What's the mark up on generetic drugs though? Manufacture is vey competitive, the UK imports them from all over the place, including India. Given the large upfront cost, as you say, are there not better ways of spending that, still within the NHS?
Westminster Politics 2024-2029
- Thread starter Pexbo
- Start date
They're still made and sold as they can be made very cheaply and still sold cheaply at a profit, but for a a new company to come in and make them the initial overheads would be huge and the profits marginal.
I'm not against it at all as I think healthcare, meditech etc should be completely under government and outside the capitalist system, but I have no idea how to get there.
You tell me, I always thought that policy was gold.
I think you get there by just doing it. You need a government that is ambitious enough to throw away large parts of the current (failing) system. The same should be done with house building, make housing a right and start a national building firm.
You want a list of ways we could improve the NHS? More doctors, more nurses, more hospitals and all the staff that work in them, together with a huge increase care provision and support. Will that do to be going on with?
Notice anything in his answer?
Free in Scotland.
All of those need to happen, couldn't agree more. I was thinking about more abstract ideas that could be revolutionary.
good on you.
I noticed he was very pleased with his little football analogy.
Yeah but you also find yourself waiting for six hours in the A&E unless your face is literally falling off.
Honestly, I would pay if it meant people worse off still got it for free. That way the money could go back into the NHS to make things slightly less shit for everyone.
Yup that's what I said, prescriptions are 9.90. They are free in France but you have co-payments there and you have to pay up front for healthcare and get reimbursed later, though I maybe wrong on that. Dentistry is also much cheaper in France.
I would pay more in NI quite happily, but would be very worried about separate charges being introduced even if means tested as it is a slippery slope.
I actually work for a pharma company, so I'm a bit conflicted here! You're spot on about generics, they're probably the cheapest element by far of any episode of illness. A tiny % of what is spent on paying for the doctor who writes the prescription, or the pharmacist who dispenses it. If the NHS got all its generic medicines for free overnight it would barely even dent their daily cash flow. There's dozens of different generics manufacturers, all operating off fairly small margins. Plus huge quantities imported from places like India, where the margins are even tighter. Trying to put them all out of business with a massive UK state run generics conglomerate would be using a sledgehammer to crack a nut.
You are right that patent protected medicines are expensive and that's a consequence of capitalism. Just like any other industry, profit and the interests of shareholders are put above all other priorities. Discovering and developing these drugs is incredibly expensive (estimate $1 billion per new drug) so they try to make all of that back and make a tidy profit (generics manufacturers don't incur any of these R&D costs). Which means they have to sell them for as much money as possible, even if they cost peanuts to manufacture. To be honest, it is a bit soul destroying but I console myself that at least we're not trying to make fat cats fatter by selling cigarettes or smartphones. And there is, every now and then, genuine innovation which can make a real difference in people's lives.
The one big difference between pharma and other industries is that our customers are governments, who are far better able to regulate prices than, say, a punter who wants to buy a new car. As well as being safe and effective, every new medicine has to prove that its cost effective. And if that can't be proven then it won't be reimbursed (can't sell it into the public health system) Believe it or not, the UK government is better than most European countries at keeping on top of pharmaceutical spending, which makes Corbyn's notion of making this a key priority even less sensible. Where costs of pharmaceuticals has got properly insane is in the US. They use more drugs and pay more money for them than anywhere else in the world, by a country mile. So Bernie's obsession with taking pharma on in the states does actually make a lot of sense. Their spending is completely out of control on every element of healthcare, mind you, not just drugs. Their system really is deeply, deeply screwed.
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Yeah to be honest I'd take a NI hike if it was ring fenced for the NHS.
Thanks for the reply. Would it make sense for the state to look after drug research then?
As regards your point on the bargaining power wielded by the UK government, I guess that's mainly because healthcare is so centralised and drug companies can only really negotiate with them to reach the market they hope.
Depends what your personal situation is.
The standard GP charge is €26.50 of which you are reimbursed very quickly 70%.
Most of the other 30% is repaid by top-up insurance which is mandatorily given and subscribed to by employers since 2016 - which the employee can pay part.
