A&E and ambulance performance worst ever - again

[lisvaneblue]

Re: A&E and ambulance performance worst ever - again

What do you mean by 'politicisation'? And how do you conclude that 'everyone wants the same outcomes'?

Pro or anti privatisation is a political question - and not just about efficiency/exploitation, management of costs and risks, and whether or not you are happy with public money going into private profit.

Choices about local or centralised priorities and decision making are political. So are questions about what is treated and what is not by the NHS (especially around fertility, gender realignment and 'lifestyle' diseases - which are often more about poverty). So are relationships with drug companies. Choices about recruitment into the NHS from other countries, and collaboration (or not) with other health services are also political. Maybe the objective (shared by all major parties according to their manifestos) of joining up of health and social care is more about management and administration - but it also includes clashes of priorities and cultures between public and private sector organisations and resolving that is a political issue - as are the choices about personal care funding.

I assume from your previous posts that the thing that annoys you most is the 'politicisation' of procurement practices - where the opposition have pointed out the greed, corruption and waste of the government handing out PPE contracts to their mates? Of course that should never be politicised! No that is 'deeply unhelpful'!

I used to work in the commercial sector of a pharmaceutical company and much of my time was spent with DoH/ NHS and procurement contracts. Without exception the procurement processes were always robust and in emergency situations, where there was no time to go out to tender, the unsuccessful companies always had the option of challenging the decision.
In my experience the weakness in the system was the failure to manage the market, particularly with specialist pharmaceuticals. It was common practice to go with the cheapest and before you know it all the business in the UK regions ended up with one company, the competition withdrew as they had minimal/no business...,so you can guess what happened next.

[Citizen's Nephew]

Re: A&E and ambulance performance worst ever - again

I used to work in the commercial sector of a pharmaceutical company and much of my time was spent with DoH/ NHS and procurement contracts. Without exception the procurement processes were always robust and in emergency situations, where there was no time to go out to tender, the unsuccessful companies always had the option of challenging the decision.
In my experience the weakness in the system was the failure to manage the market, particularly with specialist pharmaceuticals. It was common practice to go with the cheapest and before you know it all the business in the UK regions ended up with one company, the competition withdrew as they had minimal/no business...,so you can guess what happened next.

Isn't it important though to make a distinction between PPE and specialist pharmaceuticals? We've had discussions about our backgrounds so we're speaking the same supply chain language but PPE is a lot easier to manufacture than sterile catheters, for example. You're absolutely right in what you're saying, however it doesn't mean that the wholly inappropriate contracts handed out regarding PPE (or rather the way they were granted) is something a government shouldn't be held accountable for, as Jon's post illustrated.

For what its worth I've been on both sides of the NHS and these days have first hand experience of what the management problems are like as an end user and there's no doubt that - to state the bleeding obvious - it's a mess. I'm not sure any discussion can take place that's going to end in truly practical solutions without the spectre of financial argument, whether cross-party or not. People are going to have re-prioritse their financial management and we have to address the true costs of attempting to offer an free service in the 21st century. To put it simply, people will happily pay £1K+/yr on coffee in Pret than on their healthcare. It can't go on like this.

[Feedback]

Re: A&E and ambulance performance worst ever - again

What are you talking about?

The Welsh NHS is funded by the block grant. The priorities of Wales are set by the Welsh Government. If the Welsh wanted change they'd remove Welsh Labour. They haven't so they don't.

[Citizen's Nephew]

Re: A&E and ambulance performance worst ever - again

The Welsh NHS is funded by the block grant. The priorities of Wales are set by the Welsh Government. If the Welsh wanted change they'd remove Welsh Labour. They haven't so they don't.

No. You've shifted the goalposts. What has this got to do with Welsh Labour? You're allowing your politics to spill over. It's about a pot of money. Is that pot large enough? Where do we prioritise? You talked about zebra crossings as if these aren't important. They are. How can you possibly know how and where any Senedd government should spend the money unless you're actively involved?

[jon1959]

Re: A&E and ambulance performance worst ever - again

It's not sanctimonious, far from it.

I think a cross-party approach to the NHS is the way forward, but acknowledged it would never happen.

Soon after comes a response that is basically a polemic of party politics, quoting the guardian and Zarah Sultana.

