(As an aside, our national newspapers, mostly right-wing and Conservative-supporting, have poisoned political discourse for decades in the UK. The FT is the only national newspaper with a higher standard of journalism than the others.)
That was a nice short clip, and looking into it, the voice of Anna Ford was initially lost on me (not being British).
I found the German one to be the interesting too in that it was more "regular person" interview content (which was all in English) and the thoughts that they had about the Brexit, the promises that they were given and what they're seeing now. The FT video had a much more business orientation, which while informative on the, well, financial side of it didn't capture the common person's experience as much.
I've posted this before: a monthly season ticket comparison from 2017 for UK and Continental Europe. The price differences between UK and other countries are stark:
- UK: Luton to London St. Pancras (35 miles) | Monthly season ticket cost: £387
- UK: Liverpool Lime Street to Manchester Piccadilly (32 miles) | Monthly season ticket cost: £292
- Germany: Dusseldorf to Cologne (28 miles) | Monthly season ticket cost: £85
- France: Mantes-la-Jolie to Paris (34 miles) | Monthly season ticket cost: £61
- Italy: Anzione to Rome (31 miles) | Monthly season ticket cost: £61
- Spain: Aranjuez to Madrid (31 miles) | Monthly season ticket cost: £75
> UK workers on average salaries will spend 14% of their income on a monthly season ticket from Luton to London (£387), or 11% from Liverpool to Manchester (£292).
> By contrast, similar commutes would cost passengers only 2% of their incomes in France, 3% in Germany and Italy, and 4% in Spain.
I checked the German rates recently and I wish that were still true. The ticket for going between Dusseldorf and Cologne train stations with intercity or regional trains is 175 GBP (146 if you book for the whole year). The one for regional trains only but including transport within the two cities is 269 (216) GBP.
I can add an extra data point for a country on the continent.
Switzerland: £327 a month with an annual commitment, unlimited use of the swiss rail network, local buses/metros/trams/boats etc, with the exception of mountain tourism railways.
I pay £8 for a 13 mile (~20 minute) train ride, 3 days a week.
Quick maths:
8*3 = £24 per week
24*4 = £96 per month
96*12 = £1152 per year
Which is about 4% of my annual income.
If I would take the train everyday, it would be about 6%. On top of that I also make up about 2.5 miles by foot every single day, to save on bus fares or even worse, cabs.
> UK workers on average salaries will spend 14% of their income on a monthly season ticket from Luton to London (£387), or 11% from Liverpool to Manchester (£292).
these figures are deliberately misleading (well... it is the TUC)
they're using the average UK salary
not the average London or Manchester salary, which are both quite considerably higher (London is almost 100% more)
The median should probably be used - the trains are much more likely to be used by people at the lower end of the wage scale. Charles may live in London and make ungodly income, but he’s unlikely to be found on the train.
I don't think anyone commutes from the Home Counties to a job at Pret. People on lower income still live in London, just in not as great housing. People on the train are people who can afford the choice of a luxury of a home in a village or the countryside instead of London.
The "Stockbroker Belt" is a thing, and Sir Humphrey used to commute in from Haslemere (if only fictionally, but I'm sure he was based on real examples).
This twitter thread is excellent. Here are selected tweets to highlight the crisis from hospital and ambulance waiting times.
---
"England & Wales as the only part of Europe that has recorded sustained and rising excess mortality over the last few months with no obvious natural explanation."
"Patients who waited 8-12 hours had a 16% higher chance of dying in the subsequent 30 days than average."
"This was after adjusting for a huge range of possible confounders, i.e this was not due to those patients’ characteristics, conditions etc, but due to the length of the wait."
"You may have heard almost 30,000 people waited 12 hours in English A&Es in July, but that figure actually only refers to the wait after initial assessment"
"Thanks to @Rebeccasmt’s reporting, we know that if you include all time spent waiting, 100,000 people waited 12+ hours!!"
"Take ambulance delays, for example: for emergency situations including suspected strokes and heart attacks, the average wait for an ambulance to arrive on the scene is now one hour, and 40,000 people with these sorts of emergencies waited 2 hours last month."
"As before, the peaks in ambulance-related harms broadly coincide with peaks in England’s non-Covid excess mortality.
"It’s a grim picture, and an increasingly conclusive one."
could you link to that pointing out? which parts don't stack up? the 12+ hour wait times, the hospital occupancy, the discharge rate, the aging population and the slashed spending are all seem to be hard numbers (dare I say facts?) ... what doesn't add up?
the 12 hour wait is once the person enters the doors of the facility. In a hospital, if you walk into the ER, people are observing you closely and expediting people at immediate risk of death. A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.
