- this kind of authoritarian nonsense is just what Home Secretaries do. David Blunkett brought in RIP (then, to his very slight credit, changed his mind). Jack 'boot' Straw was famous for his I-AM-THE-LAWing. I don't think the Tories are any better.
- No, criticizing the NHS is not against the religion there. The newspapers are forever getting in digs about long waits, unpopular (but perfectly rational) decision from NICE about what drugs to pay for, and junior doctors and their apparent insistence on being paid properly.
- And with that in mind, having lived in three countries (four if you accept that the NHS in England and Scotland are different) I personally think the NHS is fucking fantastic. Someone close to me was diagnosed with a serious illness and immediately swept up in a production line of modern, effective treatment. Sure, it was somewhat impersonal, the biscuits are rubbish, and they were a widget on the production line, but they're also still alive ten years later, and we still have a house and savings.
- kudos to your sister. The UK is an ethnically diverse place, one of the least racist and divided that I've seen, but - like everywhere else - imperfect. The NHS always seemed to me to be a reflection of what things could be elsewhere with doctors, nurses and cleaners hired from all over the world. [which reminds me that while the right-wing press hates the NHS for being free, the left wing press occasionally hates the NHS for bringing in medical staff from poorer parts of the world. They just can't win]
This is exactly what I'm saying. The NHS are seen as perfect by some. All criticism is digs that are wrong.
I'm pro-NHS. But this perspective that it's infallible is beyond all reality.
I've never met anyone who thinks that the NHS is perfect - least of all anyone who has used it or anyone who works there.
This is why I'm pleased that for the ward I visit, biscuits and snacks are provided by a charity, it is the best of both worlds.
Not only I am not bankrupt from medical care, but I also get to enjoy decent snacks and a good coffee machine.
Many years ago now my sister turned down the chance to go to an international conference held in the Netherlands, when I asked why, she said it was because the NHS was the best in the world and had nothing to learn from other healthcare systems. I'm still stunned, and she still doesn't know anything about other healthcare systems.
Often, when people criticize the NHS they have an ulterior motive, like privatisation. Consider all the political difficulties the NHS has had in the past few years. As such, negative remarks can be read or misread as dogwhistles for other views, so they're something that have to be phrased carefully and within context.
I was unclear: did you publish a book, or did your sister?
In general, for something both as key and as endangered as the NHS is, criticism isn't always useful -- support is. Problems can be recognised and addressed through support.
I'm not anti-NHS, I've no agenda to see it privatised, I just want it to be better. I tried many, many private routes first. I tried NHS England, NHS Digital, the Innovation Service, AHSNs (many sections having since been renamed/reorganised). About 20 different contact points over two or three years, most of which seemed inappropriate but I made sure if anyone told me it was someone else's responsibility I checked with them.
The problems had already been recognised through public inquiries and yet were still ongoing.
I even offered to build the software for free, which, hopefully, for an individual dealing with an organisation with a budget into the hundreds of billions, falls under supportive. But as far as I could see, offering support was getting me nowhere.
I just had people acknowledging the issue and then shrugging their shoulders, pointing fingers at everyone else. So I wrote a book on it, spoke about the issue publicly and within months it was decided to spend tens of millions on sorting it.
Very very very few people think the NHS is infallible. What are you even talking about? We all understand the NHS has many many problems, and those of us that have used the NHS understand this even more.
However, we still think it's a lot better than the private healthcare model.
Not sure what you're getting out of this weird strawman argument you're putting forward.
This kind of political insecurity is toxic for rational conversation. Blindly rejecting the criticisms of our political opponents is just as naive as blindly accepting their criticisms. Either way we handover control of the conversation.
Yet private healthcare is a strawman, I've never argued for it.
I think it's wonderful that you offered to do that but it simply isn't realistic. Who is going to support this software in the long term? How are you handling privacy concerns? What guarantees can you offer about server security? Who is paying for and maintaining the servers in the long term? What happens (to be blunt) if you die the day after the software is delivered?
There's so, so much wrong with the way governments provision software projects from outside parties. But there is good reason to have contracts the length of the Bible. Picking up work from individuals on a whim is courting disaster.
What private healthcare mode? WHat they have in the US? Then definitely yes. What they have on France or Germany or Japan or almost every other developed country.? Then No. What they have in Singapore? Still No.
There are persistent and valid claims that the NHS is inefficient in its use of technology. It wastes lots of money, wastes clinicians' time, and sometimes fails to get accurate information to the people who need it in time to be used.
But there is a best being the enemy of the good problem here. The amount of regulation involved in supplying any kind of tech product or IT service to these public sector organisations is becoming prohibitive. Parts of the industry that have been providing these products and services into the NHS are being crippled in productivity or even literally shutting down whole supply chains because it's too onerous to comply with all the red tape. It's not just individuals but the small businesses that employ or engage them and then the medium-sized business that use the small ones.
