I've only just read this, of course, because last year I'd never even heard of Substack, let alone Mr O'Malley. And how mad would you have been then if you had known what they were actually spending the money on! Did you ever write your piece about private v public within the NHS? It amuses me that the general public never understands that most GPs are private providers!
I’ve had a three-quarters finished draft about the NHS sat in my drafts for about 18 months now. The problem is that the NHS is so damn complicated, it’s basically impossible to say anything useful about it as a whole without the thesis not quite adding up. (Which is a shame as I had an absolutely killer headline planned). Maybe one day I’ll post it!
(On Captain Tom, obviously, er, lots of questions, in retrospect. But to be fair, the original fundraiser was a straight JustGiving link that sent the cash direct to NHS Charities. All of the other, er, spas and the like, were from money raised later.)
I can sense them now. I can taste the fresh Tears of the Twitterati and bask in the deep red glow of the faces of irate gammons on Facebook who accuse me of 'disrespecting' the old trooper.
I can hear the shrill gasping of the clap-fascists and their Two Minutes Hate for anyone who dares not bow down to mindless local community obedience, as well as the future notes rustling through the hands of sulking skinflints on their way to the doctors and nurses bank accounts.
"Obviously if something like an x-ray machine required charitable funding, that would be crazy."
Oddly enough, this is often what happens — albeit in a slightly different way.
Every NHS Trust in England (Wales and Scotland operate differently) has a charity attached: these largely raise money from donations and, most importantly, legacies. These charities are usually way, way more capital-rich than the Trust itself (which is almost certainly making a multi-million pound loss each year).
So when the Trust needs a new x-ray machine or cancer ward or whatever, what does it do? It applies to its charity for the capital funds to do so. The charity might decide that it needs to do some specific extra fund-raising to afford the thing (or just to top up its coffers), but it is usually the charity entity that actually provides the funds to the Trust (not least because it's tax advantageous to do so).
The Trust will then provide the space and the staff to operate the x-ray machine (although, very often, not at weekends — there's a severe shortage of radiographers).
So, yes, if you want to thank your NHS Trust for saving your granny's life (assuming that they have) then donate to their charity — and maybe your generosity will help fund another x-ray machine. Whether or not that x-ray machine is actually able to provide value for money through consistent staffing... Well, that's another matter. :-)
It is important that these things are clearly spoken about. I’m in Australia and last year we had disastrous bush fires with approx 3100 houses burned to the ground. A very famous comedian did the right thing and started a “Go Fund Me” to raise money for “those who lost everything”, but mistakenly nominated the Bush Fire Brigade (a quasi government department) run by volunteers as the organisation which would receive/manage these funds. They raised $51 million for the poor people who had lost everything. Sounds like a good thing to give money to the government funded volunteer organisation, but their legal status prevented them from giving the money to the people whose houses had burnt down and the government effectively kept it to further fund the organisation, not passing it on to the victims.
There is a fundamental error in thinking in this. The NHS is not a bottomless pit for spending. It is possible to choose a standard of care, such as how long we want waiting lists to be a for a given size of population, how many staff and facilities we need to do that, and to work out how much that would cost, including an amount for contingencies. Then we could choose either to pay that amount or not. Yes we could always spend more on something extra, but there is no need if we decide the standard of care that we want.
I briefly dated an NHS manager who looked after the budget for HIV services in a large region of England. She said she knew exactly how much money she would need to operate a world class service for her client population.
The bottomless pit concept could apply to anything. For some reason we don't feel the fire fighting service, or road maintenance, or the postal service, or schools and universities are bottomless pits. We might spend more on those things, but that's a matter of choice.
I don't disagree with this, per-se. In fact, I think this is the correct way to look at the problem of What The NHS Should Do.
But I do think the "bottomless pit" argument does similar apply to other public services. We could give everyone free public transport, we could build more fire stations to ensure faster response times - these, like you say, are choices, and a we have to choose where to draw the line. That's all I'm saying with the NHS - there will never be a point when the NHS is perfect, so by definition a line is drawn.
The NHS as it currently exists is the result of fifty billion different decisions and trade-offs: It doesn't pay for dentists and prescriptions cost exactly £9.15 for some reason, because at some point some politician or bureaucrat decided to draw those lines. And inevitably, there will be things that are and aren't paid for either side of the line, so charity will always, at some point, pick up the slack - we just have to decide where it is.
I know that over £1m was used to buy 'gifts' for mental health workers.. these gifts included bottles tagged with 'NHS hero', RRP was £14 each on bulk purchase. Nobody wanted them, it was touted as 'a gift from captain tom'.
The only point you make is so obvious it hurts. Nothing here is interesting. How is 'comfortable break areas, tablets and devices to help staff and patients stay in touch with their families, and bereavement support. ' non-essential? Stuff that anyone as equally qualified as a doctor or a nurse would get in a private workplace? You haven't even done the bare minimum of research. You'd see that charities like NHS Charities Together do provide funding for even more essential things, like in November providing 12m of urgent funding to overwhelmed hospitals to be spent on simple things like making sure staff working long hours have food and a place to rest.
