Given they are only 3% behind on public services is hardly a ringing endorsement for Cameron.

True, very true, but it’s even more damning of New Lab that they can ever be behind on such figures.The Tories will massacre public services, but I guess do so relatively openly. New Lab has betrayed the services by spunking money away on PFIs and managerialism, imposing target culture and over-regulation that demoralises the front-line workers and pursued fragmentation, marketisation and back-door privatisation to an unreasonable, illogical degree (without even being able to strike a good deal with the private sector). The public are disillusioned with a crew that had a once-in-a-lifetime chance (with the resources and public goodwill) to really improve things, but they blew it. BIG time.You underestimate the sentiment of feeling betrayed at your peril, and it lasts.

Never mind Cameron’s credibility for the moment, why has it taken so long to ban use of premium phone rates for contacting the NHS?
http://news.bbc.co.uk/1/hi/health/8251290.stm

Even now “the ban would not apply to the cost of making phone calls from hospital beds, an NHS spokesperson said.”

I can recall from five years ago how I felt about that when I desperately needed to contact relatives from a hospital bed in intensive care. Nobody in government was worrying about premium rate phone lines in the NHS then.

The government’s own credibility is a live issue too.

Hmm. 26% of voters think that the Tories can produce ‘better’ public services? Is that really surprising given the number of Tories that make up the electorate? Not comparing like with like in this aspect are we?

Of course, you have to remember that many, if not most, Tory voters despise the public services anyway, so it is hardly surprising that they think public services being dismantled are ‘better’, is it?

No doubt for that type of Tory, no public service would represent “the best quality public services”, They wish to privatise the Health service and deny the poor access to health cover, I wonder if that is the same for the others in the Labour/don’t know would consider improving the NHS?

“They wish to privatise the Health service and deny the poor access to health cover”

C’mon. The credit for first implementing a national insurance scheme for personal healthcare goes not to Britain for creating the NHS in 1948 but to Count Otto von Bismarck, first Chancellor of the German Emprire.

“The Health Insurance bill . . was passed in 1883. The program was considered the least important from Bismarck’s point of view, and the least politically troublesome. The program was established to provide health care for the largest segment of the German workers. The health service was established on a local basis, with the cost divided between employers and the employed. The employers contributed 1/3rd, while the workers contributed 2/3rds . The minimum payments for medical treatment and Sick Pay for up to 13 weeks were legally fixed.”
http://en.wikipedia.org/wiki/Otto_von_Bismarck

Whatever else, Count Von Bismarck had no socialist inclinations whatever. Quite the opposite, in fact.

Bismarck or Beveridge: a beauty contest between dinosaurs
Jouke van der Zee and Madelon W Kroneman
http://www.biomedcentral.com/content/pdf/1472-6963-7-94.pdf

By the standards of other west European countries, independent observers rank the NHS as fairly mediocre at 18 out of 32 countries in the league table:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

“They wish to privatise the Health service and deny the poor access to health cover”

Your source for this? Even the evil Daniel Hannan doesn’t want the poor to have no access to the health service. A little fact checking would help (last I heard, the Tories were promising real terms increases in the NHS budget). Although I disagree with them on the policy, the implications of the policy mean that you can’t accuse them of wanting to privatise health.

I do agree with your earlier point about the ‘who will give better public services’ question though. Questions like this so often split down party lines and don’t really tell us a lot. For instance, a recent poll asked whether David Cameron’s cost cutting announcement the other week was a good idea or a populist gimmick. Over 90% of Tory voters said good idea and over 90% of Labour voters said populist gimmick – so we didn’t really learn a lot from that one.

[4] Is there any other European countries that sees as many as 19 million emergency patients (annually) and either admits or discharges 98% of them in less than 4 hours at a cost of just £25 per head (p12)?
http://www.cqc.org.uk/_db/_documents/Not_just_a_matter_of_time_-_A_review_of_urgent_and_emergency_care_services_in_England_200810155901.pdf

Think about that for a moment – it doesn’t matter if you come into an NHS A&E minus a limb, or with multiple severe pathologies the cost remains exactly the same, a mere £25 – now how far would 25 quid go at the vets, say?