But there are so many variations depending on your financial situation.
Our GP is now salaried so we only pay the 30% (less than €8) and get that refunded from top-up.
There is state run research. And the UK has always been better than most at doing this. This research is really good at looking at the impact of drugs that have already been developed, to see how they can best be used. Some of the best research. globally, during covid was UK state funded studies. But taking over the phenomenal expense involved in early stage drug target identification all the way through to clinical development would be out of the question. At the moment you have massive global corporations devoting billions and billions of pounds to this every year. With infrastructure and expertise that's been accumulated over decades. It just doesn't make sense for the UK government to try and compete. So they should definitely continue to invest in research about how to best use medicines but I don't ever see them starting to invent new medicines. That's a pipe dream.
I honestly don't understand this approach.
Are people genuinely saying that the only options are UK style NHS or USA style healthcare?
Or are they arguing they don't trust our politicians to be able to implement any other system?
Because it's a silly idea that solves nothing? It doesn't add capacity, it just nationalises resources that were already there. And that's just one problem.
I agree, I'm just responding to the idea that the solution must start with some kind of nationalised company doing the building. Can't see what the point of that is ( I'd also love to see you try to sell that idea to all the sparkies, chippies etc who very much like being independent contractors.)
Reform UK MP accused of mounting ‘witch-hunt’ against local teachers
Rupert Lowe says he has list of teachers in Great Yarmouth who ‘pushed’ criticism of hard-right party to pupils
https://www.theguardian.com/politic...of-mounting-witch-hunt-against-local-teachers
A Reform UK MP has been accused of mounting a “witch-hunt” after saying he has a list of teachers who he claims were “pushing” critical views about the hard-right party to pupils.
Rupert Lowe, who was elected last week in Great Yarmouth, said he had gathered the list after being contacted by parents in the constituency and would be pursuing the issue with headteachers.
His warnings have sparked unease and anger among senior figures in schools in the area, according to the deputy leader of the Labour group on Norfolk county council.
The MP tweeted on Monday that he had “heard disturbing reports of local schools forcing negative political beliefs about Reform on children during the campaign”.
Rupert Lowe says he has list of teachers in Great Yarmouth who ‘pushed’ criticism of hard-right party to pupils
https://www.theguardian.com/politic...of-mounting-witch-hunt-against-local-teachers
A Reform UK MP has been accused of mounting a “witch-hunt” after saying he has a list of teachers who he claims were “pushing” critical views about the hard-right party to pupils.
Rupert Lowe, who was elected last week in Great Yarmouth, said he had gathered the list after being contacted by parents in the constituency and would be pursuing the issue with headteachers.
His warnings have sparked unease and anger among senior figures in schools in the area, according to the deputy leader of the Labour group on Norfolk county council.
The MP tweeted on Monday that he had “heard disturbing reports of local schools forcing negative political beliefs about Reform on children during the campaign”.
I agree that the UK government would struggle and waste billions trying to compete with Pharmacy companies. In my mind, rather than try and save money on prescriptions, a big part of the answer to future proofing the NHS and care as whole in Britain, is to bring medical and social care under the same wing, properly funding both of them, by raising NI and various taxes. The mess that the UK's social care system is in is horrendous and having it run by a massively underfunded local government while the NHS is run by the central government means nothing is joined up.
But to back to your original point of "free at the point of use", that should stay as it is, it is the one thing that makes our healthcare system different from the rest of world and means no one is denied care. If we need to pay more we should do that through tax. And I don't mean just income tax and National Insurance, but taxes on sugar, salty and fatty foods and fossil fuels, in other words products that cost the NHS in the long run. The fact that
But definitely not, in my mind, through charges for GPs or A&E admissions, which I imagine would be there, more as a deterrent , than a money maker.
You're making a mockery of the system that bows and scrapes at the sausage fingered mate and landlord of a sexual predator, who also fantasies about being his second wife's tampon, for emerging out of more magical genitals than everyone else's, Jeremy!
They're arguing that, from what we've experienced in the UK, many of politicians are hand in hand with private health care and want or are being paid/lobbied to make as much as they can from it. I'm happy to give this government the benefit of the doubt for now, but I know many that aren't and I don't blame them.
