Why ’13,000 needless NHS deaths’ is more nonsense-propaganda
skwalker1964.wordpress.com/2013/07/14/why-130...
skwalker1964.wordpress.comPosted Jul 16, 2013, 8:18 AM UTC
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skwalker1964.wordpress.comIf I am totally honest I don't really care if we have nationalised, insurance backed (see Germany) or wholly private health system. What I want to see is affordable high quality care for all. I don't know which system will provide the best solution but I suspect they could all do it given the correct framework.
What I do know is that the current NHS is just a political football kicked by ALL SIDES ,both politicians and activists, and it disgusts me.
It's impossible to tell the motivation of politicians even if they are union backed, have links with the healthcare industry or are oblivious to everything (all facts which could be spun as good or bad).
It's a mess, I'm nearly 40 years old and I can't remember a government who didn't seek to undermine the other parties or an opposition that didn't use the NHS as a stick to beat the ruling party. All while some poor old sod lies on a trolly slowly dying for some unfathomable, unjustifiable reason.
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Agreed, people are too caught up on socialism, that they forget why the NHS is important to people in the first place: "free" healthcare.
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And Sir Bruce Keogh, the report's author, is on Radio 4 right now saying that his report should not have been used to claim that there were 13,000 avoidable deaths.
Edit: he has just added that national politicians "have their own aims" and that it is not for him to comment.
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A tad disappointed that out of 52 comments so far no-one, right or left, seems to be engaging with the article, (edit: my apologies to whencanistop) which argues that we are being fed exaggerated and distorted information on which to base either our "the NHS is sacred" or "slay the sacred cow that is the NHS" positions.
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Good luck with that :-)
Seriously though, the NHS is a political minefield of a subject, mostly because it's such a huge, complex beast. Because it's so big, you can always find something that's getting better, and you can always find something that's getting worse.
I have not read the full report, although I did skim it. It raises more questions than it answers, IMHO. The reporting of it, of course, magnifies the problems immensely.
I don't understand how many trusts there are, or are directly comparable, but I see that there are over 100 hospital trusts alone. What I would like to see is evidence that performance and ranking one year correlate with the same numbers next year. Otherwise, there's no reason to believe this is anything more than sheer variance, statistical noise. Then I'd want to se what was controlled for: I assume that different hospitals deal with different types of cases.
As to the reporting, the central problem is the idea of a "needless" death. If one trust has more deaths per disease instance than another, consistently, then there's an opportunity to improve. The question of coding is critical. I'd be interested to see a much more detailed review of the deaths in a small number of hospitals.
For the politics of it, I think we need more context - info like: what's the comparable rate of variance between the best and worst private hospitals? Is the rate for public hospitals growing or shrinking? What's the effective cost of a marginal quality-adjusted life year in the "best" and "worst" hospitals?
In sum, there's just not enough here to say anything more than, "hospitals differ". I'd like to see that additional research.
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Well, having read it it comes across as a nakedly political attempt to manipulated how an inconvenient set of statistics, whose results the author doesn't like, are portrayed. The end result is that the article actually ends up as a a hypocritical clusterfuck. His attempt to explain away the Telegraph's analysis doesn't hold water and is completely misleading. Amusingly it also means that the article end up arguing against itself.
Obviously averaging has its problems but this:
The world’s top 10 kung fu masters come together for a tournament. At the end of the competition, they are ranked 1 to 10. Number 10 is not a bad martial artist – he only has 9 better than him in the world. He’s just at the bottom of the top 10. But if you looked at the rankings in isolation and without understanding the context, you might think he wasn’t very good – until he either kicked your arse, or saved your life from ninjas, and then you’d appreciate how good he was.
Is complete nonsense as the sample size is over 250.
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Agreed that it is nakedly political. But so is the use of every set of figures in this fucking swamp.
Is your analysis of the article modified by Sir Bruse Keogh's statement on Radio 4 PM earlier that that his report should not have been used to claim that there were 13,000 avoidable deaths, or his reply to the email in this article prior to the report being published that said:
Thank you. I agree with your sentiments entirely. Not my calculations, not my views. Don’t believe everything you read, particularly in some newspapers.
