And I saw what happened to NHS Logistics, which was one bit of the NHS that wasn't losing money. It was running well. It was privatised to DHL in 2006 for purely ideological reasons, and then for several years was terrible. Ten years later, after Lord Carter's report into efficiency and productivity, we set up a new org called NHS Supply Chain and in effect re-nationalised it by giving the responsibility to a company which is owned by the Secretary of State for the Department for Health and Social Care. I don't think anyone has really learned any lessons from that.
So to put it another way, It is not that NHS is good, it is just the others are worse. Although this conclusion or opinion also makes me rather sad.
How does this relate to your point about a culture of self-criticism?
That's like beating your children but comforting them that they atleast have food on the table and clothes on their back.
This has been made worse by terrible political decisions, such as Brexit [0]. Specifically, austerity and political decisions (not limited to corruption) is linked to 130,000 preventable deaths [1]. Those same "budget cuts" for austerity exist while money is sent to "consultants" to "help fix things".
Not everyone in the UK has it well. The government, quite frankly, is fairly shit. And corrupt.
[0] - https://www.ifs.org.uk/publications/14901
[1] - https://www.theguardian.com/politics/2019/jun/01/perfect-sto...
The UK has one of the first (Oxford/AstraZenica), but this news about the first approved is not a vaccine developed in the UK. But I'm still happy to celebrate the Turkish couple's German company that's owned by Pfizer, as I will be when Oxford hopefully release more good news on top of their initial press release.
And our culture is far from perfect in the UK. Criticising a country's problems doesn't prevent also celebrating its positives.
I can't find the original quote but I 100% agree with you that it is pretty odd to take pride in something you have an extremely tangential relationship with
Once you've interacted with a corrupt bureaucracy or wondered whether the medicine you bought is counterfeit or realized the only thing stopping the cops from shaking you down is luck, you get a new found appreciation for stability, reliability and fairness (yes not always) of developed countries.
The UK national infrastructure does have a history of dubious at best procurement, outsourcing and "consultancy" decisions in supplying it's services - those public services often then coming under extreme criticism from the same quarters as your attack - who are often the same private sector blowhards who cause many of the problems in the first place.
Far more public sector hating and damage comes from there than from the virtue signallers you (rightly) criticise.
That is a very tactful way of describing what has gone on in this country for a while
To take the example of the NHS - it is constantly under attack by budget cuts, fragmentation and privatisation. Would it still be something to be proud of in a few decades if everyone stopped holding leaders to account?
I think you are arguing that some people are not genuine. If the price of progress is hearing people you don't care for virtue signalling, that's fine by me. I'd much rather have too much, and risk some of it not being genuine or warranted, than too little.
And I would argue that the people who genuinely want better demonstrate more national pride and a better understanding of their own culture than those sitting back and patting themselves on the back.
NHS Logistics didn't run well. As is consistently true of government run organisations it was run so badly that most of the NHS didn't even try to use its services. At the time of the privatisation the NHS sourced around half a million products but only acquired 50,000 of them via NHS Logistics. The entire purpose of privatising it was to try and make it work better and thus to encourage the NHS to buy more centrally to get bulk discounts, something that wasn't going to happen for as long as doing so required them to work with a small, sclerotic socialised bureaucracy.
Why would anyone think that an organisation which had no economies of scale, nor any demonstrated expertise in logistics in a competitive environment, be better at delivering things than DHL, a world famous delivery and logistics company that the NHS frequently chose to use anyway in preference to its own operation? That's ideology.
How much did NHS Logistics workers care about the health of the citizens who paid their salaries? Not at all: even though many of them were going to keep their jobs anyway they reacted to privatisation by going on strike and picketing trucks to stop them delivering supplies to hospitals. That's ideology. Fortunately it didn't kill anyone, but only because hospitals were already mostly bypassing the striking workers already due to aforementioned poor performance.
The NHS had its limits thrown into sharp focus this year. Mass testing is a bad idea, but putting that to one side for a moment, Germany and indeed most other places were able to ramp up test volumes far faster than the UK did, because Germany used private labs from the start when the NHS insisted on only using NHS labs, despite being given direct commands to scale up testing as fast as possible. That's ideology.
Finally, the supply chain hasn't been effectively renationalised. The contract changed from DHL to Unipart:
https://spendmatters.com/uk/dhl-challenges-loss-of-nhs-logis...
