We throw billions into this bottomless pit to then be told that things are worse than ever and that now services will have to be rationed. Constant political dabling in the NHS has made the service even more inefficient and costly - how many Patient Managers, Financial Controllers, General Managers, Nursing Managers and other quango related jobs have been created in the last 10-15 years in the NHS and how much does that cost the taxpayer each year?

Radical reform, yes radical reform is urgently needed. No wonder people go private - the public service is a joke.

Can Scotland not form a union with Cuba for its weather, sugar and health system?

There is no easy fix. Perhaps a mixture of Private and Public is the way to go forcing those that can afford it to take out private health cover to free up the public system for those that really need it?

Why would you continue to train so many student doctors if you know that you won't be able to offer them a job at the end of the training? Beats me that there is so much stupidity in the system.

Why don't we hear how other countries are managing to finance their health care. I find it hard to believe only the NHS is having these difficulties. Most western countries have an ageing population, in the US many are without any healthcare, many depend on charity handouts but what about Germany, France etc - they can't be so much younger / healthier / richer than us.

Look at whose pockets the money is lining - a certain Reg Race, foe example? It seems to me that ex-politicians see the NHS as a cow for milking.

#1 Auckland Arab raises the most pertinent points as regards to NHS costs. There are more "managers" now than beds in the NHS. Its time to clear out all that expensive deadwood and concentrate on the health side of the NHS.

In addition, as regards to "rationing", it is also time to stop funding purely cosmetic surgery on the NHS, e.g. boob jobs and similar, as well as stopping IVF treatment on the NHS. The latter has as much relevance to health care as an overabundance of managers.

The NHS is like a cash cow for ex-politicians and their cronies.
Look at the amount of money paid to Reg Race, for example. Now, there's a real convert from rabble-rousing socialism to "What's in it for me?"
The answer to that, by the way, appears to be "An awful lot of taxpayers' money."

#1 Auckland Arab raises the most pertinent points as regards to NHS costs. There are more "managers" now than beds in the NHS. Its time to clear out all that expensive deadwood and concentrate on the health side of the NHS.

In addition, as regards to "rationing", it is also time to stop funding purely cosmetic surgery on the NHS, e.g. boob jobs and similar, as well as stopping IVF treatment on the NHS. The latter has as much relevance to health care as an overabundance of managers.

Not sure about banning IVF treatment on NHS - it's fixing a fundamental fault after LL.
BUT the big headline in Scotsman today is a senior cop wanting illegal drugs to be put on prescription - free ?
I wonder if NHS rationing will apply to that ? Excuse my cynicism.

#9 I find it hard to believe that ANYBODY has had a "boob job" on the NHS.

Interesting that this article is immediately after the one suggesting that we give heroin addicts free heroin on the NHS.
The current hugely expensive methadone scheme for addicts has been and is continuing to be a costly failure; I wonder where they would fit in the scheme of rationing?

#11 I can assure you that quite a number do have boob jobs on the NHS. There are even people getting plastic surgery on the NHS for purely cosmetic reasons, i.e. not because of an accident or birth defects or similar.

All you need to do is pretend that having large/small boobs is causing you psychological problems. The same is true for cosmetic plastic surgery.

I know it is true, as I know, personally, a number of women who have had these types of operations.

I would start with those things costing the NMS billions like people who make themselves ill through obesity and binge drinking. Even smoking as well. I know smokers will say they altruistically fund the NHS single handedly but there is not a bottomless pit of staff. No matter how much one spends on the NHS if people by their lifestyles are making more demands on the system then it will get overloaded as there will not be enough staff to cope. Not everyone can be a doctor or a nurse no matter what the pay is.

Guga II: "All you need to do is pretend that having large/small boobs is causing you psychological problems."
That's it then. You've got your jugs, get on with it. While we're at it, you lot with the enormous hooters and sticking out ears needn't bother turning up either co Googs reckons it's all in the mind.
Sweeping generalisations can't work where individuals are concerned.
That said, are all of your ladyfriends liars? That may explain some of the vicious rumours that surface here from time to time. :o)

Yep, rationing makes sense - after all we need the money for the free skag, which a majority of posters on another thread think is a brilliant idea.

If we spent more on ourselves instead of giving all this aid ala that nutter Geldoff we might be better off.My old granny said look after no1, no one else will.We should get ourselves sorted first before giving it all away to these third world dictators.
Also the ammount of money these G P`s get now is bordering on obcene.They do less for a King`s ransom.Time that was sorted too.

16 - Godknows soon they'll have the same pay as civil servants - cannae have that.

#12 Guga ii
Worried about the company you keep,don't you know any whole people,and do you include your mother-in-law?

#14 No, all my lady friends are not liars. You, on the other hand, are a nasty little American troll whose attempts at debate are limited to stupid comments.

You'd better go, I think your mother is calling you. Time for your medication.

#1 - where's your evidence that it's worse? I believe that if people who have had to use the NHS are polled there is a large majority who are satisfied. I also believe that there are a large number of cynics who believe the sensationlist media reports and like to 'have a go'. eg: three times in the past 2 months I'v ephoned and goty same day appointments - albeit not my own doctor but if I'm truly ill so what?

#5 - Again a major failing with our media. It is one of their roles to inform people. What do we get? shoddily written 'articles' put together by an office based 'journo' who googles and is a dab hand at teh old cut and paste.

Generally, yes there are faults with the NHS, but 'rationing' is inevitable. With advances in science and treatment, coupled with higher expectations, the costs are going to rise. Treatments delivered today would not have been made available 10/20 years ago and treatments we think are a 'luxury' now will be regarded as a 'right' in years to come.

It's like the ridiculous post code lottery argument - again this is inevitable unless everything is managed to the lower denominators. Not all surgeons have identical skills, Mr A in the ERI will know more about disease X and Mr B in the PRI will know more about treatment Y - that's life and cannot be changed. An example - there was only one Christian Barnard, there was not a simultaneous eruption of hundreds of identically skilled surgeons all over the world. Excellence should be encouraged, in the knowledge that not everyone can access it simultaneously. Doh!

17# GP's and dentists have been given the largest pay rise known to man other than politicians.
The service for all hs depreciated in line.
We should review our ways especially with the antiquated GP system.

This would be a good thread to ask all you experts a question that`s been bothering me.
We raise millions in charities for cancer research etc
one particular charity, Breast Cancer, comes to mind, yet when drugs such as Herceptin come on the market the price is prohibitive and for a time we withold it from women with breast cancer. What happens to all the research we are paying for is the money or results handed to private companies who can then use this to milk us yet again or am I missing something.

Too many chiefs and not enough indians.

Also, reduce the hours worked by doctors and reduce their pay. Then employ more.

Free prescriptions are only going to make the situation worse. If you give from one hand you must take from the other.

The two extremes of cynicism -

1. Left Wing - all private companies are out to milk the people.

2. Right Wing - all public figures are out to milk the people.

3. Me - There are good and bad in both public and private sectors and the vast majority of folk try to do a decent job and make a decent wage and sometimes genuine mistakes happen.

#19: It's becoming clear now.

#20 has it absolutely right. The need for rationing does not come from any sort of mismanagement or underfunding, but from the simple fact that we can now treat far more patients than we could even twenty years ago, and the further we push that envelope, the more expensive the new treatments must naturally be.