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He said that he you can't infer how many additional casualties were the result of poor care.
The difference between his report and that blog is that the article you presented is trying to pretend that the data that the report casts up is merely a statistically necessity. i.e. if one trust comes first then one has to come last. However that's not what Sir Bruce was saying. His report bluntly states (or as bluntly as a report ever states) that care at these hospitals was completely crap - an issue that the article seems to skirt around. Crap care kills.
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Got you on that. I think it highlights one of the problems with this situation which is that there are at least two fronts here.
First, the blog is very partisan (Disclosure, as if you hadn't worked it out: I share its anxieties about the government's intentions but feel uncomfortable with its tone) and is pushing back hard against some egregious use of stats by what it sees as the enemy. Misuse of stats is a genuine concern and this government has learned from Blair's lot and taken it even further in their feeding of misleading information to the right wing press, for example both Duncan Smith and Shapps have been publicly bollocked for misuse. So it is a valid issue, and it seems to me that the blog risks discrediting some valuable points by over-reaching.
Second: Some really poor hospitals. They exist, I have visited a ward where the staff were so sour and unhelpful that I could smell it and feel it in the hairs at the back of my neck, something was badly broken. Other than that I and my family have all had brilliant help from the NHS. The bad ones need sorting out regardless of your political position. The trouble is that it is so politicised that there is too much noise to be able to easily identify reliable information on the causes, so people revert to tribal positions. And I do blame the government for a lot of that noise. My position, once you take in to account understaffing, poor training, isolation, no matron, nurses being too posh to slop, etc, (pick a reason realistic or hysterical), is that any large organisation will have foetid pockets of misery where things have just gone wrong. I have seen it myself where committed teams who genuinely care for and work hard for others have become poisoned and ineffectual by a simple management change, leading to a collapse in functionality and ability to care for others. My point is that a certain level of shit hospitals or wards is inevitable under any system. They need sorting out, the processes that lead to that particular situation need re-designing, but it is not always a sign or evidence that the whole system is broken, which some people seem to be keen to imply.
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They would never be able to get away with privatising the NHS, even after all the solid preparatory efforts of the Labour years, were it not for the wonderful assistance of the BBC and other media in manufacturing consent for "reform" via endless negative reports (and of course, the real underperformance created by those who are doing the "reforming").
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Should the BBC have played down the mid-staffs report? I don't know if you have read it but it is truly harrowing stuff
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The trouble with the mid-staffs report is that there were several headline grabbing figures that simply weren't part of the executive summary of the report. In fact the report stated categorically that they shouldn't be used because they hadn't undertaken academic rigour:
The Inquiry has looked at the Hospital Standard Mortality Ratio (HSMR) and the ways in which the hospital death rates are compared with each other. The HSMR for the Trust was significantly higher than the average. It was these figures which attracted the attention of the HCC and caused it to launch its investigation. There are a number of sources for such igures, some of them run as a commercial operation. The methodology and signiicance of these statistics are subject to academic controversy. Taking account of the range of opinion offered to the Inquiry, including a report from two independent experts, it has been concluded that it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the Trust. However, there is strong evidence to suggest that these figures mandated a serious investigation of the standards of care being delivered rather than reliance on the contention that they had been caused by coding.
So should the BBC have downplayed the '1,400 avoidable or unnecessary deaths'? Yes, it absolutely should have done.
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One report on a terrible hospital does not give reason to privatise our healthcare, yes there are bad hospitals but that's not actually a fault of the NHS. In fact I'd be willing to bet that the reason Mid Staffs was so terrible is because the best medical students get their pick of where to work once they graduate. This means that usually you have all the best and brightest doctors going to the same hospitals whereas you have the worst and laziest being left to find any job they can take and so you end up with hospitals who have doctors who aren't that great and don't actually want to work there!
