Election Depth, go Clegg!

greg66_tri_v2.0

DonDaddyD wrote:

NHS stuff

I thought one of the questions last night was particularly awkward, and none of the three dealt with it (largely, I suspect, because there is no palatable answer). It was this: how in the future do you deal with an ageing population who will require greater medical care in their later years, and the increased costs of equipment and drugs to treat them?

You can cut all the waste and bureaucracy you like, but there are two massive costs right there that will always rise and rise and rise. I've no idea what the solution is.

artaxerxes

Trident - Do we really need a nuclear deterrent? How have Japan, Germany, Switzerland, Brazil etc managed to survive without one?
If we must keep these doomsday devices, shouldn't we share the costs and subs with France?

Aircraft carriers - too late to cancel these and there is probably a better case for these since we have to be able to get planes to the Falklands.

DonDaddyD

Greg66 wrote:

DonDaddyD wrote:

NHS stuff

I thought one of the questions last night was particularly awkward, and none of the three dealt with it (largely, I suspect, because there is no palatable answer). It was this: how in the future do you deal with an ageing population who will require greater medical care in their later years, and the increased costs of equipment and drugs to treat them?

You can cut all the waste and bureaucracy you like, but there are two massive costs right there that will always rise and rise and rise. I've no idea what the solution is.

You're right not an easy answer.

Gordon's 'keeping people in their homes' stance I can guarantee you wins the NHS vote.

Greg T

Greg66 wrote:

how in the future do you deal with an ageing population.

Bit close to home is it oldster?

You'll be OK - I see a future for you in the underpasses around the Imax at waterloo.

Eau Rouge

People seem to have a very different understanding of this whole economic crisis than I do it seems. I don't really see that it had all that much to do with any government, or that there was much any government could do. The problem was a lack of credit in the financial sector caused by the sharing of risk. House prices, for example, didn't fall due to them being overpriced, they fell because nobody could get a mortgage to buy them because the banks couldn't borrow the money to lend to them because there was a global lack of credit.
Governments around the world "filled in" the missing money in exchange for ownership of the banks because you can't have an economy without a banking sector. To blame the government for the crisis just doesn't seem to add up to me. The UK got hit a little hard due to the fact about 1/3 of government revenue came from the financial sector.
There were decisions and choices along the way to be made, and maybe others would have made other ones, but given that it was a global problem I'm kinda glad the Tories, who don't ever seem to really get "international" weren't calling the shots.

All the parties are vague on needed cuts because it will be the same civil servants actually making the cuts no matter who gets in. There will be some "this scheme or that scheme to cut Minister" choices but nobody knows what those options will be right now, and only the actual Minister will ever be told.

I disagree with the Lib Dems on Trident. I like a nuclear deterrent and subs are the best way to have one. How do the listed countries get by without a nuclear deterrent? By enviously wishing they did have one so that they too could have the international position the UK and France do. Is it worth the cost? Maybe, maybe not, but that should be the debate, and it isn't.
Mind you, if I were in charge I'd have great fun using the need to fund the cost of Trident to beat BAE Systems about the head over Navy contracts and instead get to buy cheaper and better equipment from elsewhere.

jedster

NHS stuff

Personally I think that a social health system is a really good thing - people should get teh healthcare they need regardless of their ability to pay. That said, I think that the NHS is so big it is essentially unmanageable.

I think that much more of the service delivery should be outsourced to private companies but still paid for by the state (e.g., units that specialise in say hip transplants, cataract ops, whatever). Competing units would drive down the cost of operations, etc.

LAbour has done some of this, started under Blair then slowed under Brown. But much more is needed.

I agree with Greg, one of the best questions was about how we control the costs of new treatments and aging population.

Competition led efficiencies is one way. Another is that some things that are now free should incur a small charge. I'd start with £10 for a GP appointment. People on benefits would not be charged (like prescription charges). This would raise some revenue and deter some of the timewasting appointments.

Even with all that, I think healthcare costs will continue to rise. In case anyone hasn't worked it out yet, the reason that all the parties have said that they will protect NHS budgets is because there is no alternative. Restricting the INCREASES to 2-3% will be hard enough. There is no real prospect of lowering the spending so it's easy to say that the budget will not go down!

