Would you cancel HS2 to invest in the NHS?

[Bletchleyite]

Do you think they'd initially fill Manchester to London HS2 trains by charging £350 for Manchester to London?

They won't need to fill them, just like the present service. They will need to maximise income from them, which is what the present, nearly £350 Anytime Return does.

The via Chesterfield fare at £208 is more likely to fill trains, but that's not what they have set out to do.

 

[Qwerty133]

No, the current model of the NHS is fatally flawed and diverting more and more money into it will only work for so long (as necessary increases in funding are significantly higher than any developed countries economy will ever grow at).

 

[RichmondCommu]

Yeah, you might need a few more bands.

I concur And this where the legal costs start to spiral as those new bands are contested.

 

[RichmondCommu]

No, the current model of the NHS is fatally flawed and diverting more and more money into it will only work for so long (as necessary increases in funding are significantly higher than any developed countries economy will ever grow at).

So what model would you adopt?

 

[Bletchleyite]

So what model would you adopt?

Personally, I would adopt a defined-benefit social insurance model similar to that in Germany. The Government provides the insurance via the statutory Krankenkassen, though some can opt out. Doctors, hospitals etc are either charitable trusts or just independent businesses, and are paid by the insurance, and demand is managed by the market. It's all done relatively transparently using smartcards. I've used it and it works well.

The thing that's sacrosanct to me is basic life-saving treatment free at the point of use, paid for based on the ability to pay. I don't think the actual delivery model should be sacrosanct - a monolithic NHS has massive issues, and the CCGs have most of the disadvantages of an insurance based system with none of the guarantees and certainties it would provide.

 

[GW43125]

I'd be interested to see how many paths would be freed up if a freight line were to be built rather than a passenger one, as removing the 60-75mph freights and having everything running at 100mph+ would surely allow better utilisation, would it not?

 

[All Line Rover]

They won't need to fill them, just like the present service. They will need to maximise income from them, which is what the present, nearly £350 Anytime Return does.

In fairness, as I have mentioned previously, the Manchester to London trains that are genuinely popular with business travellers are reasonably full. 20% (ish) more passengers and you'll regularly have people standing.

 

[RichmondCommu]

I'd be interested to see how many paths would be freed up if a freight line were to be built rather than a passenger one, as removing the 60-75mph freights and having everything running at 100mph+ would surely allow better utilisation, would it not?

However the long term prospects for freight are not fantastic (although far from bleak) so I'm not sure how much justification there would be for building a brand new freight only route. Even if you doubled the Felixstowe branch how much more demand would there be for intermodal freight?

 

[JaJaWa]

Yes, but only if the commitment was made in writing somewhere I could trust – for example on the side of a bus.

 

[GW43125]

Yes, but only if the commitment was made in writing somewhere I could trust – for example on the side of a bus.

They'd never say that

 

[najaB]

I'd be interested to see how many paths would be freed up if a freight line were to be built rather than a passenger one?

Not that many. And it would still be expensive. Not as expensive since it could be bendier, but still a fair wad of cash.

 

[Qwerty133]

So what model would you adopt?

I'd privatise dentistry and optometry services, charge all for prescriptions, close down bariatric units (and replace them with posters for slimming world or weight watchers), limit fertility treatments to couples, of normal childrearing age (20-45) with no children, and stop funding PrEP and other drugs that basic lifestyle changes would make unnecessary. I'd also limit treatment to UK citizens, charge for injuries caused during professional or semi-pro sport, charge for any patient found to have consumed illegal drugs, and charge for missed GP and specialist appointments.
I'd spread elective operations fully over 7 days to make full use of all available beds (as seen by the BBC2 programme consultants currently spend significant amounts of time waiting for beds which could be reduced if 2/7ths of operations are moved to weekends).

 

[najaB]

I'd privatise dentistry and optometry services, charge all for prescriptions...

Lovely for those who could afford them. Oh, wait, they already go private.

 

[GW43125]

I'd privatise dentistry and optometry services, charge all for prescriptions, close down bariatric units (and replace them with posters for slimming world or weight watchers), limit fertility treatments to couples, of normal childrearing age (20-45) with no children, and stop funding PrEP and other drugs that basic lifestyle changes would make unnecessary. I'd also limit treatment to UK citizens, charge for injuries caused during professional or semi-pro sport, charge for any patient found to have consumed illegal drugs, and charge for missed GP and specialist appointments.
I'd spread elective operations fully over 7 days to make full use of all available beds (as seen by the BBC2 programme consultants currently spend significant amounts of time waiting for beds which could be reduced if 2/7ths of operations are moved to weekends).

Apart from there's hardly any staff at weekends...

 

[Qwerty133]

Apart from there's hardly any staff at weekends...

Move some of the staff who currently spend their days waiting to see if there's enough beds for them to operate from weekdays to weekends when there is more beds available.

 

[najaB]

Move some of the staff who currently spend their days waiting to see if there's enough beds for them to operate from weekdays to weekends when there is more beds available.

Other than possibly some consultants, I don't think they're are many staff members standing around doing nothing.

 

[Qwerty133]

Lovely for those who could afford them. Oh, wait, they already go private.

People shouldn't get free prescriptions just because they happen to live in Scotland or are over 60. Specsavers already offer free private eye-tests to those not eligible for NHS ones so its not as though people would have to pay.

 

[najaB]

People shouldn't get free prescriptions just because they happen to live in Scotland or are over 60. Specsavers already offer free private eye-tests to those not eligible for NHS ones so its not as though people would have to pay.

There's more to optometry services than eye tests, and poor dental health often translates into poor general health.

