Some Brexit

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Re: Some Brexit

Post by S1K @ Thu Nov 28, 2019 4:11 pm

I would like to see Diane Abbott interviewed about Labour’s tax and spending plans by Andrew Neil.
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Re: Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 4:49 pm

thekungfury wrote:
Doctor Congo wrote:
Dirk wrote:
Doctor Congo wrote:
Dirk wrote:
Paul H wrote:
Dirk wrote:The US drugs firms could put up their prices (to us) at any time. They don't need a trade agreement to do that. Why don't they?


I'm struggling to believe you are this stupid, Dirk. Right now we trade with the US as a member of the EU not as a lonely friendless island looking for a good fcuking.

I'm struggling to believe you are so obtuse. The NHS buts pharma from drug companies. The US is not asking to increase duty on this drugs. It is objecting to NHS using is bulk buying and negotiation to get drugs cheap. That applies whether or not we are in EU.


And if we are looking for a trade deal when we have none in place, how strong a negotiating position do you think the UK will be in the Americans force the govt to prevent NHS from reducing drug prices?

Exactly the same as we were because this is about drug company pricing, not tariffs, regulatory etc

FWIW I do not believe that the trade deal we will get will necessarily be favourable (especially given Trump's distorted view of favourable trade deals). I just don't see why this issue is at all affected


We will not have the bargaining power of being part of the EU and it’s regulatory framework, nor a trade deal with the EU where we can source alternatives for these medicines or purchase them at a cheaper price via the EU. Consequently the American companies will ride roughshod over our requirements as it’ll be our quid pro quo for concessions elsewhere, like food standards for instance which appears to be another area where the Tories are preparing to sell us up the river.

I think this medicines thing is a red herring. EU has no trade tariffs on finished drugs (ingredients are different) so after leaving on WTO or Boris’ deal the drug prices won’t change.

US pharma can complain all they want about us buying cancer drugs cheaply but ultimately it’s a global free market. NHS has big buying power and will continue to have long after we’re independent.

Tories going to a more private/insurance healthcare model is something else entirely and it does concern me for the country, even if it won’t affect me personally.


Interesting comment. Why do you think it won’t affect you?
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Re: Some Brexit

Post by thekungfury @ Thu Nov 28, 2019 5:06 pm

Doctor Congo wrote:Interesting comment. Why do you think it won’t affect you?

We have private cover. Obviously that doesn't help for GP or emergency services but it's not high on the list of my priorities to be totally honest.
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Re: Some Brexit

Post by Pigeon @ Thu Nov 28, 2019 5:18 pm

Of course "private cover" in the UK at present has to still look worth it when you can use the NHS for free instead. In the US, it's a bit different.

Doctor Congo wrote:...like food standards for instance which appears to be another area where the Tories are preparing to sell us up the river.


DOWN the river you terrible ist.

S1K wrote:I would like to see Diane Abbott interviewed about Labour's tax and spending plans by Andrew Neil.


Him? He's a wanker. I encountered him on twitter arrogantly putting people down with his supercilious of-course-I-know-better-than-you-you-ignorant-peasant attitude in defence of some point he thought was hugely significant but which was in fact based on contradicting himself in the middle of his own tweet. So I quoted one of his own putdowns back at him and pointed out that while it wasn't true of whoever he'd said it at, it was a great description of a dimwitted fuckwad who is too thick to notice that he's arguing for a logical contradiction. (Or something similar to that, I can't remember.)

It was at this point that I understood why someone who watches TV had spent the previous few weeks complaining about him being a cnut on it. Seems like his standard method is to piss people off so much with his arrogant patronising attitude that they are too wound up to respond coherently while he steamrollers them with the same kind of bollocks he was coming out with on twitter.
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Re: Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 5:20 pm

thekungfury wrote:
Doctor Congo wrote:Interesting comment. Why do you think it won’t affect you?

We have private cover. Obviously that doesn't help for GP or emergency services but it's not high on the list of my priorities to be totally honest.


You’ll be surprised how little your private cover will actually extend to. I deal with them regularly and they are continuously reducing what they will pay for. In fact some are now telling customers that if a treatment is provided by the NHS, they will not provide cover for it, whatever it is. It’s got to the point where I think it’s a total waste of money to have.
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Re: Some Brexit

Post by CJ+ @ Thu Nov 28, 2019 5:53 pm

Doctor Congo wrote:
thekungfury wrote:
Doctor Congo wrote:Interesting comment. Why do you think it won’t affect you?