The crux of your argument is that charity *has* to exist for the NHS. That if it weren't these so-called 'non-essential' things it would be for a nice box of chocolates or whatever. Working in the NHS should be a *good job* by default, i.e. made so by government funding. It shouldn't require charity to give staff psychological support, or appropriate break spaces (many hospitals have break areas that are honestly the absolute fucking worst. Everyone hates being in there and they do not contribute to good mental or physical health with drab design and bad seating).
Within the moronic confines of capitalism, your point might be correct. In the real world where the government could give a lot more money to the NHS if it wanted to, your point is useless.
I 100% agree that the various things you outline should be paid for by taxation - that's why a few paragraphs further down I say that my own view is that they should be, and that also staff should be paid for and the like! I'm glad you agree with me on this.
I think despite the fact that you've clearly written this article in a way to raise hackles (and probably clicks) that the points you make are valid and hard to contest. Or at least hard for me to contest, which may of course be a different thing.
I think your point about healthcare spending being a black hole is valid. There's not really an upper limit on healthcare spending. It represents a societal and economic quandary.
I suspect your message will be lost in a backlash because you've labelled support for staff and patients as 'non-essential'. In the interest of keeping this reply short, I'll merely say that staff satisfaction and patient perception of care impact on healthcare outcomes.
Heh, it’s a very tricky thing to try and frame. Obviously “non-essential” is too callous, and it’s not me making a judgement per-se, it’s what the current equilibrium in NHS funding has arrived at.
Like I say in the piece, many of the things that charities are currently funding do strike me as things that tax should be paying for. (I’m on the left - so I broadly want the NHS to have more money too!).
And yes, you’re absolutely right about staff satisfaction being important. It’s similarly why I absolutely hate it that, say, civil servants have to pay for their own milk in their offices, because of the fear of Daily Mail headlines about pencil-pushing bureaucrats getting perks.
I'm pretty fucking centre, possibly even right of centre, and the statement about what's "necessary" seems wholly inappropriate. In fact, I'd go as far to say that your wording mimics that of a right-wing press release.
If you wanted to be honest and frank about it, you would have said something like "... funding things that are unaffordable during a crisis". Describing things like outreach to those with disabilities (who may become super-spreaders if infected) as "unnecessary" is either deliberately inflammatory, or an indication that this article is written by someone who has no idea what they are talking about.
I've only just read this, of course, because last year I'd never even heard of Substack, let alone Mr O'Malley. And how mad would you have been then if you had known what they were actually spending the money on! Did you ever write your piece about private v public within the NHS? It amuses me that the general public never understands that most GPs are private providers!
I’ve had a three-quarters finished draft about the NHS sat in my drafts for about 18 months now. The problem is that the NHS is so damn complicated, it’s basically impossible to say anything useful about it as a whole without the thesis not quite adding up. (Which is a shame as I had an absolutely killer headline planned). Maybe one day I’ll post it!
(On Captain Tom, obviously, er, lots of questions, in retrospect. But to be fair, the original fundraiser was a straight JustGiving link that sent the cash direct to NHS Charities. All of the other, er, spas and the like, were from money raised later.)
This is deliciously brutal.
I can sense them now. I can taste the fresh Tears of the Twitterati and bask in the deep red glow of the faces of irate gammons on Facebook who accuse me of 'disrespecting' the old trooper.
I can hear the shrill gasping of the clap-fascists and their Two Minutes Hate for anyone who dares not bow down to mindless local community obedience, as well as the future notes rustling through the hands of sulking skinflints on their way to the doctors and nurses bank accounts.
And it is glorious.
Ok virgin edgelord.
"Obviously if something like an x-ray machine required charitable funding, that would be crazy."
Oddly enough, this is often what happens — albeit in a slightly different way.
Every NHS Trust in England (Wales and Scotland operate differently) has a charity attached: these largely raise money from donations and, most importantly, legacies. These charities are usually way, way more capital-rich than the Trust itself (which is almost certainly making a multi-million pound loss each year).
So when the Trust needs a new x-ray machine or cancer ward or whatever, what does it do? It applies to its charity for the capital funds to do so. The charity might decide that it needs to do some specific extra fund-raising to afford the thing (or just to top up its coffers), but it is usually the charity entity that actually provides the funds to the Trust (not least because it's tax advantageous to do so).
The Trust will then provide the space and the staff to operate the x-ray machine (although, very often, not at weekends — there's a severe shortage of radiographers).
So, yes, if you want to thank your NHS Trust for saving your granny's life (assuming that they have) then donate to their charity — and maybe your generosity will help fund another x-ray machine. Whether or not that x-ray machine is actually able to provide value for money through consistent staffing... Well, that's another matter. :-)
It is important that these things are clearly spoken about. I’m in Australia and last year we had disastrous bush fires with approx 3100 houses burned to the ground. A very famous comedian did the right thing and started a “Go Fund Me” to raise money for “those who lost everything”, but mistakenly nominated the Bush Fire Brigade (a quasi government department) run by volunteers as the organisation which would receive/manage these funds. They raised $51 million for the poor people who had lost everything. Sounds like a good thing to give money to the government funded volunteer organisation, but their legal status prevented them from giving the money to the people whose houses had burnt down and the government effectively kept it to further fund the organisation, not passing it on to the victims.