Take transplant medicine for example. Most of the people benefitting from this incredibly labour-intensive, training-intensive and pharmaceutically-expensive treatment would simply have been untreatable a few years ago. Today we expect the latest and greatest treatments and expertise to be available locally, or failing that, at least within easy travelling distance. That's where the drain on resources is coming from, not any management inefficiencies or wasteful policies.

That is why I and others reacted with such anger to the recent announcements by Ms Sturgeon that she was to overrride the decisions of various Health Boards to rationalise and centralise services, and instead play politicis and promise people expert services in multiple local hospitals. We simply cannot afford to play politics with our health services in this way.

Who is this Dr. Smallwood, he quotes two conditions hernias and varicose veins - conditions with which people could live. Both conditions can leave an individual unable to walk without severe pain and his advice is 'sorry we don't fix those no more'. If we are good enough to be ripped off in National Insurance payments from our pay packet's all our lives then we have every right to expect to be treated when we have an illness that is treatable. For the last two weeks I have been in the local hospital twice a day in Kilmarnock to visit my mother and the things I have seen are simply down to bad management, lack of supervision, lack of maintenance and out and out laziness and under staffing.

#16 Black Five Looking after No1 is only a good plan when you are at the front of the queue, as we are for the most part. You may one day have the bitter experience of suffering from the fact that other people with that point of view count you as No 999999. I think you may have a different view then. It is true many regimes in developing countries are corrupt but there are plenty of ways of helping folk there without the regime stealing from you. For example you could go and do, whatever you do, for them. I guarantee you will not regret it.

Good point, no. 27, especially because many 'conditions people can live with' can render the sufferer unable to work at their job.

And which would you rather, Taxpayers, have money going to fix the problem and keep the employee employed, or give them no choice but to give up their job and wind up on the dole?

Keeping folk healthy enough to work should be a priority as well as saving lives.

A remarkable hospital car-park observation on weekends - it's virtually empty - the hospital carries on, pretty much as usual, but without the critical mass of useless non-clinical administrators and managers save for a few who are actually necessary. Agreed that some labs and other diagnostic/treatment facilities do not operate on full staff at weekends but even with this proviso it cannot escape our attention that the burden of managerialism and its political masters have crippled clinical processes and duties. Of course patients think most things are working well in the NHS on direct contact due to the committment of the doctors, nurses and other professional health staff who battle on (rationing) best they can against the constant interference, subjugation and target-chasing of politico-management.
Get rid of political party tinkering, bring back the qualified and experienced professionals to health, education and police organisation and positions of senior authority and relegate managers to do their bidding instead of the other way round which currently and patently doesn't work in this country's best interests.

Whatever happens in the future, I think we will have a two-tier system for those who can afford it and those who can't. Don't believe me? It exists today, though just not formalised other than private or NHS.

It will get worse before it gets better!

All these comments about management are missing the point. Hospital admissions have increased by more than 20% in the last decade alone. The number of operations performed has increased by roughly the same percentage in the same period. And most of these operations were previously not possible and are substantially more expensive than established procedures.

It is clinicians, not managers, who are pointing out the inevitability of rationing. We need to face the facts.

Boy Wonder,

there has always been a two tier system and always will be - get used to it. What we can do is to work to ensure that the better of the two tiers is available to those that need it most. Unfortunately that's expensive.

As for 'it will get worse before it gets better' - what drivel - I expect your glass is always half empty. Despite the media reports of similar doom and gloom, more people are getting better treatment than ever before in the history of the world. Why else do you think life expectancy is rising?

Chairman George - what a ridiculous and asinine viewpoint! It's the same idiots running around sports fields that are enhancing their lives by being fitter and more healthy than ever!

Ok, so you don't like sport, but following your argument I hope you don't drive, walk the street, use sharp knives, climb stairs, drink or eat chocolate. In fact you're probably better off wrapping your selfin cotton wool and staying indoors.

One of the big problems is that people are living longer - therefore demands are greater on the health service due to the number of treatments for diseases of middle and old age. Moreover, with the advances in techology, many more treatments are now available than ever before.

Rationing has to take place - the problem in my opinion is that there does not seem to be any logic behind many of the decisions made. Personally, I feel thatceratin treatments, such as IVF, should not be paid for by the taxpayer - why should we the taxpayer pay for someone to have children?

I have said before that having a more commercial GP sysyem is the answer to many of the problems the NHS is having. This place is absolutely packed with small clinics of GP/Specialists who take care of the minor non life threatening problems that were killing the Hospitals here. These places have created thousands of positions for Doctors and other staff. We can go to a local clinic with its own Pharmacy and in some cases Labs and Xray 24 hrs a day. These people can either fix the problem theirselves or if important refer you to the hospital.

Yes the beurocrats have to be thinned out in Hospitals and hospitals should be run by senior Doctors, but until then I think we are just responding to a newspaper who wants to increase its sales. Its not the amount of money that is the problem, its how its being applied. If you have someone running the hospital who is playing the political survival game like the Senior Public Servant who Screwed the Labour Council in East Lothian, then you are in trouble. If you have someone who is focussed on bringing the best level of service in preventable medical care and treatment/cure service you are on a winner.

A few issues.

1) It seemed silly to give such big increases in salary to doctors(gps) who were not exactly badly paid when what was needed was increases in medical expenditure. Of all the additional money how much has actually gone on medical costs outwidth salaries, buildings etc.

2)For a long time doctors have been overskilled for some of the work carried out rather than using a lesser or more specifically skill professional. to some extent this seems to have been addressed somewhat.

3) the biggest problem is the poor state of modern medicine. quite simply for many illnesses and problems they cannot do anything for u. U simply keep attending hospital appointments with to look as if something is happening. Having said that with stem cell stuff etc we may be at the start of some real developements in the next decade.

Hey Guga.

I understand where you are coming from about cosmetic surgery but there are many cases were a woman with big boobs can have severe back pain or develop depression because she has been made self concious by being teased as she has got older. I think that both these things could produce a very unhappy person who could develope more serious illness as they grow older.

As I said before in my other post these clinics could take care of these problems because they would have the expertise and technology to stay competitive with their customers.

#35 Perhaps the Chairman went a little OTT, but there's certainly something to be said against all the "adventurers" who head off on their mountaineering, sailing or diving expeditions and regularly need rescued from danger they have deliberately sought out. The Irish Sea is awash with amateur sailors forever ringing the coastguard on their mobile phones at the first sign of trouble, and the Cairngorms are littered with idiots who set out ill-prepared and end up costing thousands to rescue and treat.

Care has always been rationed due to finite resources.

Admitting it loses votes so no government will be honest about it.

Internet and better communications mean some anomalies and variations in service are found out more often - but it is only the tip of the iceberg.

More patient choice (as in France) would help.

Guga, ignore these idiots. Let's get back to the point. If they are considering being frank about rationing the NHS, could it be because it is now certain that the wars in Iraq and Afghanistan are open-ended and will be draining the tax payer dry for years to come, not to mention the staggering cost of replacing Trident? So there is no point in pretending that we can afford a decent NHS as well as fighting pointless wars. Guns before butter, and guns before healthcare too.

