Should Ireland be copying the NHS?

We explore the problems facing the NHS, its history, and a possible solution from Britain's past.
Our thanks to Dr Kristian Niemietz.
iea.org.uk/dr-...
#nhs #britain #england #wales #healthcare #germany #switzerland #ireland #netherlands

[@ciarasweeney]

I worked in VHI for several years before and during the pandemic. For treatments like hip replacements we were regularly telling people to consider cross border if going to a public hospital as Belfast was often quicker than anywhere south of the border. It's also a bit disingenuous to note that NHS rankings pre pandemic were much better, and post pandemic are much worse, and not relate that to the privatisation push by the Tories which has been VERY direct. The Public system has been screaming for budget because they're being forced into dodgy contracts with Tory backers at every turn (PPE being only the most notable scandal of some very notable scandals) and there have even been situations where the Tories have defunded local units with an aim towards a political result - one district who regularly voted Labour during the Tory years were so badly defunded they ended up voting Tory in the next election just in the hope to get their hospital back. Germany and Switzerland do have some good ideas and i agree with you on a local focus in decision making, but lets not kid ourselves when it comes to cost of care to the end user. Mortality rates cant be as easily fudged (but still are, regularly, see the rate of trans youth suicides in the UK after the Bell case and the meeting minutes FoI'd which show this was being deliberately miscategorized) but outcomes and waiting lists can. You just need to prevent people from joining your list in the first place. Nothing like €5000 out of pocket to someone on minimum wage to make them not continue treatment. If they don't continue treatment with you, they're off your list and your stats look excellent.

[@vivalaleta]

The NHS is being purposefully underfunded to make it look shabby so it can be privatized.

[@barbarianislander3805]

I think there is a misunderstanding as to why the NHS is so beloved in Britain, privatisation of public services has had a disasterous impact on local communities whereas the staunch defence of the public NHS has been a stalwart against that. No infrastructure is free, but free at the point of use is hugely important in a healthcare setting. You make good points about regional governance and even that models of SHI or universal health insurance more broadly, but the thesis that 1.) Sláintecare is simply an Irish version of NHS 2.) Not a result of austerity, poor management and dodgy contracts is flawwed. Introducing a new model of funding and management does not necessarily change the fact that funds in regional hospitala aren't there or that good contractors are brought in only where optimal. In Ireland at the moment, the GP care system does not work for many communities because GPs can act essentially private businesses. A young trained GP can choose where they set up, (which is fine to an extent; you can live and work where you want) but means that they get to choose to operate in middle/affluent-class areas in large cities and towns and rural areas and disadvantaged parts of cities go with inadequate coverage. A state operated system could provide direct resources to these areas. Hospitals is Ireland can either be public but independently run (i.e. staff are employed by the hospital which is run by itself, but owned by the state with its own board, HSE operated (HSE staff, management directly under HSE) or private. This system creates holes in service and variations in quality as well as huge administrative core, as large amount of posts (with high pating executive roles) are available however there frequently is a lack of experienced staff to fill these roles, creating instances of overlapping responsibility and lack of expertise is certain areas. A need to overhaul a system does not mean the model itself is broken.

[@medischemusicus]

Having worked in healthcare in Belgium, Ireland, Scotland and Wales I'm suprised you didn't mention that actually the NHS isn't run nationally at all, there are quite a lot of differences by country and area. Also that the other systems cost more. Not just to the user, but to the government. Switzerland and Germany spend quite high amounts on healthcare.

[@Art-is-craft]

The NHS is a centralised system that is funded through a Westminster financed system. It is not a locally run system.

[@watermalone1681]

Making a comparison to European neighbour healthcare systems is fine but there's very little proof in this video that the reason outcomes are worse is because of the system itself vs the system being systematically undermined at every level by the tories for over the last decade. This is well known and I'm surprised it's implied otherwise in this video.

[@TheWolfXCIX]

@@1DontNoclip Why does no other country attempt to imitate it then?

[@mmaximk]

​@@TheWolfXCIXYet the UK is attempting to imitate the US system - by your logic, that validates the US system as effective and desirable.