I think highlighting that is fair enough tbh, because it perfectly demonstrated my point.

It demonstrates the stupidity of your point - which 'is fair enough tbh'.

My response was not party political - Labour gave privatisation a kick start under Blair - it was pointing out that the NHS is bound up in political choices and constraints. Pious appeals to keep politics out of the various debates about the NHS is either naive or dishonest.

[Feedback]

Re: A&E and ambulance performance worst ever - again

No. You've shifted the goalposts. What has this got to do with Welsh Labour? You're allowing your politics to spill over. It's about a pot of money. Is that pot large enough? Where do we prioritise? You talked about zebra crossings as if these aren't important. They are. How can you possibly know how and where any Senedd government should spend the money unless you're actively involved?

You've missed the point. The Welsh government could spend more money if it wanted to. Its about what they see as priorities.

[Citizen's Nephew]

Re: A&E and ambulance performance worst ever - again

You've missed the point. The Welsh government could spend more money if it wanted to. Its about what they see as priorities.

I think we've just cross-threaded and I'm too tired to try and unravel it!

[lisvaneblue]

Re: A&E and ambulance performance worst ever - again

You've missed the point. The Welsh government could spend more money if it wanted to. Its about what they see as priorities.

Exactly!!!!...and the priorities have been a £40m loan to Cardiff airport, following on from writing off £40m of airport debts. £150m on surveys etc for the m4 relief road, which, despite their own experts saying should be built, has been scrapped.

Add to that £330m on the heads of the valleys dual carriageway( despite all other road building being stopped), millions on nationalising Wales railways, millions on exploring the tidal lagoon concept at Swansea....I could go on.

Wales receives about £1.20 for every £1 England receives. I question whether our money is being spent wisely when our health service continues to fall short.

[Feedback]

Re: A&E and ambulance performance worst ever - again

I think we've just cross-threaded and I'm too tired to try and unravel it!

There's nothing to unravel.

The Welsh people choose their government, the governments sets the agenda, the Welsh people can choose to remove that government.

What is also missed is the Welsh government now has tax raising powers, so its within their power to make changes. Its not all about Westminster.

What is also missing in this thread is geography and topography. Its going to cost a lot more to provide an ambulance service to Powys than it is to London, on a per capita basis. Compare Wales with Cumbria or Northumberland and the results may be similar.

[Rjk]

Re: A&E and ambulance performance worst ever - again

Exactly!!!!...and the priorities have been a £40m loan to Cardiff airport, following on from writing off £40m of airport debts. £150m on surveys etc for the m4 relief road, which, despite their own experts saying should be built, has been scrapped.

Add to that £330m on the heads of the valleys dual carriageway( despite all other road building being stopped), millions on nationalising Wales railways, millions on exploring the tidal lagoon concept at Swansea....I could go on.

Wales receives about £1.20 for every £1 England receives. I question whether our money is being spent wisely when our health service continues to fall short.

most of the costs you've mentioned are infrastructure spending, which we definitely don't spend more on than England. whereas wales spends more per capita on general day to day spending like health and welfare because its needs are higher , it isn't within the remit of the welsh government to take infrastructure spending and spend it on healthcare instead - nor would it be a particularly good idea

[Citizen's Nephew]

Re: A&E and ambulance performance worst ever - again

OK, so to summarise so far. It's a good idea to have cross-party management i.e. work together, governments are corrupt, budgets are mismanaged, we don't prioritise our health and, my own personal favourite I'll shoehorn in... the planet's f*cked.
Thank buddha for the footie tomorrow.

[JamesWales]

Re: A&E and ambulance performance worst ever - again

It demonstrates the stupidity of your point - which 'is fair enough tbh'.

My response was not party political - Labour gave privatisation a kick start under Blair - it was pointing out that the NHS is bound up in political choices and constraints. Pious appeals to keep politics out of the various debates about the NHS is either naive or dishonest.

Must you be so ****ing rude? I'm saying party politics should be kept out of healthcare. That's a reasonable statement. You respond with a tirade and quote a far-left MP and some irrelevant guardian article about the English health secretary when we are talking about Wales.