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Isn't there a new system of relocating doctors that meant they got little-to-no-say that was implemented a few years back? I remember some outcry over it.
Also I'm not speaking in favour of privatising the whole system - I'm in favour of a public/private model like most of Europe and Scandinavia where free-at-point of access remains for the poorest and most vulnerable. There's a reason the French, Italians and Sweedish haven't copied our system.
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Nope, my cousin has just become (or is about to) a doctor and has picked where she wants to go when she starts work as a fully qualified doctors. My father left London because he got offered a better job in Birmingham, doctors get to work at the best hospitals if they're good enough, which has some merit but the best hospitals are the best because the best doctors work there. It's quite circular in it's logic.
However, I do agree that parts of the NHS could be cut, especially to those that can afford it. We have some of the best doctors in the world and it's the reason that our system is considered one of the best. There are improvements to be made but the current government is not making them.
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More harrowing than having a Health Minister who knows next to nothing about medicine and healthcare? Don't get distracted by the hype -- the NHS is being dismantled and sold off. The process of privatisation is resulting in underperformance, not vice versa.
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Read the report. People left for days with shit under their fingernails and not looked after or cared for. I'm not saying current health reforms are perfect but the nhs is not a perfect institution nor Gould it be forever protected from reform
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Yes, substandard care is guaranteed when you are busy selling off the most profitable parts of the NHS.
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Are you blind?
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I agree that putting a career politician in charge of the NHS is a terrible move but you totally ignored the question there.
Do you really think that the BBC over-hyped the mid-Staffs report? I don't think your conspiracy theory applies here.
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It's not a theory that Labour and the Tories want the NHS sold off, and for that to happen, the public love affair with public healthcare needs to be managed. The best way to ensure that is to sabotage the system by misallocating funds and creating disruption by selling off services and uprooting established practices.
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Jesus. Christ.
J E S U S . C H R I S T .
The BBC is responsible for efforts to 'privatise' the NHS?
Fuck me sideways, I've really heard it all now.
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Your phrasing is too clumsy. The BBC fulfils an important role in manufacturing consent for its privatisation, by reporting negative news but not the proper context and causes.
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Do you have any examples?
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The OP blog is full of examples.
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They would never be able to get away with privatising the NHS
You mean like your GP and dentist who have always been privatised?
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I love that people accuse supporters of the NHS of being blind and myopic - but when anything in the private sector goes wrong, like, oh I don't know, the huge global financial collapse it's a different story.
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The private capitalist economic method has seen the greatest increase in human living standards in the past century above any other form of economic system ever, what's your point?
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It's not perfect for providing everything, healthcare being one example.
Security/defense would be another.
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Point is that weasels defend the banks and champion the transfer of ownership of the NHS from the state to the banks (and other profiteers).
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What an idiotic thing to say. You don't think the agricultural revolution had a bigger impact?
Capitalism has taken resources from the poor and handed the wealth produced from those resources to a relatively small global elite. A destitute peasant is still a destitute peasant. The tragedy is that capitalism has the capability of creating such and increase but chooses not to.
And there was nothing private about its expansion - foisted on the world at the end of a musket and sabre, so spare me this angle. Nobody interested in getting rich through capitalism has ever thought "this will help other people"
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What an idiotic thing to say. You don't think the agricultural revolution had a bigger impact?
You're an idiot if you don't think the agricultural and then then following industrial revolution weren't products of capitalism.
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Well to save you all getting shirty, it depends which Agricultural Revolution you are talking about.
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The Agricultural Revolution pre-dated the ability to even conceive of capitalism by a few thousand years.
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The British Agricultural Revolution grew up alongside capitalism.
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The Green Revolution arose in a capitalist world, but appears to have been at least as reliant on international organisations as purely capitalist ones.
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"The NHS is shit, we need to privatise it!"