J

greg66_tri_v2.0

Eau Rouge wrote:

People seem to have a very different understanding of this whole economic crisis than I do it seems. I don't really see that it had all that much to do with any government, or that there was much any government could do. The problem was a lack of credit in the financial sector caused by the sharing of risk. House prices, for example, didn't fall due to them being overpriced, they fell because nobody could get a mortgage to buy them because the banks couldn't borrow the money to lend to them because there was a global lack of credit.
Governments around the world "filled in" the missing money in exchange for ownership of the banks because you can't have an economy without a banking sector. To blame the government for the crisis just doesn't seem to add up to me. The UK got hit a little hard due to the fact about 1/3 of government revenue came from the financial sector.

Wellll.... yes and no.

I agree that the banking crisis had at its root credit in the banking industry, and that was a global issue. But what could the Govt have done? Well, encouraged more prudence on the part of banks in the first place (whether by regulation or more transparent accounting policies, it doesn't really matter), so that our banks weren't so heavily exposed as they were.

Bailing or not bailing is a difficult call. RBS: probably, from what I've read, the decision was a no-brainer. Northern Rock? Hmm. I suspect that could have been put to the wall without too much blood. In which case nationalising it was a political call.

But the problem lies with the fall out: the Govt didn't hold back enough from the good years to build a surplus sufficient to provide safety net when this blew up. Remember Darling and Brown saying that the British economy was the strongest western economy to whether the credit storm (c Sept 08, IIRC)? Not so much, as it turns out.

The thing is that there's a country that's been here already in the 90s, and came out of it very successfully by making deep cuts in the public sector, AND had a history of greater prudence in its financial sector than us: Canada. There's a reason why the Loonie is crapping all over every other currency in the world right now.

(see here for a patronising summary from a patronising Starkey).

rjsterry

Competition between companies can work to reduce costs, but isn't some panacea. The privatised railways and utilities companies are a good example of where the supposed competition is almost entirely an illusion, leading to inefficient organisations which have very little incentive to improve the services they provide.

jedster

Eau Rouge,

How do the listed countries get by without a nuclear deterrent? By enviously wishing they did have one so that they too could have the international position the UK and France do. Is it worth the cost? Maybe, maybe not, but that should be the debate, and it isn't.
Mind you, if I were in charge I'd have great fun using the need to fund the cost of Trident to beat BAE Systems about the head over Navy contracts and instead get to buy cheaper and better equipment from elsewhere.

I was told by a senior diplomat that if Britain decided to give up nukes, there would be a lot of lobbying from other European countries for us to rethink. Partly it is because they feel that we offer them some protection (and indeed there are treaties to this effect). Partly it is becasue they hate the idea of France being the only nuclear power in Europe! I kid you not.

Just out of interest, where would you be looking to buy this "better and cheaper equipment"? I think the only options for most Naval equipment would be US and France. The US equipment is even more expensive. I saw a cost comparison of Astute vs Dallas-class and the US boats were much more expensive per copy. I don't think you could argue that the French ships/boats are better. Surely T-45 is the best air defence ship in the world? The French were seriously thinking about joining in the carrier programme because it offered better VFM than the De Gaulle class.

So I think the issue is really what can we afford to have. Personally I would spend a little MORE on defence (under Brown it has fallen to a low share of GDP despite the wars). But if that is not an option, I think the carriers were a mistake (good ideas if we had the money but we don't) and we should cancel the second one. You probably realise that the cost of the aircraft is much bigger than the cost of the ships. Seems likely to me that both will be built but only one will get a full air wing.

J

jedster

Competition between companies can work to reduce costs, but isn't some panacea. The privatised railways and utilities companies are a good example of where the supposed competition is almost entirely an illusion, leading to inefficient organisations which have very little incentive to improve the services they provide.

Yes, if you design a market so there is not proper competition of course comepetition doesn't work very well

Privatised monoplies (i.e., where customers have little real choice) have to be regulated because competition doesn't do the job. I don't see why (say) eye hospitals in a densely populated country like ours couldn't be pitched in real competition.

alfablue

jedster wrote:

NHS stuff

Personally I think that a social health system is a really good thing - people should get teh healthcare they need regardless of their ability to pay. That said, I think that the NHS is so big it is essentially unmanageable.

I think that much more of the service delivery should be outsourced to private companies but still paid for by the state (e.g., units that specialise in say hip transplants, cataract ops, whatever). Competing units would drive down the cost of operations, etc.

LAbour has done some of this, started under Blair then slowed under Brown. But much more is needed.

I agree with Greg, one of the best questions was about how we control the costs of new treatments and aging population.

Competition led efficiencies is one way. Another is that some things that are now free should incur a small charge. I'd start with £10 for a GP appointment. People on benefits would not be charged (like prescription charges). This would raise some revenue and deter some of the timewasting appointments.