You didn't need to do that. Could have pointed out where everyone can work together and focus on common goals. Instead it's always more sectarian stuff. It's why nothing will ever change

[jon1959]

Re: A&E and ambulance performance worst ever - again

Must you be so ****ing rude? I'm saying party politics should be kept out of healthcare. That's a reasonable statement. You respond with a tirade and quote a far-left MP and some irrelevant guardian article about the English health secretary when we are talking about Wales.

You didn't need to do that. Could have pointed out where everyone can work together and focus on common goals. Instead it's always more sectarian stuff. It's why nothing will ever change

There is nothing sectarian in my posts. I countered your opinions about people 'politicising' the NHS by pointing out that most of the decisions - legislation, resource allocation, public-private roles, access etc - are political (whether or not party political) and you dismiss that as a tirade, without engaging with the points at all. That is so ****ing rude!

The tweet from Zarah Sultana MP and the Guardian article are pointing out the way the Health Secretary has used his political position to gain personal financial benefits from the NHS and extend privatisation. You need a re-think on where the politicisation is coming from.

The other strand to this thread has been all about the political choices about the health service available to the Welsh Government. Absolutely right and it cuts right across your pitch. There are choices to be made about priorities and resources (even if constrained by UK law and UK government budgets) and the people should be able to decide on those issues through their elected representatives. But it is not just about manifestos and elections or party political 'point scoring' (aka holding the other lot to account) the thing is political with a small 'p'.

[Feedback]

Re: A&E and ambulance performance worst ever - again

There is nothing sectarian in my posts

why the straight face?

you accuse Westminster of all sorts, but ignore the Senedd. In your world when its good in wales its down to Welsh Labour, when its bad its down to Westminster. you also go on about profiting from healthcare, and completely ignore that the largest non state healthcare providers in the UK are non profit (BUPA and Nuffield Health). You seem to think that only the state can provide healthcare without turning a profit. most will agree that BUPA and Nuffield Health are light years ahead of the NHS in terms of quality of care, service and outcomes any surplus reinvested in patient care.

What I don't understand is if someone can see a specialist today, why can't the NHS pay for it today? Why do they have to wait 6 months? If its on BUPA or Nuffield then the specialist will see you straight away. All we need to do is follow the German and French model that allows private sector delivery but funded by the public purse. Waiting times are unheard of over there. However, the politicking you claim to avoid wouldn't allow you to admit there are alternatives to what we have at present that does not involve total state delivery.

meh!

[jon1959]

Re: A&E and ambulance performance worst ever - again

why the straight face?

you accuse Westminster of all sorts, but ignore the Senedd. In your world when its good in wales its down to Welsh Labour, when its bad its down to Westminster. you also go on about profiting from healthcare, and completely ignore that the largest non state healthcare providers in the UK are non profit (BUPA and Nuffield Health). You seem to think that only the state can provide healthcare without turning a profit. most will agree that BUPA and Nuffield Health are light years ahead of the NHS in terms of quality of care, service and outcomes any surplus reinvested in patient care.

What I don't understand is if someone can see a specialist today, why can't the NHS pay for it today? Why do they have to wait 6 months? If its on BUPA or Nuffield then the specialist will see you straight away. All we need to do is follow the German and French model that allows private sector delivery but funded by the public purse. Waiting times are unheard of over there. However, the politicking you claim to avoid wouldn't allow you to admit there are alternatives to what we have at present that does not involve total state delivery.

meh!

I can't remember ever commenting on Welsh Labour in the way you describe. I usually avoid the arguments about the Senedd because I don't live in Wales. I plead guilty to commenting on the cock-ups and corruption of the UK government. But there you go. meh!

I agree with your general point about the NHS accessing services immediately if they are available - but I don't know (do you?) what the NHS has to pay for those services. A registered charity and an insurance-funded 'not for profit' company maybe should have a role in health care provision to users of the NHS - they are not profit-led private sector organisations of the sort that now occupy large parts of the NHS.

I don't know enough about the French and German health care models to comment. I know you have been advocating the German approach on here for years. I understand that there are short waiting times for testing and treatments/surgery, but isn't it funded by additional health insurance payments on top of general tax contributions? Does that mean that health outcomes are partly dependent on ability to pay?

This was an interesting (and recent) reference:

https://www.william-russell.com/blog/countries-worlds-best-healthcare-systems/