You seem to attach great importance to the findings of an organisation that exhibits a clear bias toward market solutions yet even HPH acknowledge “There are NO countries, which excel across the entire range of indicators” (p14)
http://www.healthpowerhouse.com/files/2008-EHCI/EHCI-2008-report.pdf

And how are we take seriously a system that focuses on just 7 clinical outcomes, including a focus on ’suicide’ rather than mental health?
Incidentally rates of suicide hardly ever change – so are you advocating (along with the consumer group you link to) that we should have a duty to force people to live, even if they are suffering the final indignities of a debilitating illness and wish to end it all – what nonsense.

Mark M @ 5

“Your source for this? Even the evil Daniel Hannan doesn’t want the poor to have no access to the health service.”

I was talking about Toriy voters. 26% of voters think that the Tories would provide ‘improved’ public services. From what I have seen, read or heard on various media, blogs anfd forums, a significant number of people believe that abolishing public services (including the NHS) would ‘improve’ the public services.
I wasn’t talking about the Party’s declared policy as such. Though I am willing to bet that Hannan represents the rank and file Tory better than Cameron, though Cameron is savy enough to keep his real intentions close to his chest till after the election.

[7] Jim

Fair enough. Although I don’t think Tory voters actually want to ‘abolish’ health care for the poor, I accept the point that a majority of Tory blog commentors appear to believe there should be more private healthcare and a significnatly reduced roll in healthcare for the NHS.

[6] A & E Charge Nurse
“Is there any other European countries that sees as many as 19 million emergency patients (annually) and either admits or discharges 98% of them in less than 4 hours at a cost of just £25 per head (p12)?”

To the first part of the question, I have to confess I don’t know, but for clarification are you referring to the overall health system in the country or just the state healthcare system? With regard to 98% admitted or discharged, that can be an easily misled statistic because an A&E department could simply just admit everyone the second they come through the door and score 100% (exagerating a bit, but we’ve all seen the stories of A&E depts admitted patients in order to hit their target).

Mark M @ 8

“Although I don’t think Tory voters actually want to ‘abolish’ health care for the poor, I accept the point that a majority of Tory blog commentors appear to believe there should be more private healthcare and a significnatly reduced roll in healthcare for the NHS.”

I think if we were both being honest ‘forcing’ people to take on private health insurance will mean the death knell for the NHS. Those who can afford it will do so, even those on more modest incomes, will be forced into private health care, thus breaking the link between the middle earners and the NHS.

Once that is done, those on middle incomes will see no reason to contribute or defend the NHS then it can no longer command support and dies a death of a thousand cuts.

The Tories know the NHS is a sacred cow in political terms. That is why Cameron has announced that the NHS dudget is to be de facto ring fenced. Not because the Tory Party support the NHS, but because the public at large support the NHS and are unlikely to vote for a Party that wishes to destroy it.

After the next election, I fully expect that Cameron wrought iron ring fence will have sulpheric acid applied to it at certain points. Some ‘non front line bugdets will be slashed apart, IVF treatments for example.

[8] “because an A&E department could simply just admit everyone the second they come through the door and score 100%” ……….. eh !!
Why would A&E admit patients with an ankle sprain or benign upper respiratory tract infection?
Beside we haven’t got 19 million hospital beds – nowadays the NHS only has 170,000 beds, give or take (and in many hospitals bed occupancy already runs at 95+%)
http://www.dailymail.co.uk/news/article-1021814/32-000-NHS-beds-lost-Labour-say-Tories.html

After Thatcher developed the ‘internal market’ admin/management costs gradually doubled and now consume some 12% of the NHS pie (compared to a mere 6% pre-Thatch)
http://www.guardian.co.uk/commentisfree/2009/sep/03/nhs-business-markets

I’m sure Cameron will be just as effective at wasting public money – he must be rubbing his hands after the giant strides NuLab have taken implementing Thatcher’s vision of less for more under the guise of covert privatisation?