Even with all that, I think healthcare costs will continue to rise. In case anyone hasn't worked it out yet, the reason that all the parties have said that they will protect NHS budgets is because there is no alternative. Restricting the INCREASES to 2-3% will be hard enough. There is no real prospect of lowering the spending so it's easy to say that the budget will not go down!

J

It is easy to say things like "it is essentially unmanageable" but what does this actually mean? It is obviously managed, and seeing as it is the 3rd largest employer in the world (Indian Railways and Chinese army being 2nd and 1st) I would say it is extremely well managed overall. That is not to say all is perfect, far from it, but show me a large organisation under such pressure that does better. What we mustn't do is confuse ever escalating demand, and higher than normal inflation for health supplies, equipment and drugs, with a failed service.

I have no time for suggestions that private companies in competition would drive down costs. Firstly, tax money would end up in shareholder dividends and executive bonuses; secondly, admin costs are well known to be double in private health care; thirdly, the idea of competition in health care provision has been largely discredited since its introduction in the 90's (it has been greatly modified since); fourthly, these competing companies are where? Each town has 5 different hip surgery providers? I don't think so. Finally, such private providers will merely behave like a cartel to keep prices high (look at telecom providers for example, Ofcom has to intervene all the time to bring prices down, the free market doesn't do this), whilst excellent NHS services wither on the bone so they are soon entirely dependent on these privateers. Believe it or not, I think this is an absolutely AWFUL idea

artaxerxes

I think the carriers were a mistake (good ideas if we had the money but we don't) and we should cancel the second one.

Cancel them if there is no oil in the Falklands :evil:

greg66_tri_v2.0

Greg T wrote:

Greg66 wrote:

how in the future do you deal with an ageing population.

Bit close to home is it oldster?

You'll be OK - I see a future for you in the underpasses around the Imax at waterloo.

Did you nip onto someone's pc while they were at lunch? Back to the postroom for you little boy... :twisted:

greg66_tri_v2.0

alfablue wrote:

It is easy to say things like "it is essentially unmanageable" but what does this actually mean? It is obviously managed, and seeing as it is the 3rd largest employer in the world (Indian Railways and Chinese army being 2nd and 1st) I would say it is extremely well managed overall.

You forgot WalMart, which comes in at no2.

The issue with the NHS is that, well, it's there. Because it's there, it can't easily be dismantled, or restructured without howls of "abolition!". It's become a self-perpetuating monolith.

I'd quite like to give the German system a whizz. Seems to work pretty well for their 100m odd citizens.

jedster

alfa,

In my experience, basic admin processes in the NHS fall massively below the standards that would be expected in any normal business. These result in severe inefficiencies.

The sort of things I'm talking about:

1. Arriving on a ward with my ill son. Registering. Seeing a nurse. Shift change. New shift had no idea that we were there. This caused an extra night in hospital.

The problem is about communications - it's generic, not anything specific to healthcare.

2. My father in hospital with complications from cancer. His symptoms spanned three specialties. The issues about his treatment kept getting bounced from one team to another without it seeming to be any one person's responsibility to seek a conclusion/resolution. Again, longer stay in hospital than required.

Again this kind of cross-cutting problem is common in lots of organisations. You just need to have the right system of communications and accountabilities to fix it.

3. My son in an A&E department was referred to another hospital for an urgent operation. My wife was told not to drive him there herself or to get a taxi but to wait for an ambulance. After 8 hours she was told there was no ambulance and should make her own way there.

Again, this is a failure of basic planning, administration and communications. Not some medical specific issue.

All these of course are anecdotes and prove nothing.

I had colleagues whose area of expertise was "lean operations". This is the field of management about how to optimise business processes for quality, consistency and efficiency. A lot of the thinking stems from Toyota, etc. but has been applied to lots of other industries - services as well as manufacturing with great benefits. They did some work in the NHS (combination of pro bono and reduced fee) and were able to achieve some really outstanding results.

Don't get me wrong, I think the medical professionalism within the NHS is of high standard. The basic process management is not. Fixing this would bring big benefits.

J

alfablue

Jedster

These glitches are not good, at all.

1) is poor nursing, no excuse. I would discipline those responsible (assuming they had the resources to do this properly).

2) is about the reductionist approach that the medical model assumes: patients have to fit in pigeon holes, these are linked to clinical specialisms, what happened is inexcusable, it is an issue of management, but this sort of problem lies in the philosophical and cultural models of health and medicine that underpin health care organisation in most western systems. What is needed is a holistic approach to care, this has been trialled in some special units, based on nurse-led care (nurses had overall responsibility, medics used as required for their specialist input).