There is a fundamental error in thinking in this. The NHS is not a bottomless pit for spending. It is possible to choose a standard of care, such as how long we want waiting lists to be a for a given size of population, how many staff and facilities we need to do that, and to work out how much that would cost, including an amount for contingencies. Then we could choose either to pay that amount or not. Yes we could always spend more on something extra, but there is no need if we decide the standard of care that we want.
I briefly dated an NHS manager who looked after the budget for HIV services in a large region of England. She said she knew exactly how much money she would need to operate a world class service for her client population.
The bottomless pit concept could apply to anything. For some reason we don't feel the fire fighting service, or road maintenance, or the postal service, or schools and universities are bottomless pits. We might spend more on those things, but that's a matter of choice.
I don't disagree with this, per-se. In fact, I think this is the correct way to look at the problem of What The NHS Should Do.
But I do think the "bottomless pit" argument does similar apply to other public services. We could give everyone free public transport, we could build more fire stations to ensure faster response times - these, like you say, are choices, and a we have to choose where to draw the line. That's all I'm saying with the NHS - there will never be a point when the NHS is perfect, so by definition a line is drawn.
The NHS as it currently exists is the result of fifty billion different decisions and trade-offs: It doesn't pay for dentists and prescriptions cost exactly £9.15 for some reason, because at some point some politician or bureaucrat decided to draw those lines. And inevitably, there will be things that are and aren't paid for either side of the line, so charity will always, at some point, pick up the slack - we just have to decide where it is.
Is trying to help and succeeding a little bit better than not trying at all and just complaining...?
I know that over £1m was used to buy 'gifts' for mental health workers.. these gifts included bottles tagged with 'NHS hero', RRP was £14 each on bulk purchase. Nobody wanted them, it was touted as 'a gift from captain tom'.
The only point you make is so obvious it hurts. Nothing here is interesting. How is 'comfortable break areas, tablets and devices to help staff and patients stay in touch with their families, and bereavement support. ' non-essential? Stuff that anyone as equally qualified as a doctor or a nurse would get in a private workplace? You haven't even done the bare minimum of research. You'd see that charities like NHS Charities Together do provide funding for even more essential things, like in November providing 12m of urgent funding to overwhelmed hospitals to be spent on simple things like making sure staff working long hours have food and a place to rest.
The crux of your argument is that charity *has* to exist for the NHS. That if it weren't these so-called 'non-essential' things it would be for a nice box of chocolates or whatever. Working in the NHS should be a *good job* by default, i.e. made so by government funding. It shouldn't require charity to give staff psychological support, or appropriate break spaces (many hospitals have break areas that are honestly the absolute fucking worst. Everyone hates being in there and they do not contribute to good mental or physical health with drab design and bad seating).
Within the moronic confines of capitalism, your point might be correct. In the real world where the government could give a lot more money to the NHS if it wanted to, your point is useless.
I 100% agree that the various things you outline should be paid for by taxation - that's why a few paragraphs further down I say that my own view is that they should be, and that also staff should be paid for and the like! I'm glad you agree with me on this.
I think despite the fact that you've clearly written this article in a way to raise hackles (and probably clicks) that the points you make are valid and hard to contest. Or at least hard for me to contest, which may of course be a different thing.
And yet you've no issue with privatisation thieving huge amounts of NHS money.
oh, I missed that bit - which paragraph was that in?
I think your point about healthcare spending being a black hole is valid. There's not really an upper limit on healthcare spending. It represents a societal and economic quandary.
I suspect your message will be lost in a backlash because you've labelled support for staff and patients as 'non-essential'. In the interest of keeping this reply short, I'll merely say that staff satisfaction and patient perception of care impact on healthcare outcomes.
Heh, it’s a very tricky thing to try and frame. Obviously “non-essential” is too callous, and it’s not me making a judgement per-se, it’s what the current equilibrium in NHS funding has arrived at.
Like I say in the piece, many of the things that charities are currently funding do strike me as things that tax should be paying for. (I’m on the left - so I broadly want the NHS to have more money too!).
And yes, you’re absolutely right about staff satisfaction being important. It’s similarly why I absolutely hate it that, say, civil servants have to pay for their own milk in their offices, because of the fear of Daily Mail headlines about pencil-pushing bureaucrats getting perks.
I'm pretty fucking centre, possibly even right of centre, and the statement about what's "necessary" seems wholly inappropriate. In fact, I'd go as far to say that your wording mimics that of a right-wing press release.
If you wanted to be honest and frank about it, you would have said something like "... funding things that are unaffordable during a crisis". Describing things like outreach to those with disabilities (who may become super-spreaders if infected) as "unnecessary" is either deliberately inflammatory, or an indication that this article is written by someone who has no idea what they are talking about.
Brilliant James.