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How to streamline the NHS without privatisation:
- abolish patents and copyright should the latter be relevant,
- roll back car extremism which contributes to obesity, air pollutants and 20k serious injuries a year as well as the 2k deaths,
- improve cycling infrastructure reducing heart disease and many other maladies,
- go back and make the correct decision on cigarette packaging,
- sort out the anti-culture of recreational alcoholism,
- proper school meals and create a culture of healthy eating,
- phase out sedentary schooling and jobs where possible,
- do something about the ~20 hour average TV use perhaps abolish it and transfer the bandwidth to a nationalised freely accessible WIFI network,
- phase in a 4 day work week to reduce stress and improve self-care,
- more shared open space with in communities that isn't a road ("bring back the village green"),
- make medical school less expensive so we don't have to endure an inflated salary for doctors due to artificial scarcity,
- start medicine and biomechanics earlier in school,
- do something positive for the NHS staff, they look over worked, over stressed and over fed (at least at Tameside),
- stop the best and brightest being snatched up by the overpaid sector that is sport.
- edit: Decriminalise drugs.
Other suggestions would be to move away from the "factory" design of modern medical institutions favouring a more distributed model. A distribution to local ownership rather than a homogenous juicy national pie that private interests (immune to FOI requests) continuously salivate over could be another advantage.
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Gosh, I hadn't realised it was so easy!
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Oh, you. Again I apologise for making you think. Go look at this comment and realise how unoriginal you are. If you want to contribute at least be constructive rather than the monkey flinging shit from the sidelines, but if you have to do the latter at least be funny and do it in some style.
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But you aren't challenging anyone's thinking! You're not some visionary, coming up with incredible, original ideas that no one has ever thought of. Your entire list could be boiled down to "If everyone was a bit healthier and made better lifestyle choices, the NHS wouldn't be under such pressure". Which I entirely agree with! But your list isn't practical! How would you do these things, and what on earth do you think the consequences of some of them would be?!
For shits and giggles:
abolish patents and copyright should the latter be relevant,
This would involve rewriting the entire basis of intellectual property rights. What incentive would any company have to perform any research into new medicines (which costs £billions), if they then couldn't recoup their research costs?
roll back car extremism which contributes to obesity, air pollutants and 20k serious injuries a year as well as the 2k deaths,
If you're going to use phrases like "car extremism" then I'm going to mock you. Most people need to use their cars. I would love not to use mine, but I have no choice; work is too far away to do otherwise. This is not going to save the NHS.
improve cycling infrastructure reducing heart disease and many other maladies,
As above.
go back and make the correct decision on cigarette packaging
Would plain packaging really have any effect? Really?
sort out the anti-culture of recreational alcoholism, proper school meals and create a culture of healthy eating,
We already do lots of things in these areas. You're talking about massive culture shift that will take years to bring about.
phase out sedentary schooling and jobs where possible,
Yes, "phasing out" whole swathes of jobs is entirely realistic. How do you intend to do this?
do something about the ~20 hour average TV use perhaps abolish it and transfer the bandwidth to a nationalised freely accessible WIFI network,
This is incoherent nonsense. Abolish what? TV? A national, "free" wifi network (who pays for it? how?) would indeed be wonderful, but is the internet somehow less sedate than TV?!
phase in a 4 day work week to reduce stress and improve self-care
Our economy would nosedive
more shared open space with in communities that isn't a road ("bring back the village green"),
I can actually agree with this one. Planning policy should reflect the need, but when we need millions of new homes...
make medical school less expensive so we don't have to endure an inflated salary for doctors due to artificial scarcity,
Doctors have incredibly stressful, high-pressure jobs that they spend years and years training for. I'd say they actually deserve to get paid well. They do wield a lot of power when they decide they want a pay rise, because they are a highly skilled group - do you advocate breaking their union power?
start medicine and biomechanics earlier in school,
Given the outrage here and elsewhere when it was announced last week that schoolchildren would learn some basic computer coding and algebra from an earlier age, I'd be interested to hear people's reaction to this. But I actually think it wouldn't be a terrible idea.
do something positive for the NHS staff, they look over worked, over stressed and over fed (at least at Tameside),
Not quite sure what being over fed has to do with the rest of your list, but anyway. "Do something positive" is again not a suggestion, it's soundbite.
stop the best and brightest being snatched up by the overpaid sector that is sport.