[@TheWolfXCIX]

@@mmaximk complete nonsense, you're one of the propagandised religious adherents this video makes fun of

[@monkeykingeater]

I'm not really surprised by anything from this channel since the rent control video.

[@vivalaleta]

The NHS is being purposefully underfunded to make it look shabby so it can be privatized.

[@toyotaprius79]

Like falling out of love with your partner because they're being eaten alive by cancer (privatisation)

[@joekelly7108]

Jesus Christ that’s some sentence

[@TheMickydowling]

What privatisation?

[@toyotaprius79]

@@joekelly7108 the video's title changed. It was something along the lines of "why are people falling out of love with the NHS"

[@joekelly7108]

@@toyotaprius79 Ah, Makes more sense now. It's still a potent, twisted image you've crafted though!

[@fishlordusername891]

Requiring costs from users in order to access healthcare will always disadvantage the poor and the disabled, who need it most. Relying on the government to decide who "deserves" free stuff also exacerbates bigotry and will inevitably leave people behind. Healthcare is one of those things we should seek to avoid people left behind as much as possible. Free healthcare kind of avoids that. I'm not really sure if social insurance, rather than just ordinary tax, is really a better option here, but I do think more localisation is probably a good thing.

[@fishlordusername891]

Also there's a lovely though mostly unrelated video by Philosophy Tube about trying to receive healthcare as a trans person that discusses the philosophy of system building and complaint making, its not really about how healthcare should be funded but I think it is a very interesting video about the topic nonetheless and I just want everyone to watch it lmao

[@sean_haz]

Requiring costs for anything will disadvantage the poor. That doesn't mean we should nationalize everything. The problem with anything being free is people use it more than if they were required to pay the cost.

[@jamesholt4449]

How does a person abuse a healthcare system ​@@sean_haz

[@fishlordusername891]

@@sean_haz If we don't have the budget to nationalise everything, then we have to prioritise what we should nationalise and what we shouldn't. In my head, healthcare is absolutely a number one priority - i will take free healthcare over free public transport. Just because we can't have the perfevt world doesn't mean we can't have some good things. And anyways I'll take healthcare that is used too much over healthcare that is used too little. Less people die as a result of that.

[@Whatshisname346]

The thing with social insurance over general taxation is that the money follows the patient rather than hospitals and providers relying on blocks of funding from the state. This incentivises providers to deal with more patients quicker whereas a block grant provide no incentive to innovate. There are also other methods. In my country local authorities fund GP, social and some basic acute care through local income taxes whereas central government funds large strategically important hospitals who carry out complex procedures. There’s also a requirement for employers to provide free occupational healthcare from private providers which takes a lot of day to day stress off the system; ie less people queuing in GP surgeries waiting for a sick note, less serious workplace injuries kept out of local hospitals etc.

[@samgrainger1554]

Paying agencies for staff to mend only some of the holes in staffing is like renting roof tiles to mend only some of the holes in your roof.

[@epoh3334]

We need to be asking ourselves as a society why we spend a similar amount on healthcare as our European neighbours while having worse care outcomes.

[@tigercasey1554]

Germany has many hospitals owned by private investors. That has lead to more costly but profitable surgery like hip replacements and closing down of many facilities for children health. The health system is money lead and to get into a good hospital you have to have private insurance. Or you end up on a waiting list. My mother is in her 80th and pays over 800 a month for health insurance and the nursing home costs are 3000 per month. Your comparison of European health services is flawed.

[@gavinfoley103]

Excellent. I've been trying on and off to compare these systems for years and you have done it brilliantly 👏

[@Whatshisname346]

It’s a necessary video but one I doubt will change many minds. The NHS is a sacred cow to the British people which will never be run well because, as a system, it’s costs will always spiral to the point where any government will just be firefighting. Its worsened by various TV shows creating a false impression of some ‘golden age’ in the NHS as if everything was fine when it was a starched white coats and quaint nurses uniforms; it wasn’t. Both my mother and my grandmother worked in the NHS during the 60s and the work was tough and often degrading. The problem with reform is that you’re basically asking the next generation, already priced out of the housing market, having lost freedom of movement and basic job security to give up another element of the social safety net because their parents and grandparents made A LOT of dumb political choices. It’s a very hard idea to sell to all generations.

