Brexit and the waning days of the United Kingdom

[Barrister]

I've always thought our health policy debate is trapped in a perception that the two models are British and American (not the only are where that's our discourse), so I'm always interested when someone actually looks at a European model. But also - and this is starting to shift with Labour's Shadow Health Secretary - our debate in recent years has basically just focused on funding and spending levels. I think the bit that has been missing is any sense of reform (again Labour's Shadow Health Secretary starting to talk about public sector reform again).

Sounds very much like the health care debate in Canada - any hint of increased private involvement in health care is immediately labelled as being "US-style health care".  You can try to talk about German, or Australian models until you're blue in the face

[Jacob]

Sounds very much like the health care debate in Canada - any hint of increased private involvement in health care is immediately labelled as being "US-style health care".  You can try to talk about German, or Australian models until you're blue in the face

Sounds like the German model is two-tier still.

[HVC]

Sounds very much like the health care debate in Canada - any hint of increased private involvement in health care is immediately labelled as being "US-style health care".  You can try to talk about German, or Australian models until you're blue in the face

Sounds like the German model is two-tier still.

As is Australia's, but as far as I know both systems work well for them. Possibilities shouldn't be ignored because one extreme (the us) seems deeply broken for the average person. That's not saying it can work everywhere because truthfully I don't know.

[Barrister]

Sounds very much like the health care debate in Canada - any hint of increased private involvement in health care is immediately labelled as being "US-style health care".  You can try to talk about German, or Australian models until you're blue in the face

Sounds like the German model is two-tier still.

Well yes.  So is the Australian system.


Ah - I see HVC just ninja'd me.

[Zanza]

I can't make an educated comparison, but saying the German system "works well" is not entirely correct. Some things work well, others not...

[Sheilbh]

Sounds very much like the health care debate in Canada - any hint of increased private involvement in health care is immediately labelled as being "US-style health care".  You can try to talk about German, or Australian models until you're blue in the face

There's definitely that around private involvement. But it is worth re-iterating that the NHS has always been a part private system because that was the price of getting doctors to participate. That covers both the private sector providing core services - GPs are all private partnerships (they're now facing a challenge because younger doctors don't want to become partners) and always have been. But also allowing NHS staff to have a private practice, consultants for example.

The issue in the NHS that Tory and Labour governments have tried to address is how do you stop what is effectively a monopoly service becoming captured by "producer" vested interests and make it responsive to patients. I think that is an area where European social insurance models work better - for example access to specialists without the very strong NHS gatekeeping, better primary care services etc and possibly a more resilient system precisely because it isn't "efficient".

Broadly speaking the Tory approach has been to try and separate the NHS more and more from direct ministerial control, and to introduce internal market mechanisms (commissioning groups for certain services etc) that are open to private and public bodies. But the Lansley reforms in 2012 were an absolute disaster that don't function, I think NHS Englnd have basically admitted that they more or less ignore them because they're too complex.

The New Labour approach (as with all public services) was higher funding, huge data collection to produce league tables, metrics and targets plus some form of internal markets.

I think those approaches are trying to answer the right question. So I have sympathy with nurses and junior doctors, for example. But agree with Labour's Shadow Health Secretary that basically with more resources there needs to be better services, that the NHS is "a service not a shrine" and that their union the BMA are not helping themselves when they're voting for core opening hours for GPs of 9-5 or against in person consultations etc.

Thing I find frustrating is the extent to which everything is just framed around funding levels and fears of privatisation/"our NHS" rather than the quality of service that is being delivered to the public. Funding is clearly part of that but I don't think it's the only issue. I'm not personally sure we need an entire overhaul to adopt a European social insurance model - but I wonder if there are things we can learn without any reform being positioned as creeping privatisation/Americanisation.

[garbon]

https://www.theguardian.com/books/2023/jan/04/prince-harry-william-physical-attack-2019-meghan-spare-book

Prince Harry details physical attack by brother William in new book

In  his highly anticipated autobiography, Spare, Prince Harry recounts what he says was a physical attack by his brother, William, now Prince of Wales, as their relationship fell apart over the younger prince's marriage to the actor Meghan Markle.

Describing a confrontation at his London home in 2019, Harry says William called Meghan "difficult", "rude" and "abrasive", which Harry calls a "parrot[ing of] the press narrative" about his American wife.

The confrontation escalated, Harry writes, until William "grabbed me by the collar, ripping my necklace, and ... knocked me to the floor".

The extraordinary scene, which Harry says resulted in visible injury to his back, is one of many in Spare, which will be published worldwide next week and is likely to spark a serious furore for the British royal family.

Amid stringent pre-launch security around the book, the Guardian obtained a copy.

The book's title comes from an old saying in royal and aristocratic circles: that a first son is an heir to titles, power and fortune, and a second is therefore a spare, should anything happen to the first-born.

Spare is a remarkable volume, in which the altercation between the two princes forms a startling passage.

Harry writes that William wanted to talk about "the whole rolling catastrophe" of their relationship and struggles with the press. But when William arrived at Nottingham Cottage – where Harry was then living, in the grounds of Kensington Palace and known as "Nott Cott" – he was, Harry says, already "piping hot".

After William complained about Meghan, Harry writes, Harry told him he was repeating the press narrative and that he expected better. But William, Harry says, was not being rational, leading to the two men shouting over each other.