Yes, all those millions and millions of footballers, rugby players, crickets et al who could be...doing what? I don't even...
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This would involve rewriting the entire basis of intellectual property rights. What incentive would any company have to perform any research into new medicines (which costs £billions), if they then couldn't recoup their research costs?
Medicine was invented before intellectual property. So was the wheel. Oddly enough money is not the best of motivators. It is practical to abolish IP, it's just lacks the political will.
If you're going to use phrases like "car extremism" then I'm going to mock you.
Car extremism is the perfect phrase: "extremism" taking an idea and applying it universally, "car" car. Again I'm making you think about accepted wisdoms and you feel the need to attack me.
Most people need to use their cars. I would love not to use mine, but I have no choice; work is too far away to do otherwise. This is not going to save the NHS.
Estimates suggest: "If people cycled and walked more the NHS could save £17billion within 20 years." That would be a major contribution—fewer breathing maladies, fewer lost limbs, fewer disabled.
I'm more interested in saving the health of the nation rather than the National Health Service. The car allowed big freight to outsource their transportation costs onto the "tax payer" by having them pay for wider roads, employers are subsidised by employees because they are forced into being their own unpaid chauffeur. The human cost of 300k injuries, 20k maimings, 2k deaths, and the disability benefits thereafter, are again pushed out on to the "tax payer" and the NHS.
wifi and tv
A significant portion of the electromagnetic spectrum has been privatised and given to old broadcasting. With proper broadband TV is redundant and a waste of bandwidth. Who pays for the roads? The electricity for all those lamps? I would totally be happy with a de-privatised WIFI network which has data transfer costs lower than communicating with space. I digress...
Yes, "phasing out" whole swathes of jobs is entirely realistic. How do you intend to do this?
The idea that someone sits at a desk for 6 hours is abusive.
Would plain packaging really have any effect? Really?
To give your intellectual supremacy a good kicking: yes.
Our economy would nosedive
You say that but that's because you are a cynical bastard: "productivity cannot happen unless money is involved".
I can actually agree with this one. Planning policy should reflect the need, but when we need millions of new homes...
13% of the UK is urbanised. Go look around on google maps and see the swathes of tarmac and pavement parking. The car is space inefficient, think 60 people on a bus vs 60 cars vs 60 bikes.
Doctors have incredibly stressful, high-pressure jobs that they spend years and years training for. I'd say they actually deserve to get paid well.
Some do, some don't. Our culture is so flawed that we have to import doctors. Medical placements at a graduated level are restricted if I recall correctly. It certainly is limited to the straight A-students.
Not quite sure what being over fed has to do with the rest of your list, but anyway. "Do something positive" is again not a suggestion, it's soundbite.
"Over fed" is a euphemism for obese. Look at the health of carers next time you visit the hospital, especially the desk workers. The NHS should have the healthiest workers in the country! It is anecdotal but it is a highlight that there is something wrong somewhere. It was one of the few points that was non-specific and impractical.
schoolchildren
It's more about the aspiration shortage. Rich families and private schools focus students on the superior jobs. The commoner? Pop idol, footballer, movie star, etc. I don't think the school system and the curriculum helps here.
Yes, all those millions and millions of footballers, rugby players, crickets et al who could be...doing what? I don't even...
Your kneejerk mockery hints at an unbecoming arrogance. I was referring to the trend of the best medical carers being snapped up for sports teams. Some are even lavished with money to come up with untraceable doping programs. Elsewhere general inequality for example the remuneration of the financial sector is something of a brain drain on all sectors.
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As simple as that, eh?
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Most are quite straight forward. If you judge the NHS by the nation's health it is a failure, but really it is acting within an abusive system.
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Gosh, I think we must have drastically divergent definitions of what can be considered 'straight forward'.