#42 More political point scoring there. There is no correlation between the two, since NHS spending has increased dramatically during the time that these wars were being funded.

That's not to say that it wouldn't be a far better way to spend the money - Trident replacement is an idiotic waste of money, and the wars have been a waste of much more. But in fact your cause and effect argument holds no water as far as NHS funding is concerned.

#30 - Louisa, a lot of people have said the same about every factory I've worked in. "The place runs fine on overtime/weekends without all the managers and admin people."

That's very true - but - It wouldn't run at all if the same managers/administrators hadn't organised goods in, despatch, services, training, building/machine repairs etc etc etc.

Leaving clinicians totally in charge would probably give all sorts of other problems (in fact I believe this is the case whenever it happens).

Let's be brutally honest - The NHS is one of the largest and complex organisations in the world. It is going to difficult to manage, and theminute you think you've got it right a new disease rears it's head or a new treatment or a pressure group want this/that or the other. So not only is it big an dcomplex but it's a moving target.

I would imagine a rigourous analysis of the NHS would show that it is a relatively efficient organisation (80%? 90%?) with many successes and fewer issues.

For example - the press reported recently that there was a £Xbillion overspend. When you make the most cursory study you find that the £XBillion represents 1% of the budget. Now, I don't know about you but if I could budget my personal finances to 10% I'd be chuffed. Yet the press make a hullabaloo about it as if the world is coming to an end!

#40 Dunc - Now it's you that's OTT - the Irish sea is mainly awash with water when I last looked and the Cairngorms are littered with rocks in the main.

I know I'm splitting hairs but since when has the RNLI or Mountain Rescue been funded by the NHS?

#40 - ummm...that's what the Coastguard is meant to do. Suggesting it shouldn't is kind of like suggesting that anyone daft enough to go out on the beer on a Saturday night in Castlemilk can take any kicking that comes their way, or that if pensioners insist on lacy curtains then the fire brigade shouldn't be expected to pitch up if they go on fire. Oh, and #45 - RNLI is voluntary, it doesn't get tax money of any kind (other than from its charitable status).

Anyway, leaving aside the pedantry, it does seem like we're back to the "damn those pesky managers" argument, which is emotionally appealing but fundamentally nonsense. Doctors are good at medical stuff - treating people who are ill and preventing others from getting ill in the first place. That's what they're trained to do and where their experience lies. Hospital managers, financial controllers and so on are there to ensure that the many, many billions of your money and mine which goes into the system don't get wasted. Management and financial control is where their training and experience lies, and frankly getting a doctor to do it makes as much sense as getting your plumber to do your appendectomy.

The argument about Reg Race and other shysters is of course perfectly valid - but it's not the same thing as the generic abuse of anyone working in a hospital who isn't a nurse or doctor (or WRVS)

Thanks for that Ally - forgot the RNLI was a charity, perhaps the NHS should become a charity?

Your post reminds me of the ad on telly with Gordon Ramsay wiring a photocopier while the sparky messes up the kitchen.

Peter - the NHS was not founded on a lie and is not morally corrupt. Bevin was right to argue in whatever way he could to convince the reluctant medics to establish a morally correct solution to health care. Since then the ordinary people of Britain have benefitted hugely from the NHS which, in the main, is well run.

Other than that point your post makes a lot of sense. A problem will arise though, because you may think disease X has priority over disease Y - but I may have other views. Who decides?

I believe the moral contract exists - it's only the poor quality of our media reporting and information and the fools who believe them which muddies the water.

#45 Yes, fairy nuff, I was OTT there too. But I think there is an argument to say that those who repeatedly incur entirely avoidable costs, whether medical or emergency, as a result of their own stupid decisions, are part of the problem.

#48 and #49 Very good point about which health issues should be our priority. Mental health, for example, is terribly underfunded, while, say, cancer is extremely well funded. But how much of the cancer money is spent on extending the lives of terminal patients by a few weeks, and how much of a difference could that money make to mental health patients - perhaps turning a life around completely. As #49 says, who decides? At the moment, in truth, nobody is truly making those hard decisions, but those closest to the decisions - NHS managers - are roundly vilified because they cannot please everyone at once.

Duncan,

Where can that debate about priorities happen? The media has so undermined our elected representatives and institutions that the populace looks on them with contempt.

The self same media present sensationalist and poorly written articles and so the electorate are so badly informed that a public debate is often little more than a Pub rant.

Everyone who takes up a potentially dangerous hobby should have their own private insurance. We have car insurance, motor-bike insurance etc.
Insurance should be compulsory for:-
Skiers
Mountaineers
Skateboarders
Amateur sailors
...bugger it...professional sailors too
Parachutists
Hang gliding madmen
etc, etc, etc.

Why not?

#52

...and if they don't pay for insurance, charge them once the NHS has discharged them.

#51 I agree with you to a point but I don't think that our politicians are entirely at the mercy of the press. There is the opportunity for politicians of stature to lead these sorts of debates - but most have one eye on the opinion polls and the other on the opposition. We do have politicians of principle in this country but it is rare that the party system allows such people to gain prominence, because of the essentially feudal nature of party politics.

Perhaps this sort of debate can only be facilitated by having whipping boys in the shape of NHS managers. It must be absolutely soul-destroying for them though.

For those who waste time in not turning up for procedures/appointments etc-FINE THEM! The same way they do at the dentist,I cannot count the amount of times Ive waited in Drs surgeries with names being called and its obvious the people have not turned up.Also these time wasters who call out ambulances for ridiculous situations,fine them as well.This would save a fortune in the NHS.

People do not seem to understand that a person in genuine need could use the appointment YOU dont turn up for.

My local surgery posts on the wall the number of hours in lost appointments and exactly how much of the GPs time it wastes,I think they should be able to fine these people even if it was £5 an appointment that they miss.

VincentW, your posts are amongst the few sensible ones on here.

Too many people are happy to ignorantly regurgitate the media nonsense about NHS bureaucracy.

I guess these people would prefer it if doctors spent their time ordering light bulbs instead of treating patients.

This is absolutely not a news story. Everything is rationed - always has been, always will be.

If anyone wants to blame managers, then that is quite weak. Would you rather have the Dr taking time out of his day to organise the nurse rota, to improve patient flow through the hospital, to order in the needles, and so on? You need managers, and beleive me, they have a bloody near impossible job. Yes, many of them are clock-watching lazy idiots, but there are many that do a supreme job, so give them their due.

The money for our Health Service goes into the pockets of huge drug companies, in whose interest it is to have us UNhealthy. If we were all cured, they wouldn't reap profits.

Doctors should be free to prescribe natural remedies/treatments/therapies, at least, where the patient has purchased them privately and experienced relief from their use but perhaps cannot afford to go on buying them.

I was made more and more ill by the many medications prescribed to me as each symptom arose. These symptoms were caused by the previously prescribed drugs.

After much personal research and trial, I found natural remedies which really helped as did they for those to whom I referred the remedies/therapies, treatments.

The cost to me is great in relation to my income but nothing compared to the cost to our NHS of the drugs previously prescribed.

When, again after much research and self diagnosing, I was certain that almost all my symptoms came down to a fairly simple but serious answer, my GP is not allowed, because of licensing, to prescribe what would clear all, if not most of my symptoms. He did what he could and the improved difference, within days, was phenominal.

