Interview with German Ventilator Manufacturer

Which said infrastructure has no legacy from that era and completely overlook the cold-war build up and associated facilities and infrastructure of that era born out of that period. Equally let us not forget that Germany was upto not long ago - curtailed in what it could invest in military and not having that burden saw a shift into area's they could and medical and industry did well. More so when in many parts they had a clean slate to build up from.

I'm sure many aspect you mentioned are true - , however the drive for solar was born out of a distrust in nuclear and saw a rise in coal plants - which still has an effect today upon the climate of Europe as many (near on all) are located upon the borders, so that issue shifted and needed to be addressed and solar/wind was the right logical direction for them. But then - NO country is perfect or doing it perfect.

But the Germans are trying and done wondrous progress in many area's, let us not forget when they reunified the impact upon their GDP was negligible - that in itself was impressive and whilst in some parts of Germany that legacy still has more of an impact socially, it's progressed a long way and probably more than other countries would of had they been in a comparable situation.

>(what is still there as a disparity between some western states and eastern states.)

Yes - that is a product of legacy.

Yes, this is how such threads always go. It's a simple three step process:

1. Someone claims the NHS funding has been cut

2. I point out that's a lie, no such cuts have ever happened and in fact the budget has always gone up

3. Somebody else replies with: but it should have grown even faster.

The point I'm making is not about the correct level of healthcare spending, which is arbitrary and values-based as healthcare systems will consume however much money is given to them. Rather the persistent level of outright lying that accompanies any discussion of the NHS in Britain. It's absurd and quite obviously linked to a belief that misleading people is fine if it's for a 'good cause'.

But this behaviour has to stop. It isn't OK to lie even if the outcome might appear to be desirable (more political pressure for higher healthcare spending). People learn that they're being manipulated and support for the desired cause can collapse.

Having no money for CapEx is not how you maintain a health service long term.

I'll repeat this until I'm blue in the face. The NHS has more money now than it's ever had. Not only does the NHS have money for capex but it's been repeatedly allocated money specifically and only for capex, because NHS managers have a long history of preferring to divert spending on upgrades to other forms of spending - frequently salary increases.

It's bad management. The government attempts to combat this lack of forward thinking by earmarking of money specifically for upgrades (what you criticise here as "pots of money for very narrow purposes"). One of the first things Boris Johnson did is allocate a billion pounds to the NHS only for capex. Unfortunately it doesn't work:

https://www.hsj.co.uk/technology-and-innovation/exclusive-qu...

"Capital spending was particularly tight with only £150.3m spent from £354.1m of allocated funding ... funding to help NHS trusts to become more digitally advanced accounted for most of this capital underspend. The DH planned to spend £116.2m of capital on these trusts in 2016-17 – instead it spent nothing."

The idea the NHS doesn't have money for capex is just another piece of misdirection. It refuses to spend on upgrades even when central government is trying to force its hand, because it knows that the result is No 10 will blink and give up, which is what happens:

"The money was not allocated elsewhere but “as with all Department underspends, was available to offset pressures in other parts of the system”, she said."

https://fullfact.org/health/spending-english-nhs/

"Looking at the wider UK, the amount spent on health has been increasing over the long-term. That’s true whether it’s expressed in cash, cash adjusted for inflation, per person, or as a proportion of the size of the economy."

Population growth puts pressure on public services. The British people have been asking for reduction in population growth for a long time, partly out of concern for the state of the NHS, yet of course have been repeatedly denied by the EU and their own political classes. 4 years after voting to leave the EU largely to get a grip on the ever-increasing cost of public services they still haven't been allowed that.

Doctor and nursing salaries are pretty low in the UK

They're extremely high. The average pay for specialist consultants in the NHS is £120,000 or approximately 6x the average salary. This is dramatically higher than in say, Germany, where specialists earn 80,000 Euro on average. That's £71,600 or a bit less than 60%.

https://www.google.com/search?hl=en&q=average%20salary%20for...

https://www.medscape.com/slideshow/2019-uk-doctors-salary-re...

if management is diverting capital expense money to salary increases, they are doing a poor job of it.

They've done an excellent job of it. From 2010:

https://www.telegraph.co.uk/news/health/news/8206972/Billion...

"Billions of pounds spent on improving NHS hospitals has mostly gone on staff salaries while productivity has fallen over the last decade, a key National Audit Office (NAO) report has found."

"Between 2000 and 2009 the NHS workforce grew from 1.1 to 1.4 million - almost a 30 per cent rise. That included an extra 12,500 consultants, whose average pay rose from £71,900 to £120,900 over the same period - a 68 per cent increase. Doctors' pay rose by 48 per cent, nurses' and midwives' by 36 per cent and managers' by 34 per cent"