Allister on North Southery and Health

I try to do only a few directly TUVish blogs but a couple of things on Jim Allister’s website struck me. Firstly Allister has called on the DUP to ensure efficiency savings in the funding of North South bodies; apparently last year these bodies received all the money they requested. In a time when public finances are under strain this does seem to be a sensible fairly non controversial suggestion. The other issue which caught my eye (living as I do amongst the Dreary Steeples) was his comments on the closure of Omagh Hospital (as I said in my first ever blog this is always a difficult issue). However, Allister has made an interesting suggestion: “….in any redistribution of resources, a paramount rule should be that before a single bed, acute or otherwise, is removed it should be matched by a replacement bed elsewhere.” Reconfigurations of hospital services, whilst sometimes necessary, are never popular: A commitment to keep the total number of beds the same might well help reduce public anxiety. I hope that the fact that the TUV have made both these proposals (on North South savings and hospitals) does not mean that other parties cannot support them.

  • It was Sammy Mc Nally what done it

    I think that is a fair point – but the general problem for opposition parties is not when the government ignores your suggestion but when they take them up – quite often the originator of the idea does not then get the credit and it sounds childish and trite trying to get media time to say “that was my idea”. As a result sometimes partys keep their good ideas until close to an election so they CANT be implemented by government.

    It is a feature of the politics of oppositon and athough they will never admit it, there is undoubtedly an element of wishful thinking when they speculate that under present regime the country is going to go arseways.

    But without sounding too philosophical it is part of the inherent contradiciton of the human condition that our short term objecteives e.g. stuffing our faces with food is often in direct conflict with our long term objective of staying alive as long as we can – and politics being simply an expression of that condition is no different.

  • Turgon

    It was Sammy Mc Nally what done it,
    Thanks for that but a bit intellectual for Saturday morning.
    Regards

  • ABC

    He’s a bit late. The DUP have moved Assembly motions on both these issues without any prompting from Allister. Poor Jim: he’s run out of things to say and all he can do is snide attacks on others.

  • fin

    This sounds familiar, wasn’t Jimbo and various cheeleaders for the TUV getting into a lather on here regarding budgets of the North South bodies not so long ago.

    At the time I trawled through the websites of the bodies concerned, and my impression was that these were bodies where north and south pooled resources to maintain and promote all Ireland bodies to save money on not replicating the work by having two bodies north and south.

    Can I ask Jim and the TUV to confirm that North South bodies are an excellent idea for providing the people of NI with efficency savings.

    Damning hospital cutbacks so a bit cheap, who doesn’t, they are however a fact of life (unfortunately). I do however get the impression that things are inching towards an all Ireland health infrastructure, which if we are will Jim and the TUV welcome it for the effiency savings it will create.

    In fact all in all if Jim is up for saving cash surely he should be promoting all Ireland bodies which are surely the best way to conserve taxpayers money.

  • Turgon

    fin,
    “I do however get the impression that things are inching towards an all Ireland health infrastructure”

    The answer is that your impression is wrong: I make no comment on the desirability or otherwise of that; I just note that it is incorrect. I think Allister is not denouncing closing hospitals per se, what he is suggesting is that in future closures there should be proper planning an an equal number of beds opened in other hospitals to replace those closed.

    If you think that North South bodies will purely save money and could not have their budgets trimmed, I would suggest you are just being silly.

  • fin

    Turgeon, I never said, they shouldn’t have their budgets trimmed, I said they already provided effiency savings by the very nature of pooling resources. Would you and the TUV not agree?

    Regarding an all Ireland Health infrastructure, you are of course entitled to your opinion, however, I would caution against believing the world will stand still, there are already many cross border initiatives, which makes sense to anyone interested in effiency savings.

    I believe the Enniskillen hospital will go ahead and that its catchment area will include Monaghan and Donegal.

    Overall the TUV needs to firm up a proper health policy, merely replacing beds is not realistic, as healthcare changes, demographics changes and health issues change something more robust and innovative is needed for Jim to have credability in this.

    I do understand that as a micro organisation resources are not there for the TUV unlike more widely supported parties and Jim is stretched doing many roles. But I do believe it is important that minority politics, no matter how small should be represented if not at a European level in the future at least at council level.