Unfortunately he cannot prescribe a longer course so I have to lay out the cost of the natural remedy to continue treatment for the next few months as advised in USA, Canadian, Russian, French and Janapese medical papers.

If I can't find the money all symptoms will surely return and I'll be fored to treat them with costly conventional medications.

It's not where the money is used that is in question: it 's where it's misused.

The drug companies have far too much control and we need to force our politicians to change this situation.

#52 and #53 - you really are quite bonkers.

Life is for living, not sitting on our backsides writing our opinions to other saddoes.

As soon as you proscribe one dangerous activity, or price it out of the reach of ordinary folk, people will find another. The human species live for danger and excitement.

In any case the relative cost of sports injuries is a small price to pay for the benefits. Sporting activity improves physical and mental health in children and adults. It's proven to aid learning and it increases productivity.

How much is obesity going to cost?

I really don't know why I'm arguing with you - your viewpoint beggars all commonsense. You are nothing but a mean spirited, narrow minded, indolent killjoy.

What about the cost of computer linked RSI?

Vital Spark,

while I agree that there are many remedies for ill health that do not need prescription drugs and that there are many remedies available which cannot be prescribed I am totally fed up with the demonising of drug companies.

Yes they are profit motivated - what's the matter with that! I do not think publically funded research laboratories could come up with the goods.

A young friend of mine has recently joined a major drugs company and started to learn how ethical they actually are and how carefully they work and share results with other companies. How they have pulled numerous projects because of miniscule risks etc etc etc.

Have the treatments you speak of undergone such rigorous testing? What's the comeback if they haven't and someone gets hurt?

Dundan of Edinburgh.

If our polititians are at the mercy of the Press (or even public persuasion), we wouldn't have invaded Iraq.

Also, if our polititians are at the mercy of anyone/thing other than their constituents, they are far from able for the job to which they were elected and should be elected OUT. Of course, with a party political system, this is not possible as such a system denies democracy.

Smutley, it has never, in the life of the NHS, been the job of the doctor or a nurse to order the light bulbs even before the managerial influx.

Now we have non medically trained managers, who get fat bonuses for making savings on hospital expenditure. Too often those savings are made at the expense of patient care.

Yes, hospitals and medical practices have always required administration: they always will do. it was done by promoted medical staff and hospital engineers. However, the amount of managerial staff has since gone into overload.

Trim the top.

I find it interesting how much people whine about the NHS. Government never was, never is, and never will be an efficient provider of services of any kind. How long will it take for this country to understand that?

Many over here complain about the U.S. system and all of those without health care. We'd do far better to switch to private like the Yanks, for several reasons: (1) private competition means they get far more services for a far better price--and at far better quality, (2) they get to make their own decisions about their own health care, and (3) there may be millions of Americans without health "insurance," but the little-known secret is that those people have access to health care as well. They just pay for it themselves or go to emergency rooms and get it for free BY LAW.

The fact is, we here in the UK get about the level of care as uninsured Americans--rationed care. The other 254 million Americans get much, much more than we could ever dream of.

Maybe one day we'll wake up and see that the free market isn't an evil thing; it is the embodiment of freedom itself.

61 Vital Spark - why do you think it is better to promote a senior nurse (with all of his/her training) into an administrative role, than it is to bring in a specialist administrator?

Being a superb nurse does not necessarily qualify you for management (though some do have good skills in this regard), just as superb managers are not qualified to prescribe drugs!

Vincent W:

I have personal, inside knowledge of the workings of the research into drugs and believe me, it is neither as ethical nor as conclusive as you claim. See the "No Free Lunch" site established and conributed to by medical practitioners from around the globe, as merely one source of confirmation of what I claim.

If you are going to make claims stating that drugs are withdrawn, when even miniscule risks are shown, you shoud perhaps read up on Seroxat among many others.

To what publicly funded, research establishments do you refer? Surely not our universities, which do receive some public funding but you go away and do some research on from where the bulk of their funding comes.

The natural remedies to which I refer have been used effectively, without much in the way of side effects, throughout history. Do you really think that (for one commonly known example,) Aspirin, which comes form the bark of the willow, was ineffective before it was taken into a lab and chemically reproduced?

Anyway, no time to argue with you. I must away to walk my dogs.

Okay, before I go:
Smelly jobby,

Why? Because the trained nurse/doctor has, in that training and years of experience, learned the needs and most practical means of fulfilling these needs in the field of medicine.

Of course not every nurse will emerge a brilliant administrator but those who do can be chosen for such promoted post. This is as it is in schools. Not every teacher, as example, becomes the head of a school.

Perhaps you see such expertise as being better utilised in a hospital ward or in "doing the district". Does the head teacher do better, in a big school, if he remains in the classroom?

Nurses are not all intent on remaining in the hospital ward. Some wanted to run departments and hospitals. Some may have developed arthritic conditions , for instance, or suffered from injuries which negaterd their ability to do the manual aspects of nursing but their brain capacity was never diminished: they never lost the knowledge they had gained by training and experience.

From a very early stage, nurses WERE/ARE training in administration as they had to write and give reports, even in their first year. This trainiing was acquired and developed practically, over the years, until they became excellent administrators as well as nurses.

Others left or remained, through choice, in a non administrative position. Promotion is not compulsory. The wards, for example, would not be left unmanned/womanned as all had gone to administrative posts.

Now I must go as my doggies are going to fall over with all legs crossed.

Vital Spark, I agree, nurses do have a place in the management system, just as you need clinical directors, but the truth is that it is much cheaper and frequently better to get a manager to do a management job, than to take away a front-line trained nurse, with all of the years of experience and training they have expensively had lavished upon them.

Let the doctors doctor, the nurses nurse, and the managers manage. They are allowed to talk to each other, you know!

to be advised 90 billion pounds later, that rationing is the way forward, what about the national insurance contributions that we have paid into the system, what about the rise in national insurance contributions that occurred not so long ago, as a senior nurse stated to me recently, if we let recently arrived non contributory aliens use the system to its full potential then 90 billion is a fly swatting exercise, all to no avail, i am glad we are bringing their health levels to somewhere near western European standards , but not so quickly to eleviate outbreaks of various types that were eliminated 20 years ago, q e d

#67 I'm a fan of Joyce, but would you mind repeating that in sentences so that I can understand what you're on about?

#66
Trouble is, in my experience 'managers' - ie bureacrats - have a very limited and rather 'black and white' view of complex problems which they don't understand because because they have not been promoted from within the ranks of the people they are expected to manage.
Donald A. Schon's book "Beyond The Stable State" raised these sorts of issues back in the seventies, and argued that the traditional 'centre-periphery' styles of management ignored the fact that ideas need to flow both ways.
Too many bureaucrats I've met wouldn't know an idea if it hit them over the head. Usually because the inside of the bureaucratic head tends to be cavernous!

Just curious??? Are private practices available in Scotland or is everything socialized???

Here in Texas my personal insurance is only about $125.00 per month and I can see any doctor I want...

#73 Why???

Tom Macfarlane, that is simply a pathetically low-brow attempt to contribute. To say that managers are empty headed is extremely weak and makes you come across as rather silly.