If you're working with big consultancies with their own legal and compliance teams then sure you can write hundreds of pages of contracts and require compliance with several external standards about managing personal data and IT security and whatever else. But that regulation flows downhill to the smaller suppliers who don't have resources already available to deal with those issues and at some point it becomes overwhelming and everyone has had enough and decides to become a gardener. Now your only options for supply are big consultancies engaging big suppliers who charge big prices and provide big company levels of service and responsiveness (in the most pejorative sense of these terms).
Surely this isn't the best strategy for a system that desperately needs to be more efficient and sometimes more innovative. There is a broad spectrum between "adopt a one-off product with no support from a single well-meaning individual" and "everything requires so much red tape that only the places charging those £x000-per-day consulting rates we're always mocking are actually allowed to provide it".
One guy had a brain infection and was told to wait four months for an appointment. Another went in for a root canal, left without a tooth, and fainted outside the clinic. Someone else was refused an X-ray after an accident.
Meanwhile, in my tiny country, we have a dual public-private health system, and the facilities, doctors, and dentists are top notch. It really makes you wonder what's gone wrong in the UK, considering how much taxes British people pay.
There are also plenty of rules that exist for dogmatic reasons and impose absolute requirements that don't always make much sense in context instead of stating principles that should be appropriately applied.
I understand that those administering these rules don't want to leave loopholes where people or cost-conscious suppliers will cut corners for convenience and/or to save money. There is obviously a danger of that happening if you don't write everything down in black and white.
But you have to remember that the starting point here is receptionists at medical facilities asking people to email over sensitive health information or casually discuss it on the phone when they don't even know who they're talking to and what information is appropriate to share with them. Doctors are trying to read vital patient information from scrawled handwriting on actual paper in potentially time-sensitive life-and-death situations. Expensive scanning equipment in hospitals relies on software that runs on 20-year-old versions of Windows from a supplier that shut down long ago.
In this context you probably win a lot just by having clear policies and guidelines that really are short and simple enough for rank and file staff working in a wide variety of different jobs to understand. A reasonable set of basic technical measures would be far better than much of what is in widespread use today. Trying to make everything perfect so we have fully computerised health records and integrated diagnostic and treatment systems and everything is 100% secure and privacy-protected and supported is a laudable goal that would obviously be much better for patient outcomes and also for the daily lives of everyone working in healthcare. And in 50 or 100 years maybe we'll be able to do it. But not today and not tomorrow.
Unfortunately the main problem is chronic underinvestment by successive governments of all political inclinations. We tend not to fix our roof in the summer because we hope the other guys will be in government by winter when everyone inside is getting wet and they'll get blamed for the consequences of our decision. We've also made some poor choices historically around selling off national assets and questions of privatisation or public ownership.
This isn't unique to the NHS and ironically among the current Labour government the Health Secretary, Wes Streeting, is one of the few people suggesting significant changes that actually do make sense for the long term future of our country. Unfortunately a lot of them will probably require more than 5 years to implement and that puts the results over the horizon beyond the next general election. So the price for trying to "do the right thing" might be that he won't get re-elected to see it through. This enables the cycle of short-termism and lack of consistent investment to continue even though its horrible results are increasingly clear for all to see.
I've lived in both the UK and the US and there are issues with healthcare in both. Maybe the model your country uses could scale up to populations the size of the UK and the US, maybe it wouldn't. Difficult to know.
Ironically, that's not a problem in China, they have a one-party authoritarian state and can plan 10, 20 years ahead without worrying about elections or political instability.
And, it's very much a "public-private" health system. E.g. all GP's and most dentists are private businesses, paid for by the NHS to varying degree, but also with many providing private services.
The NHS uses an extensive network of private providers, including (when sufficient funding is provided) to drive down waiting lists. I've personally had a procedure carried out at a private hospital at the NHS's expense.
The NHS has many problems, but at the root of a whole lot of them is that the NHS needs a funding increase of 20%-30% to get to similar levels of funding per capita as similarly wealthy countries.
The UK spends about as much per capita on the NHS, providing universal care, as the US does on just Medicare and Medicaid.
As a percentage of GDP, UK healthcare spending is well above the EU and OECD averages. We spend a greater share of our national income on healthcare than Belgium, the Netherlands, New Zealand, Australia, Denmark, Finland or Norway.
https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?most_...
Good questions, but the quickest way I can answer them all is to say that my company had delivered software for national security purposes to central government departments. This really was nothing.
It certainly wasn't my preferred option. The offer was mostly a tool to ensure that cost of development could not be used as a reason to reject.
It certainly wasn't even my preferred option, I'd have been much happier if they said they had a team that could run with it.