Of the points you list above, many are desirable outcomes with no indication of how they would actually be achieved. 'Sort out the anti-culture of recreational alcoholism' is not an actionable policy statement - would you tax the fuck out of alcohol (prescriptive, unprogressive)? Offer hugely increased counselling and mental health support to help people get by without alcohol as a crutch (desirable, but expensive and requiring huge, and currently political untenable, investment)? Ban alcohol (good luck with that one!)?. Any political prescription which starts with the phrase 'create a culture where...' is not really an implementable policy in any sense, merely juvenile wish fulfilment.
Others points you raise just seem incredibly authoritarian and appear to indicate some deep seated disgust and horror at how other people choose to live their lives. How will banning TV change the incentives that lead to this perceived epidemic of sloth? I probably spend more time staring at a screen than is good for me, but it's not just TV, it's my job, it's my chosen leisure pursuits, its my means of educating myself. After one of the most profound technological revolutions in human history, it seems pretty specious to turn our back on it all for your peculiar aesthetic sensibility that we should all be doing 'real' work (which has anyway been largely replaced by productive capital that, to a degree which is up to debate, has freed us from the drudgery of work and benefited society as a whole).
Where you do make more reasonable proposals, such as building cycle networks, increasing the amount of open space etc., these will have long-term benefits to health outcomes that won't be realised for 20 years+, so whilst admirable, do not exactly address the situation the NHS currently finds itself in.
I think your first point is the most instructive as to where you're coming from, however, and how charmingly utopian your vision for the future NHS is. I'm no great fan of patents or copyright, but the fact is they underpin a huge amount of law in this country and across the world, and play a role in the incentivising and rewarding of drug companies and those who manufacture medical equipment. I too, belief that there could be a more equitable alternative to this system, but I would not for a minute expect that it would be in anyway 'straight forward', or that we could even have any true idea of the potential unintended consequences of such a radical shake up of our current society. Your manifesto for the new, streamlined NHS might as well start with the phrase 'First, overthrow all global capitalism, and institute a socialised representative democracy across the world which treats all citizens as equal." An admirable goal, perhaps. But certainly not one that could be considered, by any stretch, straight forward.
EDIT: Spelling / Grammar / Etc
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Yet another cynical intellectual supremacist.
is not an actionable policy statement
Most if not all were angles of attack. Criticising them for not being policies when they aren't supposed to be isn't fair.
Any political prescription which starts with the phrase 'create a culture where...' is not really an implementable policy in any sense, merely juvenile wish fulfilment.
Talking about juvenile wish fulfillment, looking around my area the nearest public spaces are all pubs and the kids make do with the bus shelters. Alcoholism is a massive problem afflicting all emergency services.
How will banning TV...
I'm talking about the democratization of the electromagnetic spectrum, ie' the broadcast network. Mass many-to-many networks rather than one-to-many broadcasting. Sedentary lifestyes is again another angle of attack. There's a bubble of a social crisis with many people on social life support hooked up to the TV. If you want to save the NHS you want to protect the people from the ubiquitous neoliberal state propaganda from the likes of the BBC... I jest but only slightly. I just threw this idea of TV in there really as another angle of attack.
Where you do make more reasonable proposals, such as building cycle networks, increasing the amount of open space etc., these will have long-term benefits to health outcomes that won't be realised for 20 years+, so whilst admirable, do not exactly address the situation the NHS currently finds itself in.
There is a line through it for a reason: short-termism. You have basically said any long term solution shouldn't be pursued which is ridiculous. However, serious injury, limb loss and other maladies would be reduced immediately. Don't take my word for it: "If people cycled and walked more the NHS could save £17billion within 20 years."
[IP] But certainly not one that could be considered, by any stretch, straight forward.
It's straight forward as in it requires nothing of no one, it's like the legalisation of drugs (totally forgot about that!!!), it requires political decision and telling America and London to go fuck themselves.
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There is need for improvement, but there's not a need for privatisation.
It needs investment, not just to be hacked up and flogged off to Cameron's mates, and before anyone considers that flippant, look how many Tory MPs have financial interests in private healthcare.