Yes, there are stupid and poor managers. They don't last long, as there are many easier ways to earn a crust than NHS management. There are, however, many more extremely good managers. They are unjustly made scape-goats/whipping boys for politicians/journalists all to often. This is unfair and simply means that many of the better ones leave the NHS and go to work as external consultants. I don't think you really understand what you are talking about though.

As regards your 70's management mumbo-jumbo, I've never met a successful manager that didn't make it their business to ensure that they had the best information available to them, and that those affected and involved (including patients) weren't active participants in any change process. This works in any line of business.

If you'd like to know why companies use management consultants (who frequently start with limited knowledge), you could try Bain's website and start to ask yourself why their clients do so much better than the average.

#70 Your experience is clearly severely limited, to the detriment of your understanding.

#77 thank you

On your socialist system I would have been blind...When I got shot in the face with a cross bow bolt I lost my left eye and the doctors told me if I was to wait any longer I could lose my vision in my right eye through something called -sympothy blindness- when the body attacks both eyes fighting infection...

I had surgery next day and was finished with hospital in 3 days...

Greetings from the states
Finally our rescue teams are charging the person or groups for their rescue when these people do stupid things, natural disasters excluded.
Now the private insurance companies are dictating the medical treatment we receive.

Texas Scot, the irony with private healthcare in the UK is that it is almost always carried out by the same docs you get to see for free on the NHS. The only advantage is that you can jump any waiting list there is. If there is something wrong with you that requires surgury you would rationally always want to be in an NHS hospital in case there are complications. They have the back-up.

What Chairman Gordon says about middle-class socialism is perfectly correct. They are the ones who can afford to live with the 'theory' of socialism, without having to suffer the consequences.

#80
Thank you... Just trying to learn about your system...

#78 Under our "socialist system" you would have been treated immediately, and free at the point of need, in a modern, well-equipped hospital with some of the best standards of care in the world. Much as we like to moan about it, we actually have it pretty good over here. :-)

There are those trying to make healthcare socialized in the USA and for 300 million people, I just can't understand how it could ever work...

#35-
The reason there are shock headlines is precisely because it makes a good story. The huge number of people treated for 'mundane' illnesses do not sell papers so don't get mentioned.

#45-
It's nothing about 'sports obsessed master race' it's about normal healthy people enjoying normal healthy pursuits which in the main benefit society by creating healthier bodies and minds. There is a 'relatively' low level of injury which is a small price to pay.

#49-
By and large the NHS provides an excellent service to the vast majority of people at a relatively low cost. From personal experience I have two parents who have had open major heart surgery and are still with due to the NHS, I have a son with serious health problems all sorted by the NHS, four healthy kids delivered successfully by the NHS and my own chronic problems looked after. I have numerous hard working and dedicated friends and relatives working in the NHS. But you want to dredge up some 60 year old statement to bash this fantastic organisation which has benefitted millions of people.

# 84
forgive my choice of words--- I don't know what else to call it

Gordon,

I'm not arguing with you - I don't give a flying cuss what these books say, if it makes you happy 'yes the NHS was built on a lie' fine now move on - all I know is I think the NHS is a great organisation which continues to deliver high quality health care to millions, it has a relatively small number of faults.

ps What's an ideologue - is it a good thing or a bad thing to be?

#59. Vincent W

Come on Vince. Did I say ban them? I merely suggested that ample medical insurance should be a priority( and if you look at my posts, some was tongue-in-cheek). If something is "risky" it should be covered. If you take out medical insurance, you'll pay more if you are a smoker. If you insure your car, you'll pay more according to risk covered (3rd party, fully comp etc). Do you think that if everybody insured their cars 3rd party only, that the companies should pay for theft even although the insurance excludes it? Obviously not. In other words, you get what you pay for. If you take out holiday medical insurance, you must declare all illnesses. If you have a condition, you'll either pay more for the insurance or the illness will be excluded. Holiday medical insurnce also does not cover "risky" sports.
...so...NOT a killjoy...merely a realist.

If the UK government and European Union stopped changing regulations every year or two, and if the government stopped interfering in the NHS then there wouldnt need to be as many managers.

That said, most NHS managers I have encountered have been hard-working, helpful and knowledgable.

Gord - it's not an opinion that the NHS has, does and will deliver high quality health care to millions of people. What is an opinion is that I believ eit to be worthwhile to persevere with the concept for the benefit of as many people as possible at teh lowest possible cost.

by the way - What's an ideologue - is it a good thing or a bad thing to be?

Melanthios

Yep I know you're tongue in cheek, but does that mean poor people can't play footie?

The vast amount of money spent on old folk in the NHS is what is crippling it.
It would make much better sense to put in place preventative care such as - get rid of damp cold housing.
Ship them off for a holiday for 4 months over the winter to spain and portugal or a caribean cruise.
It would be cheaper than the 12,000 dead injured and ill we have at present every year.

Melanthios - perhaps old people should have to insure themselves at higher rates because they're a much higher risk group than a rugby player. Their life expectancy is rubbish!

#96. Vincent W, Edinburgh 26 Jun

2007 "Melanthios - perhaps old people should have to insure themselves at higher rates because they're a much higher risk group than a rugby player. Their life expectancy is rubbish!"

Nearly impossible for my father (81) to get holiday insurance unless he pays a fortune. His attititude is to take his E111 (equivalent) and if he pops it abroad, bury him there!...but this is my point. Everything in life carries a risk. If you buy your house on a flood plain, your insurance will be immense. What to do? Insure or not? I notice that down south, yet again, houses are under water. Insurance will pay, but if you've none, who will bail you out (hey...that's a pun!). It strikes me as being sensible to take out extra insurance if you indulge in "risky" sports. If you can afford to take up a "risky" sport, you can afford to buy insurance.

Och....I'm off to do annoy a Rottweiler. Panic ye not...I have insurance.

#97

Last part should be I'm off to annoy. Don't know where the extra "do" came from.

(probably RSI)

This is a timely article for those of us in the US.

First, I would like to clarify something. Health care companies in the US are generally not "evil, profiteering, capitalist pigs" that some would make us out to be. I work for a large health care provider in Virginia. We are a "not for profit" organization, like most hospitals in the US. One way we maintain this status is by providing a community service in the way of FREE HEALTHCARE. The communities know that the taxes we do not pay don't come close in value to the free services that we provide that the communities thus do not have to. From our website: "In 2004, Sentara provided approximately $85 MILLION (with an M - my emphasis) in benefits to the community, including the cost of uncompensated care, community health programs, medical education and direct contributions and sponsorships to other charitable organizations."

Second, NO ONE IN THE US IS DENIED HEALTHCARE - NO ONE! It is against the law, as some of the more informed posters to this forum have stated. There are people without health INSURANCE, but none are denied health care. Unfortunately, like other societies on this planet, we have a significant number of bums. Bums that are bums due to their own lousy decisions, that sap the free health care and make it more difficult to provide free care to those who actually deserve it. This also drives up costs, as those of us who can pay, subsidize the bums. This is what is driving the insane calls for socialized medicine in our country.

It seems that some of our people do not learn from the experiences of others. We should all know (from simple observation - come on folks) that government does two things well: tax the people and start wars. Health care does not fit into either of these categories.

