reflection?

asking this of TJ, you are new here aren’t you.
How could he do less 😉

So you want to introduce private companies despite their care they give being worse and the cost higher?

way the NHS does things produces better outcomes cheaper than other systems.

Aravind eye hospital for example?

60% of the NHS throughput, at 1% (yes, one percent) of the cost, give away 60% of their surgery free and still makes a profit

Nope, nothing the NHS could learn from there, is there 🙄

How about the Narayana Hrudayalaya Heart Hospital?

SO DOES EVERYONE IN SINGAPORE GET THE SURGERY THEY NEED WITHIN A FEW DAYS OF DIAGNOSIS IRRESPECTIVE OF THEIR INCOME, SAVINGS, ABILITY TO PAY??

Singapore is not comparative, they have very low unemployment (between 1 and 2% iirc) which is a figure that can be counted as transitory, a large migratory work force that do not have the same entitlements as citizens.

McBoo – I know a bit about how some European systems work. Germany for example is significantly more expensive per person than the UK for outcomes a bit better. A fair bit of the extra expense goes in administration because of the complex funding. The fragmented providers can also make strategic planning more difficult.

You see thats what I’d say, and I’d really mean it. Lets be honest, you think you have all the answers already

I’ve never been shown anything better. If its out there I woud like to know All the examples of for profit healthcare that are in any way comparable are more expensive.

The NHS has and can learn from the private sector however. Control of costs is so much better now than it used to be with people down to quite a low level budget holding and information being widely available. Attention to “hotel services” should be and often is far better than it used to be. voluntary sector can and does provide good healthcare in some areas as well

TJ

Not for the first time I wonder what an earth you base some of your misinformed ex cathedra statements on. I have searched to find out the basis of your professed broad expertise in matters of health. Cannot find very much. I am new around here – do feel free to educate me…

If you read my post you would see I said that not all GPs have the expertise. Actually very few. As someone who has been involved in this sort of thing (not now) for some years and been on the courses with Don Berwick’s mob, sat on the committees, got the T shirt, set up the collaborative schemes in various clinical areas, lobbied for and got new services across a population of 450,000, worked on process mapping and service redesign in various areas, and education/promulgation blah blah blah, run an internet resource promoting local services/education/EBM for 10 years etc etc, I do know a bit of what I am talking about. Where does your experience in the management capacities of GPs come from?

We need decent managers (we ain’t got many), decent clinical leadership (usually not from Consultants who tend to fight turf-wars) and decent financial and activity analysis. Management support will be needed – but it has been needed for many years. And this will need to come from outside, because most of the decent managers fled there over the last 10 years. But no one else (Public Health espescially poor in the UK) actually gets to see the issues that happen throughout the system.

The issue is more in the way the current government is setting the whole thing up to fail. The number of changes that there have been already are mind-boggling. 4-5 years ago the system was about right and could have developed by evolution. But we are screwed.

A couple of us were discussing you at the weekend. We felt that where we found we agreed with what you were saying it tended to make us reconsider our point of view… 😉

I struggle with long sentences. Synopsis before I wade in and put the world to rights?

Ususal STW left vs right again George, that would seem to be about the size of it. 🙁

Singapore is not comparative, they have very low unemployment (between 1 and 2% iirc) which is a figure that can be counted as transitory, a large migratory work force that do not have the same entitlements as citizens.

But it was being used as a shining example of best practice compared to the NHS.

I am a Nurse but really don’t care if the whole system is disbanded if what it is replaced with is better, and if that meant everyone paying a bit more then bring it on I say. I work with people with learning disabilities and if you think your access to care is poor you ain’t seen nothing. I spend all day every day fighting the system on behalf of my patients, often with poor results.

I am also, at times, a patient and have seen examples of both excellent and appalling practice. My wife is also a Nurse and sometimes comes home in tears through frustration – she is also ill at the moment and, to date, has recieved good care.

There seems to be a perception that if you work in the NHS you love the system and think it should be protected whatever. On the other hand we have folk who believe that capitalism is king and will solve all ills.

Me, I just want the best cos at some point I may really need healthcare and I don’t want it to be shit.

Thought as much.

There is no doubt that the NHS needs a radical shake up. Privatising parts of it and loading GPs with management responsibilities is not the way to do it though.

*applauds dangerous beans*

Stoatsbrother – I am a nurse of 30 years wideranging experience. We are slightly at cross purposes here. I completely agree that some GPs have the skills and knowledge. I also agree with

4-5 years ago the system was about right and could have developed by evolution. But we are screwed.

thats the point – the proposed changes are designed to privatise the NHS. And are simply not needed nor helpful