The idea of something being set up purely in the best interests of and for the benefit of the general population has sadly become anathema, given our experience of politics over the last few decades. It's no surprise people expect the worst.
All the pressure for privatisation is coming from US healthcare.
Both kier starmer and wes streeting have been heavily funded by John Armitage. His hedge fund has around $800 million in United Health.
Its not that there are no other possible options than the NHS or the US system. Its that in the UK, the ONLy option our politicans would look at is the US system. If we let them change the NHS, that is what they will change it to.
As far as the NHS is concerned, it's clear that a growing elderly population, living longer, requiring more support, more medical interventions, and taking up 90 of the 95 spaces in the queue ahead of you when you try to get a GP appointment, is a major issue. They're filling up A&E's, they're lined up in hospital corridors, they're costing the country a fortune.
I work in a care home. The support network for the residents is staggering. There are GPs, district nurses, pharmacists, occupational therapists, dieticians, speech and language therapists, mental health nurses, psychiatrists, social workers, on-call clinicians, equipment services, and so on.
This example is very common: an elderly resident develops a pressure sore because they're old and tired and do a lot of sitting around. Their skin is fragile and they don't drink as much as they should do because their thirst mechanism has dissipated with age and they don't feel thirsty. Besides, if they drink more, they pee more, and they don't want to keep getting up to go to the toilet because they're old and tired.
The care home might need to contact the district nurses to dress the wound. The DNs then arrange for pressure relieving equipment, such as an airflow mattress, profile beds or pressure cushions (which is provided by the local authority). Maybe the wound deteriorates and becomes infected, so the GP becomes involved, prescribing antibiotics. Now that the person has an infection, they go off their food. They were already frail and lean but now their weight plummets, with their MUST score triggering a referral to the dietician. The dietician prescribes them some Ensure drinks to supplement their diet. However, that doesn't seem to do the trick because, although they drink the Ensures, they still won't eat solid food. Which then triggers a referral to the speech and language therapists (SALTs), who figure out if the individual isn't eating because there's an issue with their swallowing.
The SALT recommends that the resident only has soft or blended food and also prescribes thickening powder for their drinks, to help with their fluid intake. The pharmacist reviews their medication, changing as many pills and capsules as possible to liquid versions (which can be waaay more expensive). All of this has taken its toll on the resident, who is now bedbound. Previously only requiring some discreet assistance to go to the bathroom with one carer, now they're on a two hourly turns chart, mandated by the district nurses, requiring two carers to reposition them and attend to their continence needs. At this point, they may require bed rails to stop them falling out of bed. If they lack capacity (eg: have dementia) a DoLS (Deprivation of Liberty Safeguards) referral is sent off to the local authority. This is because bed rails are classed as a restraint and you need to justify their use.
They continue to deteriorate. Having a poor diet and fluid intake, living with chronic pain from lying in bed all day and having regular pain relief, they now require laxatives because the Paracetamol and Codeine makes them constipated. Immobile, they're now prone to chest infections and UTIs. Any fluid sits on their lungs and they're too weak to cough it up. They require antibiotics. The antibiotics don't work. The GP prescribes a second dose. This time, it just about works. They recover slowly from the infection but it brought it home to all concerned how frail they now are. The Enhanced Health Care team are contacted. They draw up, along with the individual and their family, a list of criteria that will determine whether the resident is admitted to hospital (usually only for a broken bone or if IV antibiotics are required to fight an infection). An anticipatory care plan is put in place.
Now they're categorised as End of Life. Palliative nurses come and check on them monthly, weekly or several times a day, depending on how close they are to the end. The GP has prescribed anticipatory medication, so they can be kept as comfortable as possible when they are in the final days of their life. Towards the end, they require round the clock care. This is how a lot of you will end up, whether you like it or not.
Look at how many healthcare professionals are involved. Some will be involved multiple times for different reasons. The cost is stratospheric. There will be an enormous amount of phone calls, emails, appointments, and time spent on this individual's health and wellbeing.