Poco

my scottish cousin's son was not happy with his gender so NHS gave him a sex change procedure on the taxpayers dime. enuf said!!!

You can say what you like about how so many Americans can't afford good medical health care because of the US's private health care system - but many other Americans get some of the best medical health care in the world. All this lousy socialist system gets is that EVERYONE gets the same poor health care and NOONE gets good care.

Chairman Gordon., #101.
Watched an interesting programme through the night on some channel just a few days ago, which stated that after the war when Labour wanted to create the welfare state it was unable. It had to go to America with a begging bowl for the money. The sting in the tail was we had to put the pound into the exchange system, which then crush the pound, this country, and made America a very powerful country indeed.

eeyore., #102.
This is not really the case in britain, and with greater numbers of people being in America the cost of drugs and equipment would surely be cheaper than here. The same for all doesn't mean poor service for all.

"104. Andrew Allan / 6:40pm 26 Jun 2007

This is not really the case in britain, and with greater numbers of people being in America the cost of drugs and equipment would surely be cheaper than here."

Actually the costs are a lot more becasue they have to build in a level of profit as well as taking account of the large number of mediacl negligence claims that need to be paid. My step-brother was invloved in a car crash in the States - the first thing they checked was if he had enough insurance - his total treatment won't leave much change at of three-quarters of a million dollars.

I hope you followed that - got called away and posted with my typos!!

:)

Keep it up, guys. We don't want or need "national health" here, so I'm saving your comments for the next political season when our socialists, the democrat party, try again to hang this ruinous millstone around our necks.
Rationing is a natural economic result of a high demand and low supply, with no price damper to limit demand.

This is only Doctors wanting more cash for less work ..get rid of the dross ..there is too much admin staff . pay the cleaners decent money as they used to ...as MRS is down to Private Cleaning Firms who are only interested in getting more money for less work and not the saftey of the patients or their workers..This is a Joke but not a funny one

This story makes me thankful that we don[t have a national health plan here (yet)./ I have had a lot of medical problems and have never had care and treatment "rationed". Gee, this isn't the end of WWII for heaven's sake! IIIIIIIIf Hilary C. wins she wants to push a national plan down our throats. Find if one doesn't have insurance ,it's better than nothing . However, I would rather pay for insurance than to have a bunch of government bureaucrats deciding my care and treatment. Yes, some insurance companies flex their muscles, but I have had many health problems that required a lot of surgeries, tests, etc. None were ever denied. For a first rate country with wonderful doctors, medical breakthrouighs, I can't understand why the health care in the UK is such a mess. The UK is a

above should have ended with UK is a wonderful, modern country except in the running of the health care. Great doctors, great nurses, etc. (on one of our trips ov er, we had an emergemcy and the care was good, No problems with medical staff.

#5 Pesky

Pesky said:

"Most western countries have an ageing population, in the US many are without any healthcare, many depend on charity handouts but what about Germany, France etc"

Here Pesky makes the fundamental error most Europeans make regarding the American health system. You seem to be equating National Health with "everybody gets it for free" and the American system "only those that have private health insurance get treated."

You couldn't be more wrong. In the first place it makes me wonder if you read the headline of the story you are commenting on. "Rationing" means some get it, some don't get it. In the US virtually every person has access to first rate medical treatment and on a very timely basis.

The political structure of the US is not well understood in Europe. The central government was never meant to administer constituent services such as medical care. While this might be practical in Europe, no comparison can be drawn with the US.

That is because the individual states bear most of that responsibility. It's a matter of size. The area of the UK is 93,000 square miles. Population 60,000,000. The area of the state of California is 163,000 square miles and has about 35 million citizens. This is where the type of coverage is offered to those without private insurance. If you think that the US is a heartless society because we don't have health insurance at the national level you are simply misinformed. American heath care is the best in the world and that care is available to as large a percentage of the American population as is provided in the UK by national heath, with the exception that American facilities are much more commodious and up to date.

will this include rationing highly paid managers and administrators given the budget constraints.

#109 If you think that the Democrats are socialists you've got a lot to learn about real politics (as opposed to the Washington goldfish bowl).

Anyone who thinks health care in the US is great has obviously not been in one of their public hospitals - the ones used by people who cannot afford health insurance and are not covered by Medicaid or Medicare.

Th reality is taht the US sytem does not get value for money at all - it is driven by profits - and greed.

114. 57Nomad,
You wrote

"American heath care is the best in the world "

You conveniently forgot to add "For those Americans who can pay for it"

As for you comparing England to California how stupid is that .
You are like the Talking Heads who compare the US to England.
Why not use common sense, and compare equal population blocks.

Example the US (300 million) versus Germany, France, UK, Italy, Spain (304 million)

Does this block Germany,France,Uk, Spain have 47 million of its citizens with no medical insurance as we do in the US.

Those 47 million Americans with no medical coverage suck off our system and flood our ER's.

Our medical drug programs are a criminal rip -off . Our Drug Co's, pour $hundreds millions into the pockets of lobbyists to stop competition from Canada or else where. Its nothing more than legal banditry.

Respectfully
Calactic Cannibal

I must say I wonder whether it is a genuine shortage of cash, or a case that the money available is sucked out through bureaucracy. However, I do admit I am not backing up that with a source, and so cannot state it as a fact.

It cannot be denied the current state of the NHS is diabolical. I was in absolute agony with severe chronic pain, interfering with my university studies and was told it would be four months before I would be seen by a pain specialist. I couldn't wait that long, and spent 235 pounds for a HALF HOUR consult with a private specialist. It was worth every penny but as a student that was a really significant sum of money. And before anyone jibes about students spending money on booze and clubbing, I do not drink and I have never been clubbing. I am interested in my studies and future career and am a serious student. However that pain specialist did suggest pain medication which does control my symptoms adequately. Then my GP told me he had the power to prescribe that himself, but GPs are warned not to prescribe strong painkillers for pain that is not due to cancer without a specialist opinion, as there are fears of litigation.

Last July my dad showed me a "funny mole" (Rather than ask his doctor he asks me, a vet student first which I found interesting), that I recognised as a probable nodular malignant melanoma. He saw his doctor who agreed and it was SIX WEEKS before it was removed. And then a further six weeks before he had the biopsy results back. And four weeks later he had a CT scan showing it had spread to the lymph nodes in his armpit.....And beyond belief they left it another 6 weeks before removing them because the surgeon was on holiday!

I can list more ridiculous scenarios I have encountered personally but that one just beggared belief, I would not have believed it if I hadn't seen this with my own eyes.

I think the NHS takes a short term view. I think it is very probable money could be saved in the

...This is disgraceful !....the time has come to abolish all private health care,private doctors,dentists,hospitals and and health insurance.the companies supplying the National Health Service with pharmaceuticals,capital equipment,beds,instruments disposables etc are charging far too much.What we have is a transfer of money from the taxpayer through the NHS into the pockets of shareholders in these companies....all the companies ,starting with those which build the hospitals, are on a gravy train.Nurses and other medical staff,including doctors,should NOT have to pay for their training. Profit should play no part in healthcare...if a poor country like Cuba,which has suffered 50 years of economic embargo from the US can do it then there is NO justifiable reason why medical treatment should ever be rationed in the UK.This is one problem which the gentlemen in Holyrood will eventualyy have to deal with,putting the people of Scotland before private profit and long established vested interests

For an American, this has been a fascinating discussion to read! We as well, on this side of the Atlantic, are struggling with many issues discussed here. Though we feel medical care is a right, it doesn't always translate that way in practicalities.

