Thursday, 19 March 2020

Ventilator Blues*

From The Daily Mirror:

Under-funding over a decade means NHS is lacking equipment and intensive care doctors - the government now wants factories to switch up production line in bid to battle disease

Woah there!

1. However much money you give the NHS, they will always spend all of it and want more. There is practically no upper limit on treatments they could offer and provide, or that people would demand if available quickly and easily.

I lived in Germany in the 1980s, there were no waiting lists and superb service, more or less free at point of use, so people went to the doctors with the most minor ailments or conditions that any Brit would just learn to live with.

The NHS gets what is gets, and is responsible for rationing and providing treatment in the most cost-effective way.

2. Does the NHS do a great job overall? Yes. Could it be better for the same money? Also yes. They don't do "joined up".

3. The Tories have increased annual NHS spending by a lower rate than New Labour did, but they have still increased it year on year. There seem to be far fewer stories about rampant waste and corruption, like £10 billion on the NHS Spine, so it seems that the NHS has responded to the less generous budget by trimming the fat (hooray), but I'm sure there is still some fat left to be trimmed.

4. Hindsight is a wonderful thing, but who, if anybody, should have seen this coming? Experts in the NHS or some here-today-gone-tomorrow Health Minister battling with daily crap? It's the NHS's budget and they decide what to prioritise, like cancelling non-essential operations.

5. Let's assume the NHS really needs 100,000 ventilators, seems like a fair estimate, and that their experts should have seen this coming years or decades ago. As far as I can make out, ventilators cost about £10,000 each (if anybody knows better, please leave a comment).

6. So they could have started stockpiling them ten years ago, 10,000 every year, annual outlay £100 million. This sounds like a lot of money, but it's about 0.1% of the NHS annual budget, or about £1.50 per UK resident per year.

7. But they didn't, and whose decision was it?

* Song from Exile on Main Street.


Lola said...

Or to put it more crudely in a world of scarcity and trade offs - "Which would you prefer? Us to stockpile ventilators, which might never be needed, or more dead babies"?

Mark Wadsworth said...

L, harsh but fair.

Lola said...

MW I think 'hard hitting' is what I was aiming for. Trying to get the likes of Piers Morgan to think.
Of course.
I see.

Nessimmersion said...

The amount Public Healthbhas pissed away on wokerati campaigns would pay for the ventilators above.
£4.5 billion pays for a lot of ventilators and field hospitals.
If any disagrees with taking all of the public health budget and using it for contingency planning - remember the mantra " If it saves one life"
Thw way info is now coming out about Chloroquine, 5% of their annual budget would have stockpiled enough to give the whole population a prophylactic dose.

Mark Wadsworth said...

N, ta for example of crass waste and corruption, that's the sort of thing I mean.

Ralph Musgrave said...

There's a very silly article in The Guardian (surprise surprise) by Mariana Mazzucato, which puts that "government should have been prepared" argument:

Mark Wadsworth said...

RM, yes, gloriously silly.

The NHS *is* the government department responsible for spending a limited budget as sensibly as possible, they are the experts, they are the government. You can't blame 'the government' and exonerate the NHS.

Mark Wadsworth said...

.. by the way, I'm not particularly blaming the NHS. Shit happens.

Lola said...

MW Me not 'blaming' NHS either. I am 'blaming' the structural flaws in UK health care services.

Mark Wadsworth said...

L, you can call it that. But you'd think that somewhere the NHS has a team of crack forecasters and contingency planners who remember the lessons of previous flu outbreaks - within the last few years we've had SARS, MERS, swine flue, bird flu, not to mention horrors like Ebola or Zika virus.

Bayard said...

I was wondering about this and the fact that the left always say the problem is underfunding and the right say the problem is inefficiency and I reckon the problem is actually both.
So, when the government (by which I mean the bit responsible for deciding budgets) puts lots of funding the way of the NHS, then boondoggles like the "wokerati" campaign might happen, but the basic underlying trend is Parkinson's Law, the bureaucracy goes empire building. Then you get a government who wants to cut back and so reins in the funding a bit. The logical thing to do would be to sack all the bureaucrats who were taken on in the good times, but that's not so simple. Firstly, the people who are doing the sacking are other bureaucrats and they have at best, a lukewarm desire to make savings. The ones being cut, however, are going to fight like bastards, because it's their budget that's going and, ultimately their job. So the cutters tend to look round for easier prey, which is non-bureaucrat jobs, or simply a wage freeze. Another piece of low-hanging fruit is to run down the stock levels with a buying holiday, which gives the sort of instant saving beloved of politicians. So after a bit, you have underpaid staff who are leaving and low levels of stock and no way to do anything about it except take on agency staff who cost a lot more than the ones who are leaving, but's that's OK because they are "temporary", as are the low stock levels. And then along comes COVID-19 (or CORVID-19, as I keep seeing it, as if it was something you caught from crows).

formertory said...


no way to do anything about it except take on agency staff who cost a lot more

I've always been curious about the agency staff thing. Yes, the headline daily rate is higher, but there's no pension, no direct payment of ENI, no DiS benefits, no holiday pay, no sick pay, no notice period and no chance of being sued for "bullying" or whatever wanting people to do a job differently is called these days. You need 'em? You call 'em in. You don't? You send 'em back. Nice and simples.

Mark Wadsworth said...

B, yes, all that stuff happens, but by and large, NHS spends most of its money, at least three-quarters, maybe four-fifths, on actual front line health care. So there is a mark-up (= waste, from taxpayers' point of view), but that mark-up still is a lot less than the mark-up you get in the USA, the other extreme.

B and FT, The Stigler has expounded on NHS agency staff. His theory is (IIRC), the good employees leave and have themselves re-hired as agency staff on much higher pay. The not-so good employees don't dare leave because they know they wouldn't be re-hired.

FT, for tax purposes, agency staff are taxed the same as permanent employees, with two layers of NIC etc.

Bayard said...

Mark, TS is probably right, but it still costs more than the wage freeze "saved", which was my point.

FT, I was under the impression that agency workers are employed by the agency, who pay all those things that you list and then charge the customer for them.

Mark Wadsworth said...

B, I was providing supporting evidence for your point :-)

Nessimmersion said...

Given their apparent success in dealing with the latest crisis why don't we just copy the Korean healthcare model?
Given your experience of German health care Mark, I would have thought that you would be more in favour of a 1st world system like they have, rather than the two extremes of NHS and US

Nessimmersion said...

What happens when you assume all critical cases are prescribed Chloroquinine & Azithromycine.
Before the allegations of tinfoil start flying- UK govt banned export of Chloroquine on 26-02-20