I haven't even mentioned falls, which can be prevalent, requiring ambulances, taking up space in A&E, then recovery wards. There's the cost of supplying zimmer frames, wheelchairs, etc. All of which are bespoke and require occupational therapists to assess.Every hospital visit for someone in a wheelchair requires an ambulance there and back, eating up more resources. I've only really scratched the surface. I've heard, anecdotally, that we spend more on healthcare in the last year of someone's life than we do for the rest of their life put together. I don't know if that's true but it feels like it is.
I love my job and I'm passionate about helping people, especially some of the most vulnerable in society, but I can't say I'm enamoured with the amount of time and money we spend on keeping people alive, many of whom say that they've lived long enough and just want to die. I don't know what the answer is. I'm just trying to paint a picture for those who are unaware of how much money is spent on caring for the elderly. Maybe that's why Hancock tried to kill so many of them?
So, to sum up, if you can't get through to your GP at 8am and are 95th in the queue, it's probably because people like me are ahead of you.
I work in a care home. The support network for the residents is staggering. There are GPs, district nurses, pharmacists, occupational therapists, dieticians, speech and language therapists, mental health nurses, psychiatrists, social workers, on-call clinicians, equipment services, and so on.
This example is very common: an elderly resident develops a pressure sore because they're old and tired and do a lot of sitting around. Their skin is fragile and they don't drink as much as they should do because their thirst mechanism has dissipated with age and they don't feel thirsty. Besides, if they drink more, they pee more, and they don't want to keep getting up to go to the toilet because they're old and tired.
The care home might need to contact the district nurses to dress the wound. The DNs then arrange for pressure relieving equipment, such as an airflow mattress, profile beds or pressure cushions (which is provided by the local authority). Maybe the wound deteriorates and becomes infected, so the GP becomes involved, prescribing antibiotics. Now that the person has an infection, they go off their food. They were already frail and lean but now their weight plummets, with their MUST score triggering a referral to the dietician. The dietician prescribes them some Ensure drinks to supplement their diet. However, that doesn't seem to do the trick because, although they drink the Ensures, they still won't eat solid food. Which then triggers a referral to the speech and language therapists (SALTs), who figure out if the individual isn't eating because there's an issue with their swallowing.
The SALT recommends that the resident only has soft or blended food and also prescribes thickening powder for their drinks, to help with their fluid intake. The pharmacist reviews their medication, changing as many pills and capsules as possible to liquid versions (which can be waaay more expensive). All of this has taken its toll on the resident, who is now bedbound. Previously only requiring some discreet assistance to go to the bathroom with one carer, now they're on a two hourly turns chart, mandated by the district nurses, requiring two carers to reposition them and attend to their continence needs. At this point, they may require bed rails to stop them falling out of bed. If they lack capacity (eg: have dementia) a DoLS (Deprivation of Liberty Safeguards) referral is sent off to the local authority. This is because bed rails are classed as a restraint and you need to justify their use.
They continue to deteriorate. Having a poor diet and fluid intake, living with chronic pain from lying in bed all day and having regular pain relief, they now require laxatives because the Paracetamol and Codeine makes them constipated. Immobile, they're now prone to chest infections and UTIs. Any fluid sits on their lungs and they're too weak to cough it up. They require antibiotics. The antibiotics don't work. The GP prescribes a second dose. This time, it just about works. They recover slowly from the infection but it brought it home to all concerned how frail they now are. The Enhanced Health Care team are contacted. They draw up, along with the individual and their family, a list of criteria that will determine whether the resident is admitted to hospital (usually only for a broken bone or if IV antibiotics are required to fight an infection). An anticipatory care plan is put in place.
Now they're categorised as End of Life. Palliative nurses come and check on them monthly, weekly or several times a day, depending on how close they are to the end. The GP has prescribed anticipatory medication, so they can be kept as comfortable as possible when they are in the final days of their life. Towards the end, they require round the clock care. This is how a lot of you will end up, whether you like it or not.
Look at how many healthcare professionals are involved. Some will be involved multiple times for different reasons. The cost is stratospheric. There will be an enormous amount of phone calls, emails, appointments, and time spent on this individual's health and wellbeing.