Supply Chain Coordination Ltd is what the name suggests: a relatively small coordinating body that manages contracts for various services, including contracts for logistics provisioning.
The brutal reality about the NHS is that not a single country in the world has copied this model. If it was good we'd see other countries adopt it but they don't. They don't adopt it because it's not good: this model is a relic of a time when the British public had just won a world war and as such had been exposed to years of war propaganda that made the government look artificially competent. In countries where that didn't happen the idea you'd want a single, centralised government agency to run every aspect of something as vital as healthcare was seen as insane: after all, if you go down that route why not have the government supply all food too? All entertainment? Why not run a fully USSR-style economy? Well because we know it doesn't work, that's why. There's nothing magical about the NHS that renders all those experiences irrelevant.
My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.
The NHS is not healthcare. The NHS is not doctors or nurses or life saving operations. The NHS is not hospitals. All first world countries have these things, but none have an NHS except Britain.
The NHS is a bureaucracy that manages resource allocation. That's it. That's all it boils down to.
When you saw life saving operations working as hoped, that isn't happening because of the NHS. You'd see the same in France, Germany, Sweden, the USA, Japan or many other places. We don't judge the skill of a bureaucracy or institution based on the skill of individual employees, we judge it based on factors like:
1. How much overhead does it impose?
2. How competent is it at organising its operations?
3. How agile is it, how able is it to react to new circumstances and continually improve itself?
4. How many people can access its services, who might want to use them?
5. If it fails at any of those criteria, how easy is it to switch to a competitor?
The NHS varies from average to poor when evaluated by these criteria, with the exception of (4) where it gets the best possible score because it even happily treats people who flew in to the UK specifically for free treatment! But if we exclude that edge case then it becomes pretty average again, because universal access is solved in other societies using insurance schemes of various kinds (sometimes mandatory and subsidised). The exception is the USA where for cultural reasons a lot of people don't like being forced to buy health insurance.
Although its overhead is reasonable when evaluated in pure GDP terms, this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
The biggest problem with government run industries is not that they can't carry out their mission at all. Soviet factories successfully made steel and rockets, after all. Their problem is lack of agility and lack of quality. Agility: see the NHS testing ramp-up problems discussed in sibling threads. Quality: see how slowly the NHS ramped treatment back up after the April shutdown. Other countries did much better in that regard, because private hospitals desperately want to treat people in ways that the NHS just doesn't. How could it be otherwise: if private hospitals don't treat people then they run out of money and go bust, like any other business. If the NHS doesn't treat people, its staff basically get a paid holiday with no negative consequences. Of course that affects people's behaviour.
I said average to poor, that's true except for (5) where the impact is catastrophic. Its tax funded status means the private health sector is seriously throttled in the UK. So only the rich can work around NHS failures, and even then not always (private hospitals don't do the full range of treatments in the UK).
> tax funded status means the private health sector is seriously throttled in the UK
This doesn't make sense? Bupa exists?
Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
> this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
Unsourced Tory propaganda.
How do you know? Nobody talks about alternatives to the NHS in the UK, even though it's an obvious topic that should be talked about all the time (the UK's a highly visible exception to the consensus of other rich countries and that would normally provoke debate). You don't actually know what the alternatives to the NHS are because any attempt to be honest about the system's problems are immediately met with a horde of leftists yelling things like "Tory propaganda", and insisting that anyone who criticises the NHS inexplicably hates nurses/babies/life saving operations, etc. They successfully shut down political debate every time.
It's entirely plausible that if there was a serious, honest and rational debate in the UK about healthcare then the country would move towards a European system. Why not? The UK aligns with European neighbours far more often than it does with the USA and that will likely continue even after Brexit.
Re: Bupa. Aren't you agreeing with me here, then? The private healthcare sector in the UK is anaemic compared to other countries because it's so hard to compete against "free". They end up trying to offer slightly better quality around the edges. They can offer complicated or expensive operations too, but people are already being forced to pay the government for them regardless of their own personal evaluation of quality or need, so hardly any market exists. Bupa is a minnow compared to its equivalents in the rest of the world, and how many competitors to Bupa can you name? The British healthcare market exists forgotten in the shadows because the NHS drowns it.
[Unpleasant facts] Unsourced Tory propaganda.