3) is a result of the application of the principles of the free market, and the purchaser/provider split, in the 1980's and the disintegration of the component parts of the NHS that resulted (similar to your proposal for contracting out bits of the service). These separate trusts do not dovetail perfectly - that was entirely foreseeable!

None of the above problems would be resolved by competition, which is, by its very nature, un-cooperative. Lean management, yes, that would be great, "market forces" = tried, tested, failed, and is behind some of your anecdotes. Lets learn from our recent history, not just turn the clock back and repeat it all over again!

Eau Rouge

jedster wrote:

I was told by a senior diplomat that if Britain decided to give up nukes, there would be a lot of lobbying from other European countries for us to rethink. Partly it is because they feel that we offer them some protection (and indeed there are treaties to this effect). Partly it is becasue they hate the idea of France being the only nuclear power in Europe! I kid you not.

That seems to make sense. Isn't there a global testing ban and they have probably all signed the non-proliferation treaties. Nobody wants the French alone having that power.
The Brazilians in particular are looking for a Security Council seat, a Britain without nuclear weapons would be under massive pressure from them. Europe would rather two EU countries have seats than just the one.

jedster wrote:

Just out of interest, where would you be looking to buy this "better and cheaper equipment"? I think the only options for most Naval equipment would be US and France. The US equipment is even more expensive. I saw a cost comparison of Astute vs Dallas-class and the US boats were much more expensive per copy. I don't think you could argue that the French ships/boats are better. Surely T-45 is the best air defence ship in the world? The French were seriously thinking about joining in the carrier programme because it offered better VFM than the De Gaulle class.

The US maybe dearer on subs but thats not true across the board.
I'm not an expert, but I really don't get the T-45 at all. The current two just about manage to out-gun a River Class patrol boat, but only just. They have no Phalanx and PAAMS is still trying to get out of the testing phase. But even when fully armed I don't get them.
Their (only) role is air-defense, but thats a crap role for a ship You're putting huge pressure on the weapons systems (still in testing) because by the time you spot the threat it's very late because you're radar is stuck on a ship. For a fraction of the cost you fly a fixed-wing AWACS off the carrier thats sitting a couple of miles away anyway and it sees far further than your destroyer does and is better placed to guide your fighters to intercept the threat a lot earlier. $1bn each seems a lot for such a limited platform.
Far better to do as the Koreans did, and spend half that building their own versions of a far more useful surface vessel, the US Arleigh Burke destroyers.

I almost like the carriers. There is nothing the T-45's nor the frigate-replacements BAE will come up with can do that proper carriers can't do better, so a couple of decent carriers and a couple of decent Landing Platforms is all the Navy needs of a surface fleet and we can save billions by not building out-moded ships we don't need.
But the carriers as designed aren't proper. They don't have a catapult take-off system. They need that, everything hinges on it. They can already carry more helicopters than a frigate, and can therefore do a better anti-submarine job than one. The catapult would let them replace the poor helicopter AWACS they currently rely on with a proper fixed-wing version that flies much higher and therefore can see more. It would also allow them to not buy the very expensive, unproved hovering version of the F35 but the much cheaper Navy-version that carries more weapons (there is still some concern that a fully laden F-35C won't actually be able to land on a carrier's deck as the engine won't provide enough lift) Thankfully, the carriers can easily enough be modified to have catapults, they were designed to have them. The extra money would be nothing compared to not having to replace the current frigates and buying cheaper F35's
It is, alas, too late to cancel the T-45's. Maybe we could sell them off?
Mind you, first up is telling the RAF to go take their plans to run the Fleet Air Arm and fly away....or ride away on bikes ... road bikes (this is the commuting forum)

(or at least, thats what I'm told)

jimmypippa

What is so wrong with coalitions?

I seem to recall that most (West) German Governments have been coalitions, and they didn't seem to do to badly.

il_principe

MatHammond wrote:

I don't think it would be relevant if it was just DC that had gone to Eton. But when you have a potential Prime Minister, Chancellor, London Mayor (amongst others) who all went to the same school it starts to look a little like these people aren't necessarily where they are on merit but as a result of a ridiculously privileged background.

They all studied at one of the best Uni's in the world though... dunno about you but I want intelligent, well educated people running this country, don't care what their background is really. This reverse snobbishness is a little petty really.

rjsterry

Blimey Jedster and Alfablue, do you both have the day off? There's the makings of a novel there.