If the people triaged into 8-12 hour queues have a 16% higher chance of dying in the next month, that's a pretty obvious indication that many of them are, in fact, in critical condition.
I wouldn't trust a stat like that without digging into the underlying causation. The whole twitter presentation is a nice narrative but I see many places where it could just be outright wrong, or saying misleading things (I work in medical biology and have plenty of familiarity with how hospitals run their ERs).
Fortunately the previous tweet linked to the original source, a published study of 5 million ER visits which appears to have a full set of controls and specifically measures time to inpatient transfer in excess of 5 hours as a mortality risk factor
https://emj.bmj.com/content/emermed/39/3/168.full.pdf
A retrospective, observational (IE, after the fact data analysis from a population without controls) study found a risk factor (association). That's not enough to make any real conclusions as to whether this is causal.
It may not be conclusive on the subject of whether the 16% additional deaths were specifically influenced by the additional wait, but in light of that data point, you're going to need a whole lot more evidence to justify your original claim that the cohort that dies 16% more than the baseline population in the days that follow were, without exception, not in any urgent need of medical care...
All I said was: if you can wait 12 hours, it's not an emergency. The emergency room is for things where a person couldn't wait 1 hour without dying. People dying 30 days later: not an ER problem.
Nope, the emergency department of an NHS hospital is absolutely not reserved for things where people couldn't wait one hour without dying (or people who are in danger of death period).
And since we're talking specifically about the subset of NHS emergency department attendees who are more likely to be dead within 30 days if it takes longer than the NHS' target of four hours for them to receive an inpatient bed, I'm pretty unconvinced that the alternative route of booking a doctor's appointment in the next few days to see if he'll refer in a week or two is the more appropriate one...
I know NHS works differently from the US, but the health care providers in the US that are used by major corps (IE, benefits) all have urgent care lines. I've done this repeatedly (to avoid my wife going to the ER with a sick kid). Typically, while it takes a month to get a routine appointment, the kid's doctor always can see them the next day for something urgent.
If you think about it, this makes a lot of sense because ERs are tuned for low latency, low throughput, high cost for emergencies, and if lots of people who just need urgent care go, they make it hard for the emergencies to be seen with low latency.
A few years ago I had an infected gallbladder. It was enormously painful, and I went to ER. It might not have been potentially fatal (I'm honestly not sure if you can die from it), but I didn't know that. I just knew I was in a ridiculously amount of pain.
Anyway, so I went to the ER and to begin I did sit in a chair like you said, however I don't think anyone was keeping an eye on the patients, since by the time someone came to look at me, I had been writhing in pain on the floor for an hour or so, and it had taken another patient to call a nurse over.
All and all it took 4 hours before I got to see a doctor, but this was pre-pandemic.
Still, I think you're probably right and people do show up to A and E for non-urgent issues, however it's probably also tied to how difficult it is to see a GP these days.
Your last sentence is really my underlying point: people use the ER for non-urgent issues because it's available. Ideally, we'd have far more non-ER urgent care (which costs much less to staff and run than an ER) and that would be most people's place to go when their normal doctor couldn't see them.
For the gallbladder, if it's just an infection, not fatal. If it's a gallbladder attack, it can lead to rupture. Definitely needs emergency surgery.
What is the situation of urgent care establishments in the UK? Places you can go for non life threatening but life stopping events, like say a broken leg?
It all goes through A&E, which unfortunately is meant for both the life threatening situations and urgent but not leathal ones yet. You have to go in, register and sit and wait - if it is "just" a broken leg yes you might wait a few hours before being seen.
There's a trend in the US to have urgent care facilities. For example, in my system if I have a problem I call (24/7) and they route me either to urgent care or the ER.
During my visit to urgent care (so early in the days of COVID that there was sign saying only people who had just flew in from Wuhan could be tested), I was seen immediately, the doctor stopped while seeing me, said "the person in the next room is having a heart attack and I have to send him to the ER immediately- I'll be back".
> Instead, they were using the ER for non-urgent care.
FWIW, this isn't always a call that person makes - I've had multiple family members advised to attend by the non-emergency service (111) and ended up with a 6-8 hour wait.
You also can face lengthy waits for something that needs treatment soon but isn't immediately life-threatening (grandfather fell and hit his head on a table, requiring stitches - ~4 hour wait for a handover from the ambulance, another 2-3 before he received an MRI and stitches).