This is what I mean. It's not propaganda, it's actual reality that Labour and leftists live in denial of. Literally the first result for [nhs maintenance backlogs] is this:
https://www.kingsfund.org.uk/blog/2019/10/ERIC-data-nhs-esta....
"In 2018/19, the total cost of tackling the backlog of maintenance issues in NHS trusts rose by 8.4 per cent to £6.5 billion. And of this over half, £3.4 billion, was for issues that present a high or significant risk to patients and staff (see Figure 1). Now, if these numbers don’t quicken the pulse, a little more context is needed. High-risk issues are identified where repairing or replacing NHS facilities or equipment ‘must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’"
Or you can read about it direct from Parliament (see section 2):
https://committees.parliament.uk/publications/1779/documents...
Note that this backlog is just to restore physical objects to an "acceptable state" (quoting the Parliament document here). It's not to actually make the NHS better than it used to be, just the cost to stop it being so degraded it's actually dangerous: "One director of an NHS trust told me that broken gutters in his hospital lead to water seeping through the walls when it rains heavily. This happens so frequently that nurses now give ‘water updates’ in their shift handovers, so incoming team members know when they will have to start unplugging electrical equipment".
That was the backlog before an epidemic of bad data and advice from government run bureaucracies destroyed the economy that has to pay for it. The government no longer has any financial strength left to tackle this issue, and risks triggering serious inflation by trying to print its way out.
There are many other places you can read about this. The NHS is decaying away because its managers are terminally incapable of making the difficult decisions management requires. Given a choice between paying down their maintenance backlog or giving nurses a pay rise, they do the latter every single time even when commanded by ministers not to. Sometimes they even fail to spend the money they were given and end up with a "surplus", just through managerial incompetence.
That's not "Tory propaganda". It's reality, and exactly how the Soviet union looked at the end of its days.
> Any whiff of ineligibility by payment is completely unacceptable, and rightly so, or we'd end up with the US disaster
Lots of European systems require e.g. payment for GP appointments and aren't anything like the US system. Likewise, the UK makes people pay for dentistry, spectacles.
> From a political point of view, we have to defend the existing system because otherwise the US one will be forced on us
This sounds like unsourced propaganda...
> Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
Most private healthcare in the UK covers complicated and expensive cancer treatments, including ones not covered by the NHS, so this doesn't hold water. (There are a few cheaper, less common insurance plans that don't cover cancer and are designed to complement the NHS coverage, AFAIK)
Tiny firms and shell companies are "an organisation which had no economies of scale, nor any demonstrated expertise in logistics in a competitive environment". DHL at least has a track record of large scale delivery.
> NHS insisted on only using NHS labs, despite being given direct commands to scale up testing as fast as possible
Unsourced, never heard this.
https://theconversation.com/coronavirus-four-issues-that-hav...
"Part of the reason the UK has had difficulty in meeting the 100,000 tests daily goal was because of its focus on centralised testing centres. In contrast to the robust and wide-reaching testing programmes in Germany and South Korea, the UK government initially decided to centralise all of its laboratory testing in a few large hubs"
And yes of course there's corruption and incompetence in government - in procurement as well as everything else. The fact that governments routinely fail to even write proper contracts to buy things should give pause for thought when considering how well they'd handle running the entire operation.
So, not an NHS decision but a political decision by the relevant cabinet minister? That changes the answer. It's important to distinguish between decisions made by "the NHS" (to the extent that this isn't just individual trusts, or NICE, or whatever) and political decisions made by the government which are ideological.
Are you sure about that? The median income in the US is less than $33k.
I haven't seen the word used outside the UK so a definition might be useful: a quango, or quasi non-governmental organisation is the platypus of the British government world. As the name implies it's neither a part of the government nor the private sector. Instead, quangos are paid for by taxpayers but are completely unaccountable to them, as they can't be directly controlled by ministers or the civil service.
The theory behind this is that governments are crap at things because elected politicians interfere with the expert work of technocrats. So by setting up artificial blockades to political interference, power is transferred to technocrats and things should work better.
In practice what happens is that the government ends up hiring people who aren't very good at what they claim to be expert in, and who get corrupted by whatever unaccountable powers have been delegated to them. But they aren't easily fixable because they're "independent".