IP, I agree with you there. If they're going to run the country, I'd like it to be someone decent.

I remember a similar point being made on the Daily Show with Jon Stewart about the US elections. Some rightwing commentator had labelled Obama as elitist, and Jon Stewart pointed out that just maybe running America required the best of the best, rather than 'just an average Joe'. After all they'd just tried that and it didn't work out to well.

DonDaddyD

Il Principe wrote:

This reverse snobbishness is a little petty really.

Yes, but I wouldn't want a return to the snobish class structure that the Conservatives are likely to bring... We'll have to drink at different pubs... you, Lit's and the Greg's can have yours and I'll be outside with the dog's and Irish.

The whole point is that the majority (because lets face it the majority of people in England could be identified as working class) want someone who bests represents them or who can at the very least identify with them.

I wonder why Cameron's 'hug a hoodie' never caught one... Do they even allow hoods at Eton?

greg66_tri_v2.0

DonDaddyD wrote:

The whole point is that the majority (because lets face it the majority of people in England could be identified as working class) want someone who bests represents them or who can at the very least identify with them.

Ok. Did you consider Princess Di to be "one of us", and the "people's princess"?

And a lot of people hated the greengrocer's daughter, as I recall. And weren't that keen on the son of the music hall performer who never got further at school than his O levels. But seemed to like the barrister quite a lot.

No accounting for taste, obviously.

Seriously, DDD, I think you've been suckered in by Nu Labour's Class War theme.

alfablue

Il Principe wrote:

MatHammond wrote:

I don't think it would be relevant if it was just DC that had gone to Eton. But when you have a potential Prime Minister, Chancellor, London Mayor (amongst others) who all went to the same school it starts to look a little like these people aren't necessarily where they are on merit but as a result of a ridiculously privileged background.

They all studied at one of the best Uni's in the world though... dunno about you but I want intelligent, well educated people running this country, don't care what their background is really. This reverse snobbishness is a little petty really.

I agree with Mat, and whilst their intelligence cannot be in doubt (they grasped the privileges their birth afforded with both hands), intelligence is not synonymous with wisdom, altruism or morality. Intelligent people can be highly dangerous, reckless, immoral etc. I am sure I don't want the country run by a branch of Eton College!

alfablue

rjsterry wrote:

Blimey Jedster and Alfablue, do you both have the day off? There's the makings of a novel there.

Whoops, better get back to running this NHS trust :oops:







not really

greg66_tri_v2.0

alfablue wrote:

I am sure I don't want the country run by a branch of Eton College!

I just don't get why people equate a single public school with the very worst of human qualities. Would it make a difference if they had all gone to some minor public school that not many people had heard of?

jedster

There is nothing the T-45's nor the frigate-replacements BAE will come up with can do that proper carriers can't do better,

PAAMS will shoot down missiles. The Saudis actually thought seriously about buying one or two to park in the gulf to provide missile defence to East Coast (oil fields) against Iranian missile strike.

Incidently, seems pretty likely that T45 will get cruise missiles integrated at some point in the future.

If aircraft are the answer then why do US carrier groups need Arleigh Burkes for defence?

And I don't see how you can do without Frigates - unless you are willing to give up the ability to patrol sea lanes around the world - your carrier (given you'll only have one of two guaranteed available at any one time) can't be everywhere.

Porgy

DonDaddyD wrote:

If you're a millionaire you'll be alright though...

No change from the last 31 years then :roll:

Porgy

Fireblade96 wrote:

You all have a vote .

Not me - I was homeless for too long - now I'm not on a register. Even if I put myself on now - I'll be away on May 6th. Oh woe ! - disenrachised again. I won;t get to spoil my vote now.

Porgy

DonDaddyD wrote:

Yes, but I wouldn't want a return to the snobish class structure that the Conservatives are likely to bring...

a return? when did it go away? :?:

bigmat

I don't think its petty to be concerned that the proposed next government is made up of a bunch of untested, inexperienced ex-Etonians. My concern is that they have reached their position through their opportunity and contacts more than their ability. Osborne in particular cut a pretty weak figure next to Darling and Cable in the economic debate the other week. Boris Johnson apparently looks down on Cameron as an intellectual inferior which is pretty scary. People are criticising Brown's CV but what has Cameron achieved outside of politics? A very average PR man, his main ability appears to be selling himself and his ex-school mates.

So there you go, I don't want to engage in class warfare, but I have what I believe are legitimate concerns about the make-up of the Tory front bench.