Harry then accused his brother of acting like an heir, unable to understand why his younger brother was not content to be a spare.
Insults were exchanged, before William claimed he was trying to help.

Harry said: "Are you serious? Help me? Sorry – is that what you call this? Helping me?"

That comment, Harry says, angered his brother, who swore while stepping towards him. Now scared, Harry writes, he went to the kitchen, his furious brother following.

Harry writes that he gave his brother a glass of water and said: "Willy, I can't speak to you when you're like this."

He writes: "He set down the water, called me another name, then came at me. It all happened so fast. So very fast. He grabbed me by the collar, ripping my necklace, and he knocked me to the floor. I landed on the dog's bowl, which cracked under my back, the pieces cutting into me. I lay there for a moment, dazed, then got to my feet and told him to get out."

Harry writes that William urged him to hit back, citing fights they had as children. Harry says he refused to do so. William left, Harry says, then returned "looking regretful, and apologised".

When William left again, his brother writes, he "turned and called back: 'You don't need to tell Meg about this.'

"'You mean that you attacked me?'

"'I didn't attack you, Harold.'"

Harry says he didn't immediately tell his wife – but did call his therapist.

When Meghan later noticed "scrapes and bruises" on his back, and he therefore told her of the attack, Harry says she "wasn't that surprised, and wasn't all that angry.

"She was terribly sad."

...

[Syt]

Paraphrasing Twitter: "Juiciest Harry v William British Royal action since 1066." (Yes, I know Prince Harry is technically a Henry, not a Harald/Harold )

[Sheilbh]

I thought the reference to Charles at the end was a bit sad. There's been that thing since Victoria and Albert of the royals performing as a family for the British public. So people are able to identify more easily because they're doing family things - weddings, christenings, funerals etc. In my case that can now extend to blazing family rows and estrangements

Harry recounts an anguished meeting with Charles and William after the Windsor Castle funeral of Prince Phillip, the queen's husband, in April 2021.

Charles, he says, stood between his warring sons, "looking up at our flushed faces".

"Please, boys," Harry quotes his father as saying. "Don't make my final years a misery."

Separately - and on how the rest of us live - ONS releasing census stats on housing today - they had some other stuff on work and travel in December. Then releases on sexuality and gender identity tomorrow, education next week and health, disability and unpaid care in a couple of weeks. After which I think they started working on the multiple analysis/intersections of all the data.

I know I've posted in shock at this stat before but still find this extraordinary - especially as the UK is about 85% urban There's been a small increase from 21% living in a flat or apartment. I have no evidence or basis for this but I think lots of house/bungalow owners is a factor in NIMBYism


62.5% are homeowners, 37.3% live in rented accommodation and 0.1% live rent-free.

It's really obvious thinking about it but really struck by the fact that people living in communal living are overwhelmingly either students or care home residents. Slightly surprised to see care home residents fall as a % of that group given our demographics generally:


Really striking in this winter - and probably next too - that around 700,000 people don't have central heating. There'll be more details on that and availability of a car or van later today.

Seen the Welsh stats that around 72% of homes have gas central heating which is a big part of our challenge (with insulation/energy efficiency) in the energy transition. It also seems like the proportion of people without access to a car or van has fallen. Haven't seen combined or English stats for this.

Edit: And the housing map to check out your neighbourhood:
https://www.ons.gov.uk/census/maps/choropleth/housing

[Tamas]

Most of those houses though are terraced "houses" aren't they? horizontally organised flats with sad little gardens.

Those are, incidentally, the height of our reasonable house-buying ambitions in our area.

[Sheilbh]

People love their gardens and you can't have a shed on a balcony.

In England and Wales it looks about 50/50 between terraces and semis.

[The Larch]

I have no evidence or basis for this but I think lots of house/bungalow owners is a factor in NIMBYism

Well, duh.    As I'm sure I've already badgered one too many times, the British obsession with living on single family houses with a ridiculous "garden" is one of the main reasons why IMO you have such housing issues in the first place. It's trying to pretend to be on splendid isolation while ignoring that you live side by side with other people in the same situation as you.

[Josquius]

It's really obvious thinking about it but really struck by the fact that people living in communal living are overwhelmingly either students or care home residents. Slightly surprised to see care home residents fall as a % of that group given our demographics generally:

I think there might have been a rise in supported accommodation over the past decade. I've visited one of these places before. It feels kind of like a student residence for old people.
Not quite a care home, people totally own and control their own flats, but nonetheless there is a common room and on site staff. Maybe these places aren't being counted under communal living?

Really striking in this winter - and probably next too - that around 700,000 people don't have central heating. There'll be more details on that and availability of a car or van later today.

I was really surprised over xmas to visit the rented flat of my partner's friend. Its a new build block, only 20 years old or so, and they have little stand alone electric heaters in every room. Very odd.

It also seems like the proportion of people without access to a car or van has fallen.

Now thats depressing.

[Tamas]

I have no evidence or basis for this but I think lots of house/bungalow owners is a factor in NIMBYism

Well, duh.    As I'm sure I've already badgered one too many times, the British obsession with living on single family houses with a ridiculous "garden" is one of the main reasons why IMO you have such housing issues in the first place. It's trying to pretend to be on splendid isolation while ignoring that you live side by side with other people in the same situation as you.

[The Larch]

I'm sure it's not the first time I've rambled about this.