    I can see many more cross border initiatives in the near future, I don’t believe the gardai on the ground in Armagh investigating the Quinn murder was a one off and the pooling of police resources all provides an opportunity for effiency savings.

    I am sure the TUV and its supporter will welcome and applaud any and all opportunies for effiency savings including supporting the North South bodies.

  • It was Sammy Mc Nally what done it

    fin,

    ” I don’t believe the gardai on the ground in Armagh investigating the Quinn murder was a one off and the pooling of police resources all provides an opportunity for effiency savings”

    Without wishing to go off on angle, he says going off on an angle, the Gardai involvement in SA was quite remarkable in that passed by with virtually no complaint from Unionists – this area has potential to undermine the dissident threat and their propaganda that Norn Iron has not changed significantly since the GFA.

  • Turgon

    fin,
    Right so as demographic changes numbers of beds need to change? Let us see the number of old people is increasing and they are living on average longer. That sort of means they will be in hospital more, hence, maybe the need for no reduction in hospital beds?

    One of the great fallacies of the NHS initially propagated by the Tories was that the increase in day procedure surgery would reduce the number of beds needed. That fallacy was based in part on the fact that the discovery of streptomycin resulted in a massive reduction in the time which a TB patient had to spend in hospital. It is one of the very few occasions when a change in technology resulted in a genuinely significant decrease in bed numbers needed. In reality what happens now is that advances by keeping people well tend to have essentially no net effect on bed numbers needed. More survive, grow older and get admitted later.

    The other thing people tend to forget is that the vast majority of people in hospital do not need operations etc. but are acutely ill and under the care of medicine not surgery. These people tend to be older and as such the increasing age of the population results in if anything an increase in bed numbers needed.

    As to the new hospital in the South west: the modelling does not include treatment of cross border patients. It could be modified in the future. However, we have two very different heath care systems: one semi private the other NHS. This would create massive issues about one patient having to pay and the neighbouring one not.

    In addition do you really think that the RoI politicians and people in the border counties will put up no resistance to the closure of all their hospitals? the closure of the ones so far created a storm. Finally do you think the RoI politicians are going to accept a position whereby they are paying for health care in NI yet they have little or no influence on the decisions taken by the health minister in a different jurisdiction.

    Still believe your little fantasy if you want to.

  • Turgon

    fin,
    Sorry on North Southery, I would welcome it if these organisations were producing efficiency. I suspect, however, they spend £100 to save £50: such tend to be governmental efficiency savings. Still I am glad you welcome their budgets being trimmed.

  • fin

    as an avid reader of Private Eye the NHS is already very expensively part privatised.

    Private healthcare is a part of most mid salaried jobs benefits packages today.

    Nothing in this life is free, the NHS is paid for from deductions in employee salary.

    Healtcare is been harmonised across the EU, why not Ireland.

    Elderly individuals needing healthcare are usually in residential carehomes, where the levels of care available continues to increase, this one example of what I mean regarding the TUV health policy its years behind.

    Regarding financing an all Ireland health body, the details are no different to any other cross border body. I don’t believe ownership of budgets etc has been an issue for CAWT, or arise during the All Ireland Health Conferences, or joint BMI IMO meetings (all organisations working towards my fantasy, I guess)

    Yes, of course people always want their local hospital to remain, and rebuilt and well staffed, etc, who wouldn’t, but its not going to happen, and not necessary, as healthcare improves paramedics can achieve much more than before, better roads, better vehicles, air ambulances all contribute to a changing healthcare landscape. Huge advances in treatment and the training of medical specialists means that many area’s have to be centralised due to expensive equipment and lack of specialist skills.

    Your comment regarding effiency savings actually costing more, sadly can be the case, however north south bodies by their very nature are quite the opposite. This is because as I said previously they pool resources and remove the need for replication, for example one organisation promoting tourism for all of Ireland, and a single waterways body are no-brainers for effiency savings.

    Because of the concrete effiency savings achieveable from north south bodies and because as you say in single juristriction bodies trying to save money often means spending more, would you agree that the best management of taxpayers money would be throught as much north south cooperation as possible.