[10] A&E charge nurse – “Why would A&E admit patients with an ankle sprain or benign upper respiratory tract infection?”

In order to hit their target. I realise admitting everyone would be extreme, but nothing’s stopping them admitting anyone who’s been waiting 3hrs 59, solely to meet their target.

[9] I don’t believe that the NHS would die a death of a thousand cuts if middle class take-up of private insurance went up. I think most people are reasonable and understand the need for health provision among the poorest, much like most reasonable people understand there is a need for some out-of-work benefits. It would be a much smaller organisation, but I don’t necessarily think that would be a bad thing.

As A&E charge nurse says, the internal market has increased the need for admin/support staff. A real market would remove the need for the internal market. Like you say though, it’s a sacred cow and no politician proposing massive reforms involving an increase in private sector participation will ever get into power.

“After Thatcher developed the ‘internal market’ admin/management costs gradually doubled and now consume some 12% of the NHS pie (compared to a mere 6% pre-Thatch)”

I wonder how that compares with those healthcare systems in other west European countries – the ones where life expectancy is usually longer, infant mortality rates lower, there is better care after heart attacks on independent assessments, mostly higher 5-year survival rates after diagnosis for cancer and more physicians per head of population.

I also wonder why the McKinsey proposals for 10% NHS staff cuts concentrated more on reducing clinicians than on reducing admin/management. Could it be, as I’ve been advised by some local clinical staff, that there’s a need for more, rather than less, basic admin support? How come the reports that clinicians in Britain are the best paid in Europe?

Independent assessments of west European healthcare system don’t rate the NHS well in comparisons. Other countries haven’t gone for the huge monolithic structure of a verging-on state monopoly provider of healthcare services – the largest employer in the world after India Rail and the Chinese army. Are all those other countries wrong?

Mark @ 11

“I don’t believe that the NHS would die a death of a thousand cuts if middle class take-up of private insurance went up”

Middle income rather than middle class, Mark. The Tories and New Labour have been using similar tactics on services they wish to downgrade and dismantle of the last thirty years. From everything to council housing, town centre shopping right through to education and public transport. Give middle earners the opportunity of escape routes out of these services and the service can be abandoned with gusto. There is no appetite to build council housing or subsidise public transport to the extent that is required because the middle earners don’t use them, so they will not pay tax to subsidise them. Same with education; once a school starts failing, the middle class sally forth out to other schools and hey presto! Another bad school.

“I think most people are reasonable and understand the need for health provision among the poorest.”

Well, Barak Obama would disagree with you there. I assume that you include Tory voters in the ‘most reasonable people’ category? If so, I have to confess, I have seen scant evidence of this. If we didn’t have universal health care, free at the point of use now, we would be no nearer getting it than the Americans are.

“much like most reasonable people understand there is a need for some out-of-work benefits”

Again, I don’t need to go far onto mainstream Right Wing websites to find people who would certainly dispute the need for out of work benefits in any form. I am not just talking about the way out Right, I am talking about people not too far away from the centre.

“It would be a much smaller organisation, but I don’t necessarily think that would be a bad thing”

Which neatly illustrates my original point regarding what types of people define as ‘better’. Someone who wants less public spending and less social provision will undoubtedly think Cameron will ‘improve’ the public services.

[12] “there is better care after heart attacks” – no, that is plain wrong.

The NHS is the BEST in Europe when it comes to dealing with heart attacks (see 6 Comment, point 5)
http://www.rcplondon.ac.uk/pubs/books/minap04/index.htm

And this;
“Of eligible patients in England, 85%received thrombolytic treatment within 30 minutes of arrival at hospital, compared to 84% in 2006/7. In Wales 68% of eligible patients received thrombolytic treatment within 30 minutes of arrival at hospital compared to 70% in 2006/7 (p ix).
http://www.rcplondon.ac.uk/clinical-standards/organisation/partnership/Documents/Minap-2008.pdf

Delays arise these days because some patients are slow to summon professional help but not (usually) because of substandard care by the NHS.

This is a really worrying feature about NHS admin/management: a lot of hospital trusts are evidently clueless about their costs of treating patients.