We have private cover. Obviously that doesn't help for GP or emergency services but it's not high on the list of my priorities to be totally honest.


You’ll be surprised how little your private cover will actually extend to. I deal with them regularly and they are continuously reducing what they will pay for. In fact some are now telling customers that if a treatment is provided by the NHS, they will not provide cover for it, whatever it is. It’s got to the point where I think it’s a total waste of money to have.

Aren't most private services actually delivered by the NHS anyway, but it just comes with a wine list and net curtains?*

*I have a very stereotyped and probably very inaccurate view of private healthcare, based on what it was like for an old boss of mine 30 years ago on BUPA
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Re: Some Brexit

Post by mervynp @ Thu Nov 28, 2019 7:11 pm

Just a sneak preview of what you have coming - my wife went for her annual check up recently and we got the bill this morning. Our very expensive insurance will pay for the lion share of the ~$1000 that the flobotomists charge after discount to draw three vials of blood but they have decided that one of the tests was not medically necessary so we now owe $300. Happy thanksgiving indeed - I can afford it as I'm a filthy rich silicon valley technocrat but many can't so it's no surprise that people often pass on basic and preventive care.

Also I have to say it is really something that the likes of Andrew 'Brillopad' Neil is seen as the acme of journalism and political interviewing in 2019, has the level of discourse really declined that much? It's pisspoor here but it seems to have been that way for a very long time and it is probably nostalgia but I'm sure the quality of debate and understanding about politics used to be so much better in the UK.
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Re: Some Brexit

Post by Tokyo Sexwale @ Thu Nov 28, 2019 7:36 pm

CJ+ wrote:
Doctor Congo wrote:
thekungfury wrote:
Doctor Congo wrote:Interesting comment. Why do you think it won’t affect you?

We have private cover. Obviously that doesn't help for GP or emergency services but it's not high on the list of my priorities to be totally honest.


You’ll be surprised how little your private cover will actually extend to. I deal with them regularly and they are continuously reducing what they will pay for. In fact some are now telling customers that if a treatment is provided by the NHS, they will not provide cover for it, whatever it is. It’s got to the point where I think it’s a total waste of money to have.

Aren't most private services actually delivered by the NHS anyway, but it just comes with a wine list and net curtains?*

*I have a very stereotyped and probably very inaccurate view of private healthcare, based on what it was like for an old boss of mine 30 years ago on BUPA

I had an op privately 2 years ago and it was nothing like the NHS in drag.
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Re: Some Brexit

Post by thekungfury @ Thu Nov 28, 2019 7:40 pm

Doctor Congo wrote:It’s got to the point where I think it’s a total waste of money to have.

From very recent and semi-recent (past decade) personal experience and close family experiences I disagree and would never not have it.
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Re: Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 8:14 pm

thekungfury wrote:
Doctor Congo wrote:It’s got to the point where I think it’s a total waste of money to have.

From very recent and semi-recent (past decade) personal experience and close family experiences I disagree and would never not have it.


A decade is a long time. It’s astonishing how much they charge for premiums and how little they cover and offer. My speciality is the busiest outpatient speciality in medicine and we do the most interventions by a long way and most insurance companies now provide the bare minimum and often refuse to cover any more than a consultation. It’s cheaper to pay per use than pay premiums and find they won’t fund treatment when it’s needed.
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Re: Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 8:17 pm

CJ+ wrote:
Doctor Congo wrote:
thekungfury wrote:
Doctor Congo wrote:Interesting comment. Why do you think it won’t affect you?

We have private cover. Obviously that doesn't help for GP or emergency services but it's not high on the list of my priorities to be totally honest.


You’ll be surprised how little your private cover will actually extend to. I deal with them regularly and they are continuously reducing what they will pay for. In fact some are now telling customers that if a treatment is provided by the NHS, they will not provide cover for it, whatever it is. It’s got to the point where I think it’s a total waste of money to have.