    Or do you think that the TUV singling out north south bodies in paricular for budget cuts when they are already giving effiency saving displays a narrow unionist mindset trying to sever links between the peoples of Ireland, and that the TUV would actually prefer to remove north south bodies even if it incurred an increase in spending for these essential bodies to be replicated north and south.

    I note, despite several opportunities you have yet to agree with me that north south bodies do actually provide effiency savings and should be supported and encouraged, and do you think the TUV should focus on other areas for effiency savings, possibly through north south cooperation.

    Can you post on your feelings towards north south bodies.

  • It was Sammy Mc Nally what done it

    Turgon

    re: “Finally do you think the RoI politicians are going to accept a position whereby they are paying for health care in NI yet they have little or no influence on the decisions taken by the health minister in a different jurisdiction. ”

    There are various instruments under the GFA for them to have influence but if the cooperation is sensible then there will be gains for people on both sides of the border and there should not be cause for complaint.

    I feel a bit of light philosophizing coming on again – it is interesting how people (including myself) can select arguements of convienence which are idelological neutral e.g. it will save money to advance their ideological position and neglect more compelling arguements which might prove something which is ideological repellent to them.

    There are some dangers in adopting non ideological arguements – at the SF Ard Fheis it was full of references as to why a UI was to be aspired to becasue it made good business sense but recent world economic events and their impact on ROI have recently made this a much less attractive and convincing arguement.

  • Turgon

    I very much doubt these North South bodies have ever saved more money than they have cost. Coordination of services is, however, reasonable, for example improving roads on both sides of the border at the same time would be a good idea. Resurfacing the roads between the Boa Island, Pettigoe and Castlederg would for example be a good idea especially if that could be coordinated at the one time. I suspect, however, that would be beyond either the NI or RoI roads services individually or collectively since roads in Ni or RoI seem to be fixed in an entirely random fashion.

    Things like the Foyle Fisheries commission seem pretty sensible.

    In terms of part privatisation of the NHS there are problems. However, people still do not pay to attend the GP or go to see a hospital consultant or go to A+E. Care to remind me which of those cost money in the RoI?

    I see, however, you have given up trying to tell us that the new hospital’s “…catchment area will include Monaghan and Donegal.” Maybe you could admit to talking nonsense on that one?

    You are, however, completely correct about the reasons why hospital services need to be centralised. That was the subject of my first ever blog on this site.

    It was Sammy Mc Nally what done it,
    I tend to agree: we all select the common sense which suits our own political position. I remember until relatively recently nationalists trying to suggest that unionists should support a UI as they would be richer. Now with the virtual extinction of the Celtic tiger I suppose some unionists will propose the opposite. The reality is of course that simple financial reasons alone will persuade few: well not you or me anyway.

  • Turgon

    fin,
    Oh by the way health care has not been harmonised to any significant extent across the EU: that is utter nonsense. There is some harmonisation with the E111 form but the differences are far, far greater than the degree of harmonisation.

  • fin

    Turgon, you need to look here http://www.guardian.co.uk/uk/2008/jul/02/euro.health

    the E111 form is totally different, its intended for tourists or business travel.

    er NO, I still believe north south healthcare is moving towards a single body, and the Enniskillen hospital will cover parts of Donegal and Monaghan.

    The cost of a GP or visit to A&E;is about 12% of my gross salary, and I doubt if the cost of healthcare in the south varies by much. as I said before nothing is free in this life.

    No Turgon, I said specialised health services need to be centralised, I also mentioned that care for the elderly was generally in residential carehomes with high levels of medical care available, the NHS in GB is moving towards small local hospitals and superGP surgeries, this is the modern approach.

    I’m not sure you’ve thought about the north south bodies, surely the sharing of resources, premises, research, knowledge, marketing, backoffice (payroll, HR, admin, etc) etc secure effiency savings for taxpayers north and south.

    Is this any different from commercial companies merging, initialy the cost may rise, but generally the reason for mergers are to save monies on spending in these area’s in the long term.

    Do you think it would make effiency savings to have two tourism boards doing fairly identical marketing?

    Do you think it would make effiency savings to replicate the ‘GulliverIreland’ booking system north and south?