The Electoral Commission is a good example of a completely broken quango. Its only goal in life is to organise elections and referendums in ways that everyone agrees is completely fair and trustworthy. It is a staggering failure: the board of directors is full of people who publicly state very strong political opinions. It engaged in a legal vendetta against people who campaigned for Brexit. It has constantly prosecuted pro-Leave campaigners and got its ass kicked in court, where judges have repeatedly dismissed cases on the grounds that they have no evidence and/or are engaged in malicious legal behaviour. They've referred cases to the police that were then dropped for lack of evidence. Senior staff have posted on Facebook that they cried when the Tories won the election. Nobody who has followed these sagas can possibly believe these people are neutral, independent or even possess basic competence, but as they're a "quango" there isn't much of a framework to fix it beyond changing the law to totally abolish them.
tl;dr quango = power without accountability.
Still, there has not been the same hit from the disease, which only underlines that the differences in effect that are seen worldwide are about differences in population and geography - being overweight, having a very low friction of movement (e.g. excellent transport links, many borders), and not being low in vitamin D etc - far more than they are about government response.
I'm not saying the UK government has done well but it's striking to me that, from a distance, the criticisms of the UK and US I see coming from my friends are very similar, very parochial, and seem driven by media headlines rather than anything objectively sound.
In short, I'd give it another few years before you judge them more harshly than the government that brought us the Iraq war, for one.
While governments change and might or might not be incompetent, those structures largely remain the same.
I'm not saying that the government shouldn't be kept in check, but the fact that the UK government appears to move with all the speed of a striking slug appears to be the fault of the system they are required to follow, not the government itself.
they're pushing for more cycling, more climate measures, more taxes on IT giants etc
and these are Conservatives, the opposite of left-leaning.
on the other hand, their Covid response was the same as Spain, Italy, France etc i.e. pretty bad. but they also approved the vaccine really quick, and we're getting that next week.
so overall, a meh, like most other countries where I lived.
as a point of reference, from the countries I lived in, I consider Singapore and Tokyo to be a notch above the rest of the world when it comes to governance.
but most government of the countries i've lived in were the same as the UKs: they only react, they're politicians, they're detached from the real world etc etc
was this always so? i've noticed this while living in London and, coming from a literal 3rd world country, I do not understand it. i'm trying to find when this started... i don't it started anytime in the recent past. seems to have been going on for a while.
Being self deprecating is very common in a large number of countries, among all those who are reasonably intelligent or educated, to be able to notice how many bad things exist around them.
As others have already mentioned, this is caused by the fact that people can see directly the many bad things that exist in their neighborhood, but they have very little information about how things are bad elsewhere, and they hope that at least in other distant places the same mistakes are not being made.
A huge part of the perception that the UK is failing at dealing with Covid-19 due to awarding contracts to cronies comes from exactly this comparison with a South Korean success story that is a complete and utter media illusion. (They're also testing at something like a twentieth the rate of the UK - not enough to offer free testing to everyone with potential symptoms like we do, let alone do regular testing of all medical staff or any of the other things our press says our government is incompetent for not achieving - but you wouldn't know that from the UK media coverage either. Judging from their media reporting on the number of people awaiting results, they're probably not even doing any better at returning the results to people fast either.)
Sometimes they even just outright lie. When the UK hit 100,000 Covid tests in a day, the BBC ran a completely false claim that Germany reached that level of testing a month before the UK when in reality they didn't until several months after us. The BBC kept that claim in an article that was prominently featured on their news front page for a month after they were aware it was false meaning a substantial proportion of the entire UK population probably saw it. I still see it popping up everywhere. (They also claimed that meeting the 100,000 a day goal was faked by counting tests when they were sent out rather than when they were completed. In reality, it was met either way, and one of the minsters involved even pointed this out in a BBC interview - but people who followed the BBC coverage wouldn't know about it.)
The UK has universal healthcare so the infrastructure and public understanding are in place to actually do the vaccination programme per se. I have every confidence that the NHS medics will do their part efficiently as they do every year for the Flu shot I get, but getting frozen vaccine delivered to local NHS clinics is a logistics problem and an opportunity for somebody's wife's best friend's ex-boyfriend to be given a £100M contract even though he has no relevant experience and is obviously the wrong choice.
Six months later, with headlines about vaccine shipments defrosting abandoned in carparks miles from their intended destination and tens of thousands more dead the government will announce it had a brain wave, the Army (always the people drafted in when policy has failed) will now deliver vaccines. Don't worry about the money which has meanwhile mysteriously increased to £250M due to "performance payments" which somehow didn't involve performance but did involve payments - that's water under the bridge, can't be helped ...