Aren't most private services actually delivered by the NHS anyway, but it just comes with a wine list and net curtains?*

*I have a very stereotyped and probably very inaccurate view of private healthcare, based on what it was like for an old boss of mine 30 years ago on BUPA


The staff are the same, the premises will be different, the interventions offered marginally more than the NHS. The biggest advantage is less waiting time, and more comfortable wards. Ironically the theatre staff/equipment are inferior to the NHS equivalent as they do not invest in equipment in the private sector unless it’s cost effective for them. Hence my private hospital had a 25 year old operating microscope which was dangerous until a month ago despite repeated requests for it to be replaced.
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Re: Some Brexit

Post by thekungfury @ Thu Nov 28, 2019 8:28 pm

Doctor Congo wrote:
thekungfury wrote:
Doctor Congo wrote:It’s got to the point where I think it’s a total waste of money to have.

From very recent and semi-recent (past decade) personal experience and close family experiences I disagree and would never not have it.


A decade is a long time. It’s astonishing how much they charge for premiums and how little they cover and offer. My speciality is the busiest outpatient speciality in medicine and we do the most interventions by a long way and most insurance companies now provide the bare minimum and often refuse to cover any more than a consultation. It’s cheaper to pay per use than pay premiums and find they won’t fund treatment when it’s needed.

Again, from numerous personal and family experiences I disagree. Things were covered a decade ago and they’re still covered today. I don’t know anyone that’s been denied any cover whatsoever.
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Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 8:54 pm

thekungfury wrote:
Doctor Congo wrote:
thekungfury wrote:
Doctor Congo wrote:It’s got to the point where I think it’s a total waste of money to have.

From very recent and semi-recent (past decade) personal experience and close family experiences I disagree and would never not have it.


A decade is a long time. It’s astonishing how much they charge for premiums and how little they cover and offer. My speciality is the busiest outpatient speciality in medicine and we do the most interventions by a long way and most insurance companies now provide the bare minimum and often refuse to cover any more than a consultation. It’s cheaper to pay per use than pay premiums and find they won’t fund treatment when it’s needed.

Again, from numerous personal and family experiences I disagree. Things were covered a decade ago and they’re still covered today. I don’t know anyone that’s been denied any cover whatsoever.


I do. Probably around 50% of my clinic last week contains 15 patients in the private sector. They were denied funding for cataract surgery, intravitreal injections and multifocal lens implants.

Of those patients their premiums were around 500 a month. What do I know though.
Last edited by Doctor Congo on Thu Nov 28, 2019 8:55 pm, edited 1 time in total.
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Re: Some Brexit

Post by Käsemeister @ Thu Nov 28, 2019 9:17 pm

500 a month?! What the fcuk? Even my 80 year old parents don’t pay that much.

I paid 160pm to cover four people. Rarely ever seemed to be about facilities, mostly about waiting lists. Son’s surgeries were 9-12 months waiting, wife’s gall bladder was 8 months, both carried out within 48hrs of consultant deciding to do it.
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Re: Some Brexit

Post by Doctor Congo @ Thu Nov 28, 2019 9:28 pm

Käsemeister wrote:500 a month?! What the fcuk? Even my 80 year old parents don’t pay that much.

I paid 160pm to cover four people. Rarely ever seemed to be about facilities, mostly about waiting lists. Son’s surgeries were 9-12 months waiting, wife’s gall bladder was 8 months, both carried out within 48hrs of consultant deciding to do it.


Yes that’s the advantage, and also having a chosen person do the operations. My patients are often elderly with Co morbidities which makes premiums sky rocket. Nonetheless despite that extortionate rate, they still limit cover for certain interventions or chronic diseases, which is disgraceful
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Re: Some Brexit

Post by thekungfury @ Thu Nov 28, 2019 9:43 pm

Käsemeister wrote:. Rarely ever seemed to be about facilities, mostly about waiting lists. Son’s surgeries were 9-12 months waiting, wife’s gall bladder was 8 months, both carried out within 48hrs of consultant deciding to do it.

Likewise the little things like appointments, scans and tests. All done without waiting days/weeks/months.

I had a blood test recently and had to wait 1.5hrs at the local hospital. The following week I had a consultant appointment and during the discussion he said “We should do a blood test to check”. Within 5 minutes my blood was taken and they called me at 7pm the next day with the results.
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Re: Some Brexit

Post by Careless Whisperer @ Fri Nov 29, 2019 9:31 am

thekungfury wrote:
Käsemeister wrote:. Rarely ever seemed to be about facilities, mostly about waiting lists. Son’s surgeries were 9-12 months waiting, wife’s gall bladder was 8 months, both carried out within 48hrs of consultant deciding to do it.