I haven't even mentioned falls, which can be prevalent, requiring ambulances, taking up space in A&E, then recovery wards. There's the cost of supplying zimmer frames, wheelchairs, etc. All of which are bespoke and require occupational therapists to assess.Every hospital visit for someone in a wheelchair requires an ambulance there and back, eating up more resources. I've only really scratched the surface. I've heard, anecdotally, that we spend more on healthcare in the last year of someone's life than we do for the rest of their life put together. I don't know if that's true but it feels like it is.
I love my job and I'm passionate about helping people, especially some of the most vulnerable in society, but I can't say I'm enamoured with the amount of time and money we spend on keeping people alive, many of whom say that they've lived long enough and just want to die. I don't know what the answer is. I'm just trying to paint a picture for those who are unaware of how much money is spent on caring for the elderly. Maybe that's why Hancock tried to kill so many of them?
So, to sum up, if you can't get through to your GP at 8am and are 95th in the queue, it's probably because people like me are ahead of you.
Fair enough.
I have to be honest and say I don't think the American model could be implemented even in the USA if they were starting from scratch today. I definitely think it's literally impossible that we'll end up in the UK with people having no access to healthcare at all (though with the waiting times, that is essentially the case already for some) or having to pay huge out of pocket sums to access any healthcare.
American VC firms and private healthcare companies are definitely eyeing up the UK system though, there's no doubt about it.
But guess we'll have to agree to disagree on the likely overall direction.
Like I said in the election thread, some of the discourse around this is genuinely a bit baffling to me. Sunak and Starmer clambering over one another to announce how they'd never use private healthcare, as if you're asking them whether or not they'd kill someone and not whether they'd use a form of hybrid healthcare that is pretty standard across most of our peers (or betters) across Europe, Australasia and Asia.
I have to be honest and say I don't think the American model could be implemented even in the USA if they were starting from scratch today. I definitely think it's literally impossible that we'll end up in the UK with people having no access to healthcare at all (though with the waiting times, that is essentially the case already for some) or having to pay huge out of pocket sums to access any healthcare.
American VC firms and private healthcare companies are definitely eyeing up the UK system though, there's no doubt about it.
But guess we'll have to agree to disagree on the likely overall direction.
Like I said in the election thread, some of the discourse around this is genuinely a bit baffling to me. Sunak and Starmer clambering over one another to announce how they'd never use private healthcare, as if you're asking them whether or not they'd kill someone and not whether they'd use a form of hybrid healthcare that is pretty standard across most of our peers (or betters) across Europe, Australasia and Asia.
That's a fascinating read. It's amazing how much there is to it.
Care to expand on that? How is it silly? Why would it not help with supply? The only resources that would need to be nationalised is the labour required to make it happen, most people call it employment (creates jobs, in other words).
They won't do it over night. The process started decades ago, we're just seeing an acceleration now.
Great post. This is a huge problem all over the developed world and trending to get worse and worse. I’m as clueless as you are about how it gets fixed.
Rachel Reeves launches £7.3bn national wealth fund
Chancellor says government aims to attract billions of pounds of private cash for big infrastructure projects
https://www.theguardian.com/business/article/2024/jul/09/rachel-reeves-national-wealth-fund-labour
Is that it?
Chancellor says government aims to attract billions of pounds of private cash for big infrastructure projects
https://www.theguardian.com/business/article/2024/jul/09/rachel-reeves-national-wealth-fund-labour
Is that it?
I’m pretty sure it’s not going to get “fixed,” because there is no fix to massive ageing populations and modern healthcare which prolongs their life at great cost.
Countries will be muddling through by raising taxes, spending less on other areas, healthcare getting worse, and possibly some experimentation with euthanasia.
Logan's Run
That's nearly 21 weeks of payments to the EU according to Boris's big red bus.
I would definitely support legalising assisted suicide
Killed everyone over 29. The great majority of scientic breakthroughs and invention has been made by people under 30, and 30 is pretty much the benchmark for people to start to slow down physically as well, so it would make a lot of sense.Logan's Run