Remember when we were going to do a snap Brexit, no transition, just drop dead one day suddenly? Basically the same group of fools paid people with no relevant experience and no ships to provide last minute ferry services. How do you provide ferry services with no ships? You don't, you just pocket the cash.
Some perspective would be nice.
When you tell your buyers to go grab every last bit of PPE they can and cut them a blank cheque to do it of course you're not going to get the best price, especially when every other country in the world is doing the same things.
Do you focus on the 10s of millions of pieces delivered successfully? Absolutely not, get the tinfoil and red yarn out, we'll dig up something questionable. I've seen some other countries equipping medical staff in bin liners and gaffer tape, on reflection we have it pretty good.
>In the months following the emergence of the COVID-19 pandemic in March 2020 in the UK, government awarded around £18 billion of contracts using emergency procurement regulations to buy goods, services and works to support its response to the pandemic. Government was having to work at pace, with no experience of using emergency procurement on such a scale before and was developing its approach at the same time as procuring large quantities of goods and services quickly, frequently from suppliers it had not previously worked with, in a highly competitive international market. This procurement activity secured unprecedented volumes of essential supplies necessary to protect front-line workers. Our separate report on the supply of PPE looks in detail at the extent to which demand for that equipment was met and the value-for-money achieved.
While government had the necessary legal framework in place to award contracts directly, it had to balance the need to procure large volumes of goods and services quickly, with the increased commercial and propriety risks associated with emergency procurement. We looked in detail at a sample of contracts selected on a risk basis. Although we found sufficient documentation for a number of procurements in our sample, we also found specific examples where there is insufficient documentation on key decisions, or how risks such as perceived or actual conflicts of interest have been identified or managed. In addition, a number of contracts were awarded retrospectively, or have not been published in a timely manner. This has diminished public transparency, and the lack of adequate documentation means we cannot give assurance that government has adequately mitigated the increased risks arising from emergency procurement or applied appropriate commercial practices in all cases. While we recognise that these were exceptional circumstances, there are standards that the public sector will always need to apply if it is to maintain public trust.
From: https://www.nao.org.uk/report/government-procurement-during-...
And remember everyone, when reading reports like this one should replace any soft seeming rebukes with phrases such as "these muppets had no idea what they were doing" and "this looks incredibly corrupt, but if we say that this report will never be released".
Where we fuck up is in the competency of the people in charge of awarding contracts.
Be it Grayling giving millions of pounds to a ferry company with no ferries owned or leased, or indeed any experience at all with ferries (and, wonderfully, with a T&Cs on their website copy-pasted from a pizza delivery site). As a wonderful finale, the government was sued by EuroTunnel because they awarded the contract without going through the proper process (which, of course, would have meant that the drawbacks of a pizza delivery business offering ferries might have been identified); we gave millions to a Ferry company incapable of delivering anything, and then millions to an actual transport company in compensation for breaking the rules on tendering.
Or be it KFC awarding their chicken distribution (despite warnings from people who knew) to a company with no experience in or facilities for cold food distribution, leading to KFC going literally out of business for a couple of weeks because they had no chicken in the stores.
We Brits have a competent infrastructure and the ability for the people in charge to award contracts to entirely the wrong parts of it.
Large PPE contracts were given to companies with no experience in making nor providing PPE, while companies with some experience were ignored. (Sometimes these contracts were awarded to personal contacts of ministers -- one was given to a bloke in the pub who happened to have the minister's contacts in WhatsApp.
[0] I don't actually mean "thanks". That's childish and passive-aggressive of me, and I shouldn't do it. What I really mean is to suggest that I think you've added nothing to this and that you're addressing a point that nobody made, for reasons only you know. I would guess that it's some kind of hyperbole, and that what you kind of mean is "oh, for something as important as this, someone will do a proper job" which is at least a meaningful statement (if perhaps something of a triumph of hope over experience), but if I have to pick apart your snark to get the actual meaning, I'm doing your job for you. Can you not just write clearly, and state what you mean?
Both of the massive fuckups I listed were highly unlikely, but they still happened.
No, I didn't actually interpret your comment as a claim that KFC will be in charge of the rollout. There's no need to be aggressive.