“Last week an HSJ investigation revealed private patients are getting hundreds of thousands of pounds of treatment subsidised by the NHS.

“The most concerning revelation was not that some 30 per cent of patients were charged less than cost, but that almost half of trusts were unable to share even a rudimentary understanding of their spending on private patients.”
http://www.hsj.co.uk/news/finance/trusts-in-the-dark-over-cost-of-private-patients/5001878.article

#14:”The NHS is the BEST in Europe when it comes to dealing with heart attacks”

That is NOT what the Health Powerhouse, an independent Swedish healthcare think-tank, concluded after its assessment in 2008. According to the Euro Consumer Heart Index 2008 Report, the UK ranks at No 9 among 29 countries in the performance league table:
http://www.healthpowerhouse.com/files/euro-heart-index-2008.pdf

Regarding survival rates after heart attacks, this is one of the reasons why we need to question whether the sheer size of the NHS is dysfunctional:

Pay is centrally negotiated because the NHS is managed by the Department of Health and provides what is verging on a monopoly of healthcare services in Britain. But centrally negotiated pay means hospitals and other supply units can’t respond to local labour market conditions.

LSE researchers predicted that the ensuing difficulty of recruiting and retaining nursing staff in regions with strong labour markets would have worse medical outcomes than regions with weak labour markets where it is easier to recruit and retain nurses. And that is what they found:

“Hospitals in the north gain from a more stable pool of nurses. Southern ones have to lean on temporary agency nurses, who can be paid more but tend to be less experienced, less familiar with the hospital and less productive. Do southern patients suffer as a result?

“The economists look at the proportion of patients aged 55 or more, admitted to hospital after a heart attack, who die within 30 days. They find a strong link between this ratio and local private-sector wages. The higher the private wage, making it harder to get good nurses in the NHS, the higher the death rate: to be precise, if the private wage is 10% higher in one area than another, the death rate is 4-5% higher.”
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_TDVGGRSS

The original LSE research is posted here:
http://www2.lse.ac.uk/ERD/pressAndInformationOffice/PDF/CanPayRegulationKilll.pdf

[15] The Health Consumer Powerhouse Euro Consumer Heart Index 2008 Report states; “It is essentially impossible to get any type of official data on the quality of cardiovascular healthcare in most European countries” (p20).

Although, “It turns out that Austria, Denmark and the United Kingdom provide their citizens with latest quality information such as: Where are the good cardiovascular clinics? What are the success rates, fatality rates?” – same page.

Luxumberg, the most costly health system in Europe comes top of the list for cardiac care – but it it is not possible to make any direct comparison (with the NHS) if we think specifically about heart attacks because the relevant data is simply not made available amongst the HCP figures.

I’m not saying the info supplied is not interesting but it should be interpreted with caution, not just because of the many variables associated with certain types of health issues (such as the famously low rate of cardiovascular disease in France) but also because it is very difficult, if not impossible to directly compare a tiny principality like Luxumberg with a seething metropolis like the UK.

Slightly off topic, I know but here is some stuff on the ‘French Paradox”
http://www.healthscience.org/index.php?option=com_content&view=article&id=358:the-french-paradox-a-the-mediterranean-mix-up&catid=75:healthy-eating&Itemid=123

All goes to show that health comparisons between European countries is not always straightforward (or even understood).

Even further off topic – but continuing the heart attack theme – anyone taking a statin should watch this (since the cholesterol hypothesis does not bear scrutiny)
http://www.youtube.com/watch?v=XPPYaVcXo1I

[13] Jim

Fair enough. I think we’ll have to agree to disagree on this. I just happen to think that most middle earners (I actually meant middle earners earlier, not middle class – my typo) would be happy to pay some level of tax in order to provide some level of healthcare for the poorest – although I do agree that you don’t have to go far onto the rightie blogs to find people who would leave the poor to fend for themselves, I don’t think these people are representative of middle earners.

Like I say though, we’ll have to disagree because you appear not to believe that, and I’m not so arrogant as to presume my beliefs are any more correct than yours (likewise I’m sure you are not that arrogant either).