    Do you think it would make effiency savings to have two Food Research Councils, with two lots of scientists
    esearchers in two lots of Labs researching the same issues and problems?

  • Turgon

    fin,
    That article suggestion is not going to happen.
    Debating with you on this is difficult because you tell me that for example North South bodies will save money yet cite no specific examples.

    When you do cite examples they are clearly incorrect:

    You stated that the new hospital near Enniskikllen was going to serve Monaghan and Donegal: it is not.

    You stated that health care was partly privatised in NI yet ignored the vast difference etween NI and ROI viz no charge for attending GP or A+E etc.

    You stated that health is being harmonised across EU yet it actually is not.

    The examples you have used that I happen to know rather a lot about are completely incorrect and either you are lying or simply ignorant of the facts. As such I find it difficult to accept any other suppposedly factual contribution you make.

    Try learning a bit about health policy and then come back.

  • fin

    Turgon, I will of course give way to your superior potilical analysis, please do consider this a learning experience for myself, the link I posted starts

    “NHS patients will be given the right to free treatment anywhere in the European Union under a new blueprint for cross-border healthcare.

    The move, which covers all 27 countries in the EU, is designed to give patients greater freedom and ease congestion in health services with long waiting lists for operations.

    The draft directive, approved by EU governments today, guarantees that treatment costs are covered by the national health scheme of the patient’s home country.”

    a key line is “new blueprint for cross-border healthcare” which in my political ignorance I mistook as an ongoing harmonisation of crossborder EU wide healthcare, where patients can choose from healthcare facilities EU wide, thus harmonising healthcare, for instance should the south have a superior ability to treat cancer or stroke victims than patients across the EU including NI can avail of it, or if NI has a capacity to provide immediate surgery for say heart bypasses than patients in the South or anywhere in the EU can avail of it, be it in Enniskillen or elsewhere.

    Regarding an all Ireland health infrastructure, I did only use words such as ‘believe’ unlike yourself with your superior political mind been able to give an absolute ‘NO’ for which I’m sure you will give reference material to support in your next post.

    In my ignorance I allowed myself to be led to believe that when patients would be allowed to choose to be treated in either the north or south dependent on the quality of care available, coupled with the ‘All Ireland Health Conferences’, CAWT, and the ever growing relationship between the BMI and IMO that it an all Ireland health infrastructure was possible.

    Regarding the different cost models north and south, again I was possibly awkward in my response not having the political insights of yourself, but again I would look to you for leadership on how, say a UK patient can be treated in say Germany Poland or Spain but not in the South of Ireland, and of course vice versa on the strenght of a different costing model, not having your knowledge, I would imagine that the respective health agencies would bill each other, but interested in finding the real answer from yourself.

    With regards to the North South bodies, which I am having difficulty in getting you to speak about, and hence inhibiting my learning experiences, I’m guessing you don’t need me to post examples of how sharing resources provides saving effiencies thats a no-brainer and I wouldn’t insult you with basic examples, however, I believe from your posts that you don’t believe non replication of work provides for these savings, possibly you can assist with my learning experience by posting examples,

    Thank you for engaging with a political pymgy such as myself and I look forward to learning from your answers to my questions.

  • Turgon

    fin,
    That is the problem. You read about health policy. I am involved in it. On this subject I suspect I know a great deal more than you. Still carry on as it is quite amusing for me and those who know who I actually am to see you trying to explain how much you know.

  • fin

    Oh Turgon, regarding the Enniskillen hospital, my thinking was as patients are able to apply for treatment anywhere in the EU, it isn’t (in my simple mind) a big leap for the south to make an arrangement for patients in south Donegal or Monaghan to be treated in Enniskillen and for the NHS to invoice the respective Irish health boards, who in turn can invoice the patients. Again I await your superior political intellect explaining why this is not possible and will never happen.

  • fin

    Turgon, I am nevergoing to learn if you don’t answer any questions, please answer the questions

  • fin

    Turgon incidently I’m guessing by your behavior you have been directly involve in drafting this legislation, what exactly is your involvment in the health policy

  • Turgon

    fin,
    I am not going to tell you who I am or exactly what I do because you are a republican and you live near me: I think you can work that one out.