The death of the NHS will be a tragedy for the UK, but a massive payday for the Tory Party.
The very idea that they care about 13,000 deaths, they're looking at the profits to be made in ensuring the masses can't afford basic health treatment.
Agreed. The issue has never been about the quality of healthcare provided by the NHS. The World Health Organization ranks the UK 18th in terms of performance of healthcare and 26th in terms of money spent on healthcare. Meanwhile the US with privatized healthcare is ranked 38th for performance and 1st for money spent.
France, Italy, Singapore, Spain, Japan, Norway, Portugal, Iceland, Ireland, Switzerland, Belgium, Sweden, Germany, Israel, Canada, Finland, Australia, and Denmark all offer Universal or near-Universal healthcare, and all are ranked above the US for performance and below the US in terms of cost.
Ultimately you can make it look like any service is bad and unsustainable if you cherry pick damning statistics and ignore all the benefits. If you can't find statistics poor enough simply cut funding until the system falls apart, and then claim it doesn't work.
Allowing private involvement in the NHS does not mean we immediately become the US. Most of the countries you listed have privatised parts of their health service while still offering universal care and getting betting results than here.
Have you got any information on privatisation of universal healthcare in other countries? I'm genuinely interested to have a read.
Many countries have partially-privatised healthcare, but the Netherlands takes it farthest, to my knowledge. Mandatory private insurance close to half of healthcare expenses. Here's more.
Granted. I just use the US as an example of the other side of the coin. There's a middle ground, sure. Though I don't think certain things should privatised since privatisation ultimately means 'for profit.' There's no talk of privatising the army, for instance. Private healthcare should be (and is) an option. But the NHS is still competing with the other top ranked countries despite a relative lack of funding. The idea that it needs privatization at all in any amount seems to be an idea that is being pushed on us without any real justification.
Most countries that are above us in the WHO rankings have a much more privatised system than the UK. Italy, France, Japan, Singapore, Norway, and Austria are all better than us but mostly privatized but publicly funded. There is justification in copying a system that works better than ours.
Erm, the middle ground is all of those countries you listed.
You missed the boat on that one. Outsourcing is becoming routine for Army stuff.
Training has been partly outsourced to G4S and Babcock in terms of facilities and services.
Recruitment was partly outsourced to Capita.
It's been going on for a while.
We have already privatised parts of the military in a sense, in that many private companies are contracted to fight and do security and intelligence tasks in warzones for the UK.
My concern is that other countries seem to have a better grip on managing the balance between public and private than we do. Also, the reason for changing the nhs has nothing to do with improving and all to do with getting more public money into private companies hands.
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The NHS had well over a decided of continuous increasing investment, with the amount of money going up massively year by year, and managed to just swallow up every penny it was given and produce only incremental performance increases, there's nothing wrong with capping it's budget, not allowing more investment and forcing it to become more efficient. And by opposing privatisation in the NHS, I assume you have a problem with your GP and dentist who have always been privatised?
I'm up for more efficiency, I just don't believe in privatising any more of the NHS, people's health shouldn't be run for profit.
I do have a problem with my local GPs, I live in a poor area, and it's so hard to get them to do anything, prescribe anything etc, but because of catchment areas, we're locked to bad GPs. I used to live 10 miles away in a better area and the difference is shocking.
My dentist however, is wonderful, she might be privatised, but she sure isn't in it for the money - I've had to pay before, because the forms got delayed, due to a hitch in the claim, and she just said 'don't worry, if you have to pay, let me know next time and I'll sort you out a bill.' She totally understands she's working in a poor area and isn't obsessed by money.
Privatising doesn't make it better by default. The BMI hospital in Guildford was in the news as recently as May for putting patients at risk and no one seems to be talking about that up any more. Sorry for using a Daily Mail link (I feel bad for giving them page views).
http://www.dailymail.co.uk/news/article-2318063/Mount-Alvernia-Private-hospital-stops-childrens-surgery-report-patients-lives-risk.html
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