20 Mark M

I would be happy to agree with you had the evidence been there. So far, the evidence that once you remove people from a system they are quite happy to continue paying to improve a system they no longer (directly) benefit form. The Tories have been quite adept a dividing people from the poorest in society.

No Government has been willing to invest in council housing once the middle earners have been removed from council housing.
Public transport has been allowed to die off since middle earners have migrated to cars.
Failing State schools are allowed to crash and burn as long as middle earners can afford to buy themselves into better catchment areas.

Look at the job that Obama has trying to get pretty modest reforms through. The Right have put all kinds of scare stories up and mobilized the lie machines to convince America that universial health care would spell the end of the Republic. The clear implacation being that “why should the poor get treatment they cannot afford?”

The list goes on. I have no doubt that the majority of the Tory Party would see the NHS flushed down the toilet and Hannan repersents the rank and file of the Party more than David Cameron.

With the centralised management by the DH of the NHS – the third largest empoyer in the world after Rail India and the Chinese army – any future government will need to tackle this:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

And this:

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication. The number of alerts relating to errors or ‘near-misses’ in the supply or prescription of medicines has more than doubled in two years, the National Patient Safety Agency said.

“More than 86,000 incidents regarding medication were reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005. The figures, for England and Wales, show that in 96 per cent of cases the incidents caused ‘no or low harm’, but at least 100 were known to have resulted in serious harm or death.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

“Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable.

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

In answer to the question “is Cameron really trusted on public services” I think this is the best response I’ve seen so far
http://juliemcanulty.blogspot.com/2009/09/if-it-was-crime-to-be-conservative.html

I gave up on the Conservatives when, at the end of last year and the beginning of this, they opposed proposals for a modest fiscal stimulus to counter the recession in Britain even though governments in other rich countries were proposing larger fiscal boosts to counter recessions in their national economies.

As for the NHS, on the evidence, it has pervasive, entrenched defects. I dearly want to know why, on independent assessments, other west European countries manage to have better healthcare systems, in terms of outcomes for patients, than we have.

All have social insurance schemes for personal healthcare costs, as we have. The distinctive feature of the NHS is that it also amounts to a verging on state monopoly provider of healthcare services in Britain managed by a department of central government – which is how, in the final analysis, we came to have so many PFI funded NHS projects as those had to be approved by the DH.

Other west European countries have avoided the NHS model. Why?

A fantasy to mull over: should Patricia Hewitt be personally surcharged for wasteful spending in the NHS on the PFI projects and on that £12.7 bn database of personal medical records?

[20]

My point exactly. Different views of the world. Public transport to me hasn’t died off, but then it depends what you want out of your public transport system. You think it has, because presumably you want to see more people using buses etc.

I’m not in a position to say who is right or wrong, so we have to disagree.

Mark M @20

“You think it has, because presumably you want to see more people using buses etc”

No Mark, not quite, though I do see what you are diriving at. I don’t want ‘more people’ using public transport per se. I want people, given the chioce, choosing public transport because it is better than the alternative, i.e.driving on the roads.

I have seen the state of our public transport compared to major cities all over Europe and I have to say, our transport sytem is rubbish. If we had a better system, we could improve our Cities many times over.

In Thursday’s news: “Health secretary announces that fixed ‘practice boundaries’ are to be abolished within the next year”
http://www.guardian.co.uk/politics/2009/sep/17/andy-burnham-gp-boundaries

Of course, giving patients the right to choose their GP is a flagrant example of what Frank Dobson – Blair’s first health minister – was apt to regard as “cockeyed competition” in healthcare which can only serve to “push up costs” in the NHS.

Don’t believe me? Try this:
http://www.guardian.co.uk/uk/2003/sep/13/politics.society

I can’t imagine how they cope in France where you can walk along a street and pop into any GP’s surgery on the way if you want to. You have to pay for the visit but you can recover most or all of the cost from the state as well as from any occupational and personal insurance cover you may have. The test of whether this works is whether patients get a better standard of healthcare measured by patient outcomes, not the comfort of clinicians and politicians.