    I do, however, know a great deal about this subject. If you really want you can email Mick Fealty or fair_deal and they can explain.

    The EU draft legislation will indeed suggest all this and it will have practically no significance. The idea that someone will travel a long way for say post stroke care or the vast majority of care is simply silly. Incidentally the stroke care in the Erne hospital has been noted to be the best in NI (source Northern Ireland Chest Heart and Stroke Association).

    The other issues you fail to understand include that most specialist treatment in the rest of the EU involves a contribution by the patient and is frequently private.

    Suggesting that patients in NI might have faster access to heart bypass surgery is amusing since we rountiely send people to GB and private hospitals in the RoI for these proceedures.

    You have raised inaccurate and erronous claim one after another. Quoting a newspaper article does not a health expert make.

  • fin

    Turgon, firstly I live in London, secondly “Patients will have to pay upfront for their treatment but as long as the cost was lower than in the NHS, they could will be able to reclaim the amount in full.” so thats funding covered.

    Thirdly, the parts of my posts you respond to are getting smaller and smaller, ‘strokes’ was just an example I gave,

    some evidence from me

    http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseastreatmentguidanceforNHS/DH_4074778

    starts “The local NHS Trust or PCT will select patients who they think will be interested in being treated abroad. The patient will be contacted directly by local healthcare organisation, usually the local hospital or possibly the local PCT, to be invited to an Overseas Assessment Clinic (OAC).”

    http://www.dailymail.co.uk/news/article-88916/NHS-patients-set-treated-Greece.html

    starts The Government is negotiating to send as many as 25,000 NHS patients to a Greek hospital for treatment next year.

    “Talks are under way between the Department of Health and the private Interbalkan European Medical Centre about treating British patients who need a hip or knee replacement or cataract surgery.”

    Please do address the rest of my questions, also can you post evidence that this legislation will fail

    As well as the health issues I am still waiting on evidence from you as to why cross border bodies cost more, please do post links to evidence as well.

  • fin

    Turgon, I wanted to know at what level you work within the DoH, purely because you give the impresion that you decide policy and draft legislation, a job title is hardly going to expose your identity, OR if you are actually one of only a few people at an extremely high level, as you seem to imply than yes I am happy to email Mick to confirm you are only one or two levels down form the Minister of Health.

    Incidently I personally know the leaders for such things as eborders (on the commercial side) managing the cabinet office, and count as friends consultants who advise the FBI CIA and MI5 on security matters. I’ve also been a guest at the house of Lords (of a Lord) on several occasions for commercial meetings for IT security contracts, and I’ve signed the offical secrets act. Happy to provide references if needs be.

  • Turgon

    Well fin,
    The legislation will have little significance as patients do not tend to get on planes when they become unwell.

    Also to get a given treatment it will need to be NICE approved: so a treatment not approved by NICE will not be paid for by the NHS.

    Since the maximum waiting time is already prescribed by the DoH and is being met in the UK these rules will not be relevant. The NHS might (just might) buy some care from abroad. However, since the current private sector treatment centres are underworked this is highly unlikely. Currently the NHS does bring doctors across from other countries to do things like cataracts: I believe this happens in the Tyrone County. However, they tend to be from England.

    Patients will not be coming from RoI for in patient care in NI in large numbers since at the moment the ambulances do not cross the border and there is no provision for their care in the new hospital.

    Again you fail to understand that the vast majority of care is not elective but emergency.

    Quoting the Daily Mail is a pretty weak attempt at an argument. Again I have dismissed statement after statement by you and yet you refuse to understand this.

  • fin

    http://www.nhtrusts.com/pages/page_95.htm

    starts – TREATING PATIENTS ABROAD
    Widening patient choice-NHS, private or abroad?

    Up to 100,000 NHS patients could be offered operations abroad this year through extra government funding to cut waiting lists. France was the first to take English patients in January and Germany followed. Since then Greece has shown what healthcare services it can offer, and may prove an even more popular choice,

    http://www.guardian.co.uk/society/2002/jan/21/NHS1

    starts – “The first NHS patients to travel abroad for long-awaited treatment have spoken of their satisfaction at the quality of the care they received at the French hospital which operated on them over the weekend.”

