Compromise and Conceit

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An Australian statistician and role-player living in Japan, interested in the theory and practice of role-playing…

Alternative NHS Reforms

So previously I mentioned that I don’t think the Tory’s reforms of the NHS will work, and there was a bit of discussion (well, me waffling, really) about alternative models. Today via the Guardian I discovered this gem of a website, in which the Treasury has put up a list of suggestions that British people submitted for ways to save money. They then get rated and the Treasury will (apparently) seriously consider some of them. So of course, since it’s about spending and costs, the NHS has a whole section of its own. This includes terribly exciting suggestions for cost-cutting like “rationalise journal purchasing across NHS Trusts[1]” (someone must have thought this process was serious!)

Of course, one of the most endearing traits about the British is that they can take the piss out of anything, with a depth of cynicism and wit that I think is unmatched in the world[2], and indeed they’ve managed to do so with this. Here are some alternative suggestions:

  • The NHS should prescribe monocles: and patients can pay the extra for two lenses out of their own pocket. Sadly this won’t work because “top-ups” are banned in the NHS.
  • Stop selling alcohol for one week: I think this has been tried before and wasn’t quite a cost-cutting success, but the person submitting it (“bigoted_oaf”) has an amusing dig at “moderate drinkers” and an excellent implementation strategy: “Go into Tesco with a golf club and set about their cut-price displays. Let everyone else know politely that it’s not allowed.”
  • Tax cigarettes: and restrict where they can be sold. Anyone think this might have been tried somewhere before? Maybe we could raise money by taxing people’s incomes, too?
  • More alternative therapies: because they’re cheaper. Whatever would Prince Charles say?
  • Get stoned: apparently natural hemp oil kills cancer. You heard it here first!

In amongst these reform suggestions were the serious ones, which seem to mainly consist of:

  • charging a nominal fee for doctor’s appointments, A&E appointments, or prescription drugs
  • charging people for non-attendance at appointments
  • some arcane stuff about end-of year budget rollovers
  • blaming foreigners

There were also a few sad comments by people using the site to lodge complains about the poor treatment they received in the NHS.

Oh, and someone wanted to bring back Matron!!!

—

fn1: For some reason in the UK a Hospital or small collection of Hospitals is referred to as a “Trust,” even though when you visit, all they do is give you a paracetamol and send you home

fn2: Though I get the impression that the Polish and maybe Iranians give them a run for their money

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3 responses to “Alternative NHS Reforms”

  1. noisms Avatar
    noisms

    I think they need to move towards a compulsory insurance model like they have in Japan. I’m not an expert on the NHS by any means, but I’ve used both it and a Japanese hospital and I know which one works better.

    Then again it’s hard to think of anything which DOESN’T work better in Japan than in Britain…

  2. faustusnotes Avatar
    faustusnotes

    That’s pretty much the model Paul and I are suggesting. Japan also has its problems, but they don’t stack up compared to the NHS. But you’re right, given that trains, banks, post offices, cafes, restaurants, bars and busses all work better in Japan, some element of the NHS’s problems must be system-independent, and have something to do with British workplace/institutional culture. You don’t change that when you change your insurance model.

    I think the big problem for a system like Japan’s is the risk of market failure in poor or rural areas. The Australian system gets around that with various government incentives or interventions (our rural health challenges make Japan’s look rather trivial). Also, if you establish large, well-run state hospitals for teaching and complex functions, and force the private ones to compete with them, it ups the quality of both sectors. I think this happens in Japan too, with some hospitals state run and probably also receiving block grants from the government in addition to the funding they get through health insurance provision. This sort of mixed model works best to make sure the system is efficient and responsive, but doesn’t create black spots or extreme postcode lotteries.

    I don’t think there’s any chance it’ll happen the UK though. It’s too big a change and too many entrenched interests on every side of the debate – the supporters of private systems in the UK seem to be focussed on an American style private system, and the supporters of state systems seem to ignore anything that isn’t the NHS – and heaven forbid that they learn a lesson from Germany or Japan!!!!

  3. Paul Avatar
    Paul

    You do realise that if you suggest that the UK learn from Germany or Japan then the “debate” would pretty quickly devolve to a chant of “Two world wars and one world cup” from some quarters, right?

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