Our system is a multi-tiered mixture of private/public/and charity. Nationally, 18.1% of Americans lack insurance coverage of any sort. The rest have a combination of employer provided insurance coverage; self paid insurance coverage; or government coverage. I have a combination of
Medicare (because of a disability) and a self-pay Blue Cross/Blue Shield private policy. The BC/BS policy costs me $745./mo and Medicare is somewhere around $90./mo. If I didn't have the private policy to back up the govt. Medicare policy I'd be up a creek as my prescriptions cost my BC/BS $3200/mo. No way would Medicare pick that up and my income is $1345/mo. Were it not for my extended family I would not have the BC/BS plan.

Quality of care varies widely on the federal and state sponsored programs. It's all over the map. Sick kids are actually dying in Texas ( home of our presdent) because they have to wait so long to get on the special insurance program for severely ill children (like upwards of 5years)while in Vermont ALL children 19 or younger are covered under their state health plan.

We are struggling with some of the same issues all of you are talking about (two tiered system/rationed care/layers of empoyees who have no patient contact but are driving up hospital costs/plus young physicians graduating with debt which is enormous, etc. etc. etc)

We are resisting a national health care plan but the alternatives aren't all that rosy either.

IVF is rarely covered by private pay
or employee sponsored insurance and most definitely is NOT covered by any of the public programs I am aware of at this time.

Cosmetic surgeries are covered in the cases of congenital or accident caused disfigurement

#122 'wisdom', have you been out drinking the absinthe tonight?! I don't think you'll find many pharma companies willing to give of their research for free. I broadly agree with you, but we have to be real, man!!!!!!

Well all of the above can apply equally here in NZ.Especially the bits about damn Managers, Financial Controllers etc who drain the system of huge amounts in salaries and bonuses. The latter is what they get when they "appear to save the system Millions in expenditure" Whatever happened to the people who should run hospitals and health? The Doctors Nurses etc. They know what is required and why should anyone be rationed or placed on a Too old Basket?
Fegr

Guga, Aukland Arab and Ferg are right, there are too many people in management drawing large salaries and not enough people working.
We had a major reform some years ago and ended up with more people carrying clip boards than we had to man the ICU dept. Of course they had to be found fully furnished offices, computers etc. The hospital almost had to be rewired.
Seems its a worldwide problem.

So, the doctors' union baron says we have to be rationed. What a shame he's not so economical when it comes to his members' salaries. The man's a prat. There is plenty of money. We are told constantly of the strength of our economy and then that we only have enough money for Trident and not for cancer drugs.

I read a job description recently for a senior post in the BMA; the words patient interests did not appear in it, only best interests of members (doctors) and these were everywhere. We should tell Smallwood to belt up and get his troops to work when they are needed, not when it fits in with their busy taxpayer funded lifestyles. And we should tell the scoundrels in Westminster and Holyrood that we want our money spent on our health and not on incinerating Iraqi babies. Time for some health riots. BMA not welcome.

First I would like to reply to the comment #114 'America has the best healthcare in the world". This is a hugely inaccurate statement! While we are the leading spender in terms of healthcare dollars, we are behind every other industrialized nation (and a few 3rd world countries) in terms of health outcomes. We are the most wasteful and ineffecient healthcare system model in the world. We spend the most and get the least out of each healthcare dollar! You would think that a country that has such a large proportion of funds dedicated to healthcare that we would be among the more healthy populations of the world....but thats simply not the case.

(http://dll.umaine.edu/ble/U.S.%20HCweb.pdf)

While I agree with #62 that a free market would improve healthcare, what we have in the US is really not a free market healthcare system at all.

Take presription drugs for example...people pay a flat rate (copayment) for a drug and the insurance company pays the rest....so someone who gets a $300 dollar a month medication pays the same $5 copayment per month as the person who gets a cheaper, more cost-effective medication that may cost only $20 per month. The person recieving the prescription doesnt know the value / cost of the medication, its absorbed by the insurance plan. There is no incentive for the person to choose less expensive drugs because nothing comes out of their pocket, it comes to the cost of the insurance company.....the free market forces can not really be effective here.

I dont understand why rationing is such an ugly word....people do it every day. If you had to finace your own heathcare, would you be paying out your hard earned cash for a sex change or other non life-sustaining intervention? Maybe you would, but I would opt out.

Of course there would be a few that could afford it, but the rest of the people would "ration" their money els

Reading through a lot of the comment here is depressing as it is so ill-informed. I understand that most comments will be based around people's perceptions, and sometimes their experience, but it may be enlightening to read the minutes of Health Board meetings (I know they are lengthy) and talk with clinicians to get a better understanding of what a good number of people involved in the NHS are trying to do to improve services. For example, in the Greater Glasgow and Clyde Health Board area waiting times for treatment of breast cancer is down to 31 days, and for other types of cancer 62 days (the target time) or less. There are huge improvements being made in mental health provision as well as in other areas.
No point in making sweeping generalisations denigrating NHS managers. Some are very good and others not so good at their jobs - much the same as other professions.
Credit where credit is due. Yes, there is much to be done, but recognise that genuine improvements in service provision to patients have been made and will continue to be made as targets become ever more challenging as improvements are sought.

In addition to post 128, in the USA, people who can't pay and who don't have insurance, it is common practice for the hospital to attempt to collect the debt by use of debt collection agencies. You are also only entitled to free emergency care, not care that is not an emergency. A GP or other doctor can turn people away.

In practice at an ER the treatment is given anyway, and the hospital will try to collect the debt, though in some cases they do agree to write it off, though this will affect a credit score rating.

I know I'm not American, but do have experience of the US healthcare system, following a claim which was denied on travel insurance, although after years of fighting it was resolved by the ombudsman who made the insurance company pay, but not before years of letters and phone calls from debt collection agencies.

Another constantly overlooked item in regards to the 'free' healthcare provided in ERs here in the States is that those of us who cough up these horrific premiums for quality
insurance plans are actually underwriting all this 'free' care for the uninsured and indigent.

The hospitals factor in a percentage
of what it costs to provide this ER care and tack the cost onto say what my healthplans pay for everything from an office visit to blood tests to x-rays to physical therapy, whatever. So MY health plan isn't paying just for me but also all those who are uninsured and too poor to pay. THEN even if they are able to collect something from the uninsured, they are not obligated to reimburse the insurance companies ANYTHING (Hope that made sense) (Most of the time the conditions which bring an uninsured or indigent patient to the ER are not true emergencies but the hospitals are forbidden by law to turn the patient away. If the person presents themself they have to be treated in the ER)!

I recognize this is all a very complicated issue but every year the premiums for my health insurance plans goes up significantly.

Here in my town we are fortunate to have a quality free clinic for those without health insurance coverage and who fall into a certain
economic strata. Unfortunately, they are at their capacity for patient
load so far too many people still end up being treated in the ERs of this city.

The whole issue will make one nuts
and we have an administration in Washington which is hardly truly concerned about this problem. Put a bandaid on it and call it fixed should be their slogan.