[@Art-is-craft]

The NHS could be changed in the UK without tearing it apart. Originally the system was to be funded through National Insurance.

[@HamSaladtv]

Just fund the NHS properly dammit. It will work if given the means.

[@graceosullivan1367]

Are you the guy who does the troubles podcast?

[@Briggie-_]

Weird drop in quality, you should stick to videos about planning in Ireland, clealy more up your alley.

[@Art-is-craft]

The NHS is a disaster moving towards an iceberg.

[@ahahaha3505]

Just wait until private equity has had its way with it.

[@lawrencebishton9071]

its a stereo type launder ring machine for stolen data life tv (universal) studio

[@KILMARTA]

you have a table with tretable deaths per 100k, I have tried to find numbers for Ireland to compare them, no luck, have you found that data?

[@TheLFarrell]

One of the most biased and poorly argued videos I've seen from this channel. Totally left out several of the reasons behind the decline of the NHS in recent years and glossed over similar publically funded systems that function more successfully in the Nordic countries with a cursory mention in order to fit your argument. I also did not like the smug sneering at the British public at the end of the video for their continued fondness for the concept of the NHS. I was previously a fan of this content's channel but this attempted hatchet job has left me really disappointed. You've lost yourselves a subscriber.

[@polysee]

Other state run systems perform better than the NHS, it is true, and both we and Niemietz mention that. But we are not the BBC - we are entitled to take a view - and this video makes the case for SHI to be considered in a dispassionate analysis. This channel favours localism, as we feel smaller entities are more manageable, and we also favour more independence and local autonomy in health. To call that a 'hatchet job' is harsh.

[@dimebucker2]

@@polysee im out too - unsubscribed

[@epoh3334]

It's a shame people can't be exposed to different viewpoints.

[@TheLFarrell]

@@epoh3334 I can handle different viewpoints and have disagreed with Polysee videos before without feeling like I won't be able to wacth anymore of their content. I just do not have any further interest in watching their videos if this is the kind of poorly assembled arguments they are going to be putting forward in future. You can parse through their biased agenda if you like, I will be seeking out more balanced and well constructed content.

[@ThomasBoyd-w6f]

No Ireland not copy it NHS. German told truth about NHS England London Britain. Does work for England in 2024. Bad situation you cannot see a GP they overpaid £200000 salary. Ireland better system politically with Italy private healthcare.

[@daycentchunage5341]

Glad to see most of the comments are pushing back against your biased, pro-market perspective, btw. All hope is not yet lost, but gullible people may still buy into the misleading narrative of your video.

[@user-jd3de8zj4n]

You should do a video about a hammer with a camera inside it!!

[@daycentchunage5341]

Of course a German thinks the German system is better, and papers over the cracks - a profitable system with tiered levels of healthcare and significant inefficiencies. The problem with the "state-run" healthcare system is that it isn't state-run. It's been stealth privatised through agency work and service level ageeements. There would be much better value for money if the system was properly funded and run on a strict non-profit basis, to freeze out private providers piggybanking on public infrastructure for obscene profits.

[@tsar1547]

Soviet-grade stupidity

[@EuropeanQoheleth]

sigh A libertarian channe lwould say the NHS is bad.

[@rogerturner8177]

The poorer outcomes are down to the Tories deliberately underfunding the NHS for decades. End of. Poor comparisons and a neo liberal stance has me hovering over the unsubscribe button.

[@polysee]

Comparing the NHS's performance to its European peers is fair analysis. SHI is not a free for all that leaves people behind.

[@krombopulos_michael]

This is a very thought-terminating and dogmatic comment. Just declaring something and saying there can be no further discussion or investigation is not an intelligent way to approach any subject. Germany's or most other EU countries healthcare systems are hardly neoliberal either, they just have alternative ways to reach universal coverage.

[@TheWolfXCIX]

Aside from the fact that the NHS has been consistently given above-inflation budget rises, would you not consider the sensitivity to which government is in charge an inherent flaw of the system?

[@alechannan5741]

Is 6 grand per taxpayer not enough for the NHS?

[@aengusryan5948]

I'd be interested to see which healthcare system ireland should copy upon unification. Not the NHS clearly.