http://www.bbc.co.uk/news/uk-politics-19802234

A bit too bloomin' late, pal! Why didn't you and your muckers work a bit harder to stop it before it passed into law?

They really think we don't notice this rubbish, don't they?

To be fair, I don't think your average Mr John Q Tabloid does notice. They don't care if you notice it, as long as there's a dozen that don't, for every one of you.

Sad, but true.

The big problem is no matter who you vote for the government always wins.

One of the papers reviewed Milibot's speech yesterday, and claimed it moved Labour into the centre ground. Huh? They already were in the centre, how can they move there? Apart from the Bullingdon Boys showing they really are far right nutjobs after all, the centre ground has been so crowded in the past couple of decades it's a wonder all the political classes haven't suffocated under their own egos.

This is one of my pet hates, common to all politicians. They are not in power, they are in office - to serve.

The language they use speaks volumes.

The vast majority are not interested in internal NHS markets or anything similar. What people want is their local hospital is good for their needs. Simples.

Our Government has never got the concept of "simple". It never will.

No government has. It is an area where they can make their mark. They want their grubby fingerprints on something to leave a mark for history.

And its something that can never be supplied. The cost of having everything that people want in every hospital is beyond what the country can sustain.

Fixed for you. Now it's more accurate

Yes but that is what rationing is for. Doctors assess people on medical need. When that happens they want the best treatment possible, funds allowing. Sure we could aspire to the top US health level but that costs. I have no problem with various drugs being restricted because of cause. There was a stink about Herceptin a few years ago. It was very expensive and did not work for everyone. So yes it should be rationed for those that it would benefit, not necessarily given to everyone. What politicians have done is raised expectations beyond affordable.

The NHS is structurally unsound and subject to political interference of those who prefer ideological truisms to actual truths.

On the right are those whose love of markets is an article of faith. On the left are those whose fear of money grabbing murder corporations is its equal opposite. In general, markets allocate resources and spread good ideas much more efficiently than plans and committees do, but that only applies where the market works without distortion. Ideologues on both sides are too prone to wishful thinking and selective data analysis to cope with this problem.

In the past when politicians were too eager to play around with money supply for temporary economic relief at election time, they finally did the right thing and made the Bank of England independent. It's time the running of the NHS was put on a similar basis, with an independent board of governors handling how medical care is provided; a beefed up CQA with whistleblower guarding powers to oversee the results; and politicians can just hand over the money in gloomy silence.

The problem is the NHS can never be an 'ideal' market. There are restrictions upon it that fundamentally break that model - free at the point of delivery regardless of local cost variations, the wish for people to have local care in a service where the market can only operate at a national level, the fact health problems have 'local hotspots'. The fact some conditions are profitable whereas others are cost sinks etc..

You just can't operate the NHS as a market. At some point either the NHS's core principles or the market's core principles will have to give. If you let the NHS give you end up with an American health system and is anyone really going to argue that's a better way to do it? If you let the market give, you end up with the NHS eating a greater and greater amount of government expenditure.

So you just can't do it that way. Someone has to come up with a better idea than the ones that we've already had, because they were all rubbish. You can't just throw money at the problem (labour's approach) and just saying 'the market will fix it' (the tory approach) have both failed by any reasonable analysis. Repeatedly.

I do like the idea of it being an apolitical organisation with some level of informed, objective oversight and legal protection for whisteblowers. I think that may, in reality, be a bit pie in the sky though.

Jon

One thing that I hate about market fundamentalists is that they are not including all the duff products launched by private companies. Without which many private companies may be no better than the public sector at allocating resources. Though I do like the idea of completely independent trusts there is the problem of coverage. Making sure that every area is able to deal with most conditions and has enough surplus capacity to cope with a disaster.

I would love for it to be free from Govt interference. There are always silly policies. Recently, it was that ward rounds should be mandatory! Given that when I was in hospital, we would start the day with a ward round, it seemed ridiculous to make it mandatory. (The only time it wasn't in the mornings was if the consultant was going to do a formal ward round in the afternoon, in which case we did a "paper" ward round, liaising as appropriately with the nurses). The issue was not enough nurses attending ward rounds.

Prior to this, it was deemed necessary for nurses to do hourly bedside checks on all patients. If nurses are busy doing hourly checks, they're not going to be around for the ward round (which can last anywhere from 1 hour to 3 hours). Having patients' relatives there will only slow it down. After the ward round, it's time to do the jobs. If the ward round is sufficiently slowed down, then there won't be any time for the work to be done!

To give them their due, they definitely do consider that. The whole rationale behind their consideration of little else. The idea is that providers create new products and services, consumers purchase the best of those, and so the market efficiently filters out the crud and promotes the innovative.

The problem as Jon has identified is that that's great for the car industry where state planning created cardboard death machines and the Austin Allegro, while markets created BMWs and (less conveninetly for me) Hummers. But that isn't so good for cancer services, where innovative failures result in gruesome failings.

A major problem with previous attempts to introduce markets into the NHS has been risk. Companies can only invest if they reasonably expect a return. A wildly fluctuating NHS that changes its mind not just every time the government gets replaced, but each time the opinion polls look iffy or a ministry gets reshuffled is a terrible environment to make that investment in. So in order to get any private involvement, bad contracts that guarantee high returns for shoddy service have been signed. Those are market distortions that completely undermine the whole idea, and if markets can't be introduced without such foolishness then they must be shunned altogether.

I think there's some scope for markets there though, it requires honest assessment though of what a market can and can't fix. Health services can be capital intensive, with costly machinery which is purchased for very legitimate clinical reasons, but is then not used at full capacity (MRI machines that do nothing at weekends and nights for instance), which wastes budget. Bureaucracies are not good at fixing that sort of thing, but dirty money grubbing wide boys have their purpose in such cases.