Likewise the little things like appointments, scans and tests. All done without waiting days/weeks/months.

I had a blood test recently and had to wait 1.5hrs at the local hospital. The following week I had a consultant appointment and during the discussion he said “We should do a blood test to check”. Within 5 minutes my blood was taken and they called me at 7pm the next day with the results.

So what we're saying is that the problem is that there is a huge backlog and no ability to catch it up.

In any other industry, this would be solved by strategically planning to run a limited outsourcing programme for a fixed period of time to clear the backlog. Once it's caught up, the outsourcing stops and there are no further costs. Maybe strategically, some funding needs to be set aside for periodic 'catch-up' periods as a contingency measure, but not as an ongoing operational plan.

But with the NHS, the solution is always seen as pumping more money into it, we need bigger facilities, more staff, outsourcing is a bad thing - all because it's only ever thought about as a permanent requirement - but that may not be necessary (certainly not in all areas).
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Re: Some Brexit

Post by Doctor Congo @ Fri Nov 29, 2019 4:15 pm

Careless Whisperer wrote:
thekungfury wrote:
Käsemeister wrote:. Rarely ever seemed to be about facilities, mostly about waiting lists. Son’s surgeries were 9-12 months waiting, wife’s gall bladder was 8 months, both carried out within 48hrs of consultant deciding to do it.

Likewise the little things like appointments, scans and tests. All done without waiting days/weeks/months.

I had a blood test recently and had to wait 1.5hrs at the local hospital. The following week I had a consultant appointment and during the discussion he said “We should do a blood test to check”. Within 5 minutes my blood was taken and they called me at 7pm the next day with the results.

So what we're saying is that the problem is that there is a huge backlog and no ability to catch it up.

In any other industry, this would be solved by strategically planning to run a limited outsourcing programme for a fixed period of time to clear the backlog. Once it's caught up, the outsourcing stops and there are no further costs. Maybe strategically, some funding needs to be set aside for periodic 'catch-up' periods as a contingency measure, but not as an ongoing operational plan.

But with the NHS, the solution is always seen as pumping more money into it, we need bigger facilities, more staff, outsourcing is a bad thing - all because it's only ever thought about as a permanent requirement - but that may not be necessary (certainly not in all areas).


There's a huge backlog due to insufficient staffing and funding over the last 10 years. The funding of the NHS has not kept up with rising demand over this time frame. Added to that, the government have done their best to encourage nurses and doctors to leave and want to retire en masse, have cut the nursing bursary to discouraging applicants from training to be nurses, destroyed the morale of junior doctors resulting a high rate of attrition, increasing numbers of GPs retiring and not being replaced.

In addition, social care has been totally neglected and underfunded, meaning that patients who should be cared for in the community are bed blocking and taking up capacity in the hospital services, hence reducing the capacity for more patients to be seen and managed.

Outsourcing already happens on a large scale in certain specialities. My speciality for example has large numbers of independent sector contractors taking the easy, routine work away from NHS providers and treating patients in the private sector. Whilst this reduces the waiting time for patients, it means that there are no opportunities for junior doctors to operate on these straightforward cases, so they are unable to gain the necessary skills and are progressing through their training hopelessly inexperienced. Any complex case is dumped onto the NHS and for consultants (like me) to do, and these cases are totally unsuitable for trainees. What tends to happen is these providers undercut the tariff (as they are allowed to whilst NHS hospitals are not allowed to) and do things cheaper as they have fewer overheads, aren't incumbered with training or anything else. The local hospital services then collapse as they are unfunded meaning complex cases or any comorbidity has to travel to a regional centre, where they are flooded with patients from a massive geographical area.

So basically, if people want things to remain free and a good efficient service, we should expect to fund the NHS to a greater extent. Independent sectors can help, but at present they are causing huge problems by being allowed to select what they do/don't do meaning patients are being unfairly discriminated against if they have any problem that might make them less than routine. I could go on and on about this as I am at the sharp end of an acute crisis in staffing levels, capacity and demand from increasingly elderly patients with more and more comorbidities and we are expected to manage this increase in activity with no extra resources.
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