  • Turgon

    Yes fin this is the probelm.

    You started by suggesting a series of things about the Erne hospital which were incorrect. You then suggested a series of things about NI vs RoI health care which again were easily demonstrated to be false.

    You are repeatedly suggesting things about elective procedures in a draft EU guideline failing to understand the significance of NICE or the fact that the majority of healthcare is emergency and not elective.

    Now you are quoting articles from newspapers and an out of date (2002) NHS paper. The 2007 NHS paper you will notice states that NHS trusts may organise treatment abroad if they feel that is the best way to reduce waiting times. Since waiting times in England are now within government targets this is irrelevant. The Guardian article about patients going abroad was also 2002: that was a long time ago when NHS waiting lists in England were much longer.

    Yes a very few patients may avail of this service: a very few. However, what I was pointing to in the first place was the lack of in patients beds since the closure of the Tyrone County: the thing Jim Allister highlighted. You are off on a silly counter factual tangent. Incidentally all the political parties have opposed the closure of the Tyrone County: Jim Allister has, as far as I can see suggested not that the hospital should have stayed open but that its closure should have been properly planned: something which did not happen.

    As to telling you anything about me: no thank you. You say you live in London: well maybe. However, on a previous thread you explained that you were from Fermanagh and also justified practically every murder of Protestants committed in Fermanagh. As such there is no way I am telling you anything abut myself: I value my family’s safety a little too highly for that.

    Now by all means carry on your current silly line of argument: I find it vaguely amusing.

  • Sick as a dog

    This may be slightly tangental but the above reminds me, somehow, of the ass kicking Alex Attwood received from Alex Maskey not so long ago.

  • Turgon

    fin,
    Here is the web site for the 18 week patient journey which has now been enacted in England. Hence, patients are not going away. They might have done in 2002: not now.

  • Expenses

    I just want to say – I hate Jim Allister

  • fin

    Turgon, The operations I believe were knee and hip ops, hardly urgent, the Mail story was todays, you’re hard to please, the storys too old, the stories from the wrong paper, you’re not goldilocks are you,

    Whats the rubbish link you posted, a few posts ago you said NICE wouldn’t allow patients to be treated abroad !!!!

    Bit disturb you seem quite light on detail of what you claim to be an expert on.

    Found your “there’s not enough ambulances” excuse hilarious, you kill me with these stories, do you actually believe them or desperate for an exit

    Anyway if you find the health stuff a bit unhealthy for you you can always have a stab at all my other questions.

    If it makes life easier I can start doing this as multiple choice for you.

    Incidently I never said I was from Fermanagh, I wonder what Mick thinks about what you are implying here?

  • Turgon

    fin,
    I did not say there were not enough ambulances what I explained is that currently ambulances do not move out of area. The NIAS is currently in a state of crisis.

    I did not say that NICE would not allow patients to not be treated. I said that they allowed only NICE approved treatments.

    I see that you are not trying to defend a 2002 article any more and seem to have accepted that the 2007 article you quoted is irrelevant. As such all you are left with is the Daily Mail: not a lot really is it.

    You might also accept that very little of health care is hip and knee operations. You started this debate saying that the new hospital in Enniskillen was going to treat patients from Monaghan and Donegal: now you are reduced to saying that the Daily Mail thinks some hip and knee surgery will be done abroad.

    I am also fascinated as to how many of these people you think will want to travel abroad. Since the NHS in England can manage to treat people within 18 weeks in practically every case how many elderly people needing operations will go abroad: it tends to be the elderly getting hip and knee operations.

    You also might note that people having strokes, heart attacks etc. are even less likely to decide to travel to get the care. They might want to be treated relatively near where they become ill. try to remember that the overwhelming majority of hospital admissions are emergency and not elective.
    In terms of your comments about Fermanagh let me quote: “You ask me to condemn the IRA for the failed bombing at Tullyhommon, ABSOLUTELY, not only because it would possibly have killed people I went to school with (I’m quite local to there) but because it was wrong.”

    So maybe you are not from Fermanagh but you seem to be from close enough to make me not want to tell you who I am.

    Try not to tell lies about what I have said to try to bolster your case.