I agree that prescription charges should be looked at - but only because studies have shown that drug wastage is lower when people have had to pay something.

 

[Qwerty133]

There's more to optometry services than eye tests, and poor dental health often translates into poor general health.

I agree that prescription charges should be looked at - but only because studies have shown that drug wastage is lower when people have had to pay something.

I wonder how much time and money could be saved if there was one set of rules in place across the whole country instead of numerous sets
of managers setting totally different rules for different parts of it...

 

[najaB]

I wonder how much time and money could be saved if there was one set of rules in place across the whole country instead of numerous sets
of managers setting totally different rules for different parts of it...

The theory is that local control actually saves money since services can be tailored to the needs of local communities.

 

[neonison]

Cancel HS2 and give the money to the NHS. Cancel Trident and give the money to the NHS. Cancel road building and give the money to the NHS. You cannot give too much money to the NHS, and that is the problem.

 

[Xenophon PCDGS]

Cancel HS2 and give the money to the NHS. Cancel Trident and give the money to the NHS. Cancel road building and give the money to the NHS. You cannot give too much money to the NHS, and that is the problem.

Even if all that what you state was to happen, how long would it be before the NHS used up all these new resource monies and then where would we be?

 

[DarloRich]

the naivety of several posters in this thread is almost amusing were it not so worryingly simplistic.

 

[Senex]

Even if all that what you state was to happen, how long would it be before the NHS used up all these new resource monies and then where would we be?

Not very long, and then the Labour Party would be back demanding even more money for its NHS. In its present form, where no-one feels any real responsibility for looking after the money, the NHS will always consume everything that's thrown at it and then demand more.

 

[neonison]

Even if all that what you state was to happen, how long would it be before the NHS used up all these new resource monies and then where would we be?

I was being ironic. There will never be enough money.

 

[class26]

I was being ironic. There will never be enough money.

Unfortunately true. With anything that is free demand will outstrip supply. Sooner or later the way the NHS is funded will have to change and that day is probably closer than we think.
I am not sure what is wrong with the French or German system of some form of personal insurance backed up by the state. Lets face it, neither country are right wing bastions but this system seems to work. Can we say the same ?

 

[rf_ioliver]

With the Health Service the way it is across the whole UK, it's evident for all to see that the NHS under the current government is at breaking point. Given the ever rising estimated costs of HS2, would you cancel HS2 if it meant we could give the health service the lump sum it needs to get back on its feet?

In my opinion, I think HS2 is a must but given the state of the NHS, I can see why a lot of people think our priorities should be reconsidered.

A few things:

1. the NHS's problems aren't going to be solved by a lump sum

2. you're going to have to be more specific than matching a specific rail infrastructure project with a while organisation...the question could be generalised to: should we shift budget from rail to health, *or*, specialised to: should we defund cancer services to pay for HS2's signalling (for example)

3. there's an extra 350million GBP *PER WEEK* coming real soon now, honestly...I read it a paper, saw it on TV, that nice politician said so and there was an advert on a bus...

4. like many large organisations the NHS has problems, much of this is to do with government policy, management etc. HS2 could pay for a huge amount of accountants to solve the NHS's problems...

5. training more nurses takes at least 3-4 years, plus an extra year for specialisations - we'd actually need to cancel HS2 and pay into the university system to solve that one. Training doctors/anaethetists takes even more time. We could entice well trained professionals from abroad, eg: from the EU....oh wait....see #3

6. investing in infrastructure benefits the whole country, though payback from infrastructure investments is relatively slow.

7. the money for HS2 is actually spread over many years - this is true of many infrastructure projects. For example, if a bridge is said to cost 1bn over 5 years, that acutally means it only takes 200million investment per year. There is no 1bn lump sum available. What you could potentially do is use HS2's available money for this year to pay to the NHS, but then you get all problems associated with allocating a lump sum of money (see #1, #4 and #5) along with delayed infrastructure, see #6

8. government policy ... I don't think the current goverment (or the last few, regardless of party) are really interested in saving the NHS - admittedly things need to change to keep up with technological developments, but this isn't solved by an actively hostile health policy and political dogma (again, regardless of party).

9. changes must be sensible: so, asking nurses to check people's passports might save money in that we no longer treat "immigrants"/"unworthies"/"nasty johnny foreigner" we lose money in nurses' time, training, health cost payments (eg: UK charges France and v.v.)

Phew...I'll stop there...Anyway, being born and bred in the very area where Aneurin Bevan worked and spearheaded the formation of the NHS I do fear for the service - I fear that when it goes, it'll be gone forever and it'll effectively be our fault, but then again the same happened to the railways under another "doctor"...

Excellent question BTW....are you thinking of going into politics?

t.

Ian

 

[Bletchleyite]

There's more to optometry services than eye tests, and poor dental health often translates into poor general health.

This is very true - in particular untreated abscesses can lead to far more serious infections - a reservoir of bacteria close to the brain is actually a really dangerous thing.

 

[Bletchleyite]

I agree that prescription charges should be looked at - but only because studies have shown that drug wastage is lower when people have had to pay something.

That's a difficult one - you could also apply it to something like a £10 fee to see a GP, which, while it has problems with the concept, would indeed reduce waste of GP appointments.

 

[Bletchleyite]

Cancel HS2 and give the money to the NHS. Cancel Trident and give the money to the NHS. Cancel road building and give the money to the NHS. You cannot give too much money to the NHS, and that is the problem.

Yes, you can. If it had unlimited funding, it would waste money.

I would suggest spending needs increasing to around 12% of GDP, roughly where the German system sits. Though it is notable that the spend has increased substantially over the years - I was surprised by this:

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&start=2014&view=bar