A few years back the doctor sent me over to the ER. Had I gone home instead there would have been zero (above background average) risk of dying in the next 12 hours. That doesn't say the doc was wrong in sending me there--I had a kidney stone, the risk was kidney damage and infection, not dropping dead.
I had a similar situation (sitting in the ER absolutely needing immediate surgery at risk of death), but after a bit I called my parents, who called the surgeon, who saw me immediately (outside the hospital) and then immediately scheduled me for surgery back at the same hospital, all before I would even have been seen at an ER.
Imagine if French citizens were facing energy bills as high as the UK (£5,816, €6850). French citizens would never tolerate such levels.
From Reuters: "France has committed to capping an increase on regulated electricity costs at 4%. To help do this the government has ordered utility EDF (EDF.PA), which is 80% state owned, to sell more cheap nuclear power to rivals"
France really feels like they're building towards serious trouble in the near future. The gap between the discounted electricity costs paid by consumers and the actual underlying wholesale prices is only widening (to the point I think they may even have the lowest consumer costs and highest wholesale prices in Europe, or at least not far off), and that basically all has to be subsidised by the government using debt. They're also part of the Eurozone which is founded on common agreements on government debt, and they're at twice the debt cap and rising. The general consensus is that they cannot stop doing this without serious civil unrest and likely widespread rioting which seems well founded in past events. Energy prices are not the only problem - they have more generous retirement policies than other countries, for example - but changing those other things is just as intolerable.
They are finalising the full nationalisation of EDF, their main electricity supplier and owner/operator of their nuclear power plants.
Then, the electricity wholesale price on the open market becomes irrelevant. As long as their set a price that covers their actual costs for their own consumers they are fine and it is sustainable, and certainly does not require any debts since it does not actually cost anything (beyond the cost of buying the remaining 20% of EDF).
Privatizing everything is great when things are going well. When the shit hits the fan it's nice for elected representatives to be able to force essential utilities to lose money.
Ah, but what many might not grasp about (British) politics is that when the S.H.T.F it is traditional for the UK to vote in the 'other lot' (be that Labour or Conservatives) since the current lot 'are a useless bunch of twats'. This has the advantage of the 'new' government being able to blame all the current problems on the 'old lot'.
And our political system basically guarantees the same people will be in charge until Jan 2025?! 2015 me would never have believed how rapidly things could fall apart.
- Investment bank Citigroup forecasts UK inflation will hit 18.6 per cent in January 2023 — the highest peak in almost half a century — because of soaring wholesale gas prices.
- The bank predicted that the country’s retail energy price cap — which limits how much the average household pays for heating and electricity — would be raised to £4,567 in January and then £5,816 in April (approx $6880, €6850) compared with the current level of £1,971 a year. It added that the shifts would lead to inflation “entering the stratosphere”.
- UK and European wholesale natural gas prices are already trading at close to 10 times normal levels and other forecasters have also raised their inflation predictions.
- The energy regulator Ofgem will on Friday (26 Aug) announce the energy price cap for the period between October and January, which most analysts expect to rise to more than £3,500 for a household with average usage of energy — an increase of 75 per cent on current levels.
NHS funding has increased massively under the Conservatives
That is simply not true. The Conservatives came to power in 2010. Here's what the The King's Fund [1] has to say on funding:
"In the decade following the global financial crisis in 2008, the health service faced the most prolonged spending squeeze in its history: between 2009/10 and 2018/19 health spending increased by an average of just 1.5% per year in real terms, compared to a long-term average increase of 3.6 per cent per year. These pressures were not unique to the UK, whose public spending on health care as a share of GDP is above the EU average, though lower than several comparable nations, including Germany, France, Denmark and the Netherlands." (Source: https://www.kingsfund.org.uk/projects/positions/nhs-funding)
[1] The The King's Fund is an independent charitable organisation working to improve health and care in England.
To put that 1.5% annual real-terms budget increase into context:
In the same decade the proportion of people aged 65+ increased from 16% to 22%ish of the population, an increase of a third. Since these are the people who consume the vast majority of NHS resource, the actual age-adjusted funding has been shrinking steadily every year.
But we're not talking about whether budgets increased by as much as random HN commenters feel would be ideal, I said funding had increased massively i.e. in absolute terms, which it has.
Any discussion of the NHS budget has to accept this reality - the British state is already deep in deficit for decades and had built up incredible debts just trying to keep the NHS budget rising, which it always has. To say the NHS would works better with more money is simply to admit it's broken and can't be fixed, because the government can't even afford the current levels. Especially not after the attempts to stop COVID blew debt and inflation through the roof.