#129, Yacker, right on. No one makes decisions (or statements either, for that matter) based [necessarily] on facts but on perceptions. That said, all bureaucratic systems suffer the same basic malady: self preservation and expansion through "rational" practices. Hence, as one poster said early on, "there are more managers than beds..." We have a cynical little joke about that dealing with an American crew who lost an important race. After management consultants(!) had studied the problem, all but one rower was dismissed to be replaced by assorted levels of supervision. When he lost the race next year, he was released as "inefficient", the supervisors reassigned to another sport and the Director dismissed with a huge bonus!

It isn't pleasant for me to read that Scotland (and the rest of the UK?) suffer from the bureaucratic malady, too.

#119 Taking a b m,

Taking said:

"Anyone who thinks health care in the US is great has obviously not been in one of their public hospitals - the ones used by people who cannot afford health insurance and are not covered by Medicaid or Medicare.

Th reality is taht the US sytem does not get value for money at all - it is driven by profits - and greed."

This poster has proved one thing to anyone who has ever lived in the US and it is: Taking a Bigots Money has never been to the US and knows nothing at all about the American health system. He posits the existence of a low class hospital where the indigent are treated by ill trained staff and in shoddy circumstances. Here is a direct quote for his post #119, "their public hospitals - the ones used by people who cannot afford health." No such hospitals exist in the US.

No doubt he's seen plenty of them in Europe, but that class of hospital can't exist in the US for the obvious reason. We don't have national health insurance. Where are the public hospitals going to come from if you don't have a national health system?

In all major cities there are large hospitals that serve all comers. But, the idea that these are warehouses is nonsense and again demonstrates the posters absolute ignorance of the American system. I live in San Diego County. Right in the middle of the City of San Diego there is a hospital that is open 24 hours a day, seven days a week, 24 hours a day. The term public hospital doesn't fit though, not the way you use it. If an individual shows up at the hospital, they will be treated. If they are insured, the insurance will be billed, if not, then there won't be a bill. Mexicans scoot across the border all the time to have their babies there. No one is turned away. The doctors and the facilities are world class. How do we do this without national health? It is the University of California, San Diego hospital. UCSD has two hospitals,

#128 Pharmdoc

Pharmdoc said:

"This is a hugely inaccurate statement! While we are the leading spender in terms of healthcare dollars, we are behind every other industrialized nation (and a few 3rd world countries) in terms of health outcomes"

Let me ask you something Pharmdoc. Didn't the school that granted you your Pharmdoctorate require you to take logic? You have to prove your case that there is a causal relationship between "heath care," and "health outcomes" are causally related. There are hospices that offer wonderful care but everyone that enters them dies within six months. The two cannot be presumed to be correlated. You have to prove it, you've only claimed it. Why should we take you seriously?

strike "are causally related"

There's an easy solution to the NHS's problems - gut the ranks of the management and replace them with staff who actually do the jobs that need done. The service is gagging on red tape and bureaucracy to the point where almost nothing can be accomplished.

By replacing management with skilled staff - and yes, I do mean to imply that the current management are unskilled - we will massively increase capacity while reducing costs through a massively lower wage bill.

You can't cure disease with paperwork...

Heres a thought - apparently something like 80% of accident and emergency treatments at weekends are alcohol related. People who get in fights, crash their cars, drink until they are legless.

Simple solution: anyone who turns up drunk, abusive, aggressive (in the care of the police) gets sent to a private 'police hospital' where they get charged £500 a day - or whatever their treatment costs.

This would a. free up accident and emergency for genuinely ill people; b. protect nurses and doctors from abuse and assault by drunken idiots. c. reduce the NHS bill by a huge amount.

#124....and I agree with you too...these companies will not give up the outrages profits they make....power and money are NEVER given away....however,if they won't give it up then it may be time to taken it off them.....

It's been really instructive getting so many views from the USA.

The main messages I get are:-

1. That there is probably no one best way to provide high quality health care at low cost to all citizens.
2. It's a very complex issue

The cultural differences between countries are incredibly diverse, and it's clear that many Brits can't get their heads round the American way of thinking and vice versa.

The common ground seems to be that:-

> We all know it's going to cost,
> Better off people will need to help their less fortunate brethren,
> We all have to work to reduce abuses (from whatever source)
> The pot is finite
> However the system is managed it must consult and listen to patients, clinicians and managers

#134 Nomad (in response to my #128 post)

First, lets keep this a philosophical and educational debate and not a personal attack on anyone's opinions (or in my case education....) My university did provide me with the basic education to assume a causal relationship, I was merely referencing facts from the World Health Organization.

( ...which you can read for yourself here: http://www.who.int/whr/2000/media_centre/press_release/en... )

The WHO uses 5 separate measures when they "rank" countries healthcare: "WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness...distribution of responsiveness within the population...and the distribution of the health system's financial burden within the population (who pays the costs)."

And while your hospice example does illustrate a good point, you can not use just one factor in evaluating a healthcare system as a whole. And just make a point about reasearch methodology you would be hard pressed to find a study on hospice care that used "death" as the final end point. Of course those people are going to die, you would certainly use other measures.

But back on topic: The facts are that the US spends the most on healthcare and as the worst healthoutcomes per capita. Does this mean the US has poor healthcare on an individual basis? Probably not. When the money going in doesnt translate into the care going out, it indicates a wasteful, ineffecient system.

Texas Scot #78 and before - can you tell me what sort of insurance you are buying for $125 per month that allows you to go wherever you want? I have worked for the last 30 years at a major medical center here in Texas. I pay $348.35 per month medical, $55.27 per month dental (there is premium sharing for people who insure their dependents). I can in theory go see whichever doctor I want, but working in the field, I am in reality sort of captive to this institution and its providers. Seeing a physician within the institution incurs a $25 copay per visit. Seeing any physician I want - which is certainly permissible - leaves me to pay 60% of that physicians' charges (out of network). Not saying I don't believe you - but can you give me a recommendation perhaps?

#114--you siad it all.You are so right regarding our medical care. #123, from Ann Arbor, Michigan. I don't know WHAT kind of area you live in but here in the Philadelphia area we have some of the best medical facilitiesin the world. Childrens Hospital of Phila. is known world wide and I have never seen a child turned way or given substandard care. Ditto our other hospitals. We have several medical schools that have wonderful hospitals and everyone gets first class treatment. Even the homeless are not pushed aside. You are giving other countries a very poor image of a country with the finest medical care in the world and it doesn't "ration" that care. Perhaps you should consider re-lkocating. People in the UK pay dearly for their so called "free" care. Their taxes are sky high and they pay for everything from television liscenses to a very high VAT tax. Count your blessings.

#119. Where did you get the idea that we have public hospitals here in the US? We have NO SUCH thing here unless they are in some unforgotten town in the boon-docks. Back in the 1950's there was PGH (Philadelphia General Hospital) It was a teaching hosptial that was a designated "city" hospital. Any nurse or doctor who received medical training there could write their own ticket upon graduation. They produced first class nurses and doctors. However,it was demolished years and years ago. Anyone who is sick can walk into a hospital and be treated with first class medicine.Should you ever be in the Phila. area and get sick, you will receive first class treatment.