We were talking about the NHS being underfunded, and you said that funding has increased in absolute terms. Both of these things can be true simultaneously.
But, we were not. This thread starts with the claim that "NHS funding has massively increased under the Conservatives" (true) and someone else saying "that's simply not true". But it is true.
NHS apologists always seem to try this switcheroo: someone will point out NHS funding has massively increased - an objectively true claim - and then they'll be accused of lying, by someone who claims it's "underfunded", an entirely subjective and different claim. As you point out, both can be true, but the latter is not disproof of the former nor even a well defined statement.
Looking up in the thread, I see "Another is the massive. underfunding of the NHS over the last decade" in the first post and things like "No, it isn't due to lack of funding, that's a lie" in the replies.
That definitely sounds like the thread was talking about underfunding/lack of funding to me.
Also, for what it's worth, I think your use of "massively" carries an implication to the reader that funding has increased above and beyond maintenance levels (i.e. that it's gone up in real terms, compared to inflation and demographic changes), as I think most people wouldn't describe increases that are below the level needed to maintain service relative to costs as being "massive increases". You'd probably get less pushback if you described it as "increased in absolute terms", or specifically pointed out that the funding increases have been lower than the underlying cost increases.
I know you did eventually add the "in absolute terms" part, but perhaps consider starting with that next time.
"I think your use of massively carries an implication to the reader that funding has increased above and beyond maintenance levels"
The word massive here just means a massive amount of money relative to other levels of government spending changes. From 2010-2020 most govt departments got budgets that went down (austerity), but the NHS was excluded and its funding continued to increase. The amount of money it got is truly massive even on the scale of government.
Trying to talk about "real terms" or "maintenance levels" with something like the NHS is impossible because demand for healthcare constantly increases even with a stable population demographic (some speculate that healthcare demand is actually infinite), as does demand for increased wages. History has shown that there is simply no level of funding increase that the NHS's supporters would ever consider sufficient because they can always claim that the system is strained, could use more people, better paid people, the latest treatments etc. So there's no fixed level that can be identified as maintenance, as one person's maintenance is another's underfunding, which is why all claims about underfunding are impossible to argue with - the statement is literally meaningless.
Related problem: enormous sums of money get allocated to it at a time when every other service gets cuts, explicitly earmarked for upgrades to capacity or buildings and it all gets immediately spent on pay rises in blatant defiance of direct government instructions. So service capacity doesn't change at all but govt can't do anything because too many voters worship the NHS and assume it's perfect except for lack of money.
You realise that this quote supports what I just said, right? It takes massive funding increases to consistently increase budgets year over year for over a decade by that much after inflation adjustment given how huge the NHS budget already is. Go on, compare the budgets between those periods in actual pound sterling terms and then think about how much more tax had to be raised to sustain that (or rather how much debt had to be issued).
France and Norway are cushioning the impact of high energy bills in particular:
France: "..forcing the state-owned energy provider EDF to limit electricity wholesale price rises to 4 per cent for a year. The move is expected to cost €8.4 billion. The French government aims for this move to limit electricity price increases to 4 per cent, compared to an expected 45 per cent.
Norway: "According to a scheme introduced by the government in 2021, Norwegians only pay bills in full when prices are under 70 crowns (€7) per kWh. When energy bills pass that threshold, the government covers 80 per cent of the total."
Meanwhile in the UK, we have a self-absorbed government that has effectively 'checked-out' with no urgency to tackle cost-of-living crisis.
I'm not sure that the move to cap electricity prices in France really 'costs' anything since moat of electricity is from local nuclear and hydro. It sounds more of a loss of potential earnings for EDF (which is indeed in the process of being fully re-mationalised so the State may be fine with that).
The issue in the UK is that the government has nowhere to go apart from actually paying hard cash to subsidise prices to consumers... an inexistant national energy strategy cannot be dreamt up overnight (it's not just this government, it's been going on for decades).
It's going to be an absolute shitshow this winter and the (UK) government may be forced to do something even if that means borrowing even more, although they can also impose a windfall tax in energy companies (they already have).
Just correcting the units of order here for Norway:
The Norwegian government pays 80% of the price above 70 øre (€0.0704) per kWh.
From October they will increase this to 90%. The coverage is capped at 5000 kWh consumption per month.
I can also recommended this short video (3 min): Brexit update (August 2022) https://www.youtube.com/watch?v=IUiJxH2pclM
(As an aside, our national newspapers, mostly right-wing and Conservative-supporting, have poisoned political discourse for decades in the UK. The FT is the only national newspaper with a higher standard of journalism than the others.)