X Close

The toxic British worship of the NHS We need to protect patients, not sanctify the institution and place halos on staff

The 2012 Olympic opening ceremony, which celebrated Britain being the only country in Europe with free healthcare, if you only count Belarus and maybe Albania. Photo by Cameron Spencer/Getty Images

The 2012 Olympic opening ceremony, which celebrated Britain being the only country in Europe with free healthcare, if you only count Belarus and maybe Albania. Photo by Cameron Spencer/Getty Images


December 2, 2020   7 mins

When Michael Gove sought to shore up support for the Government’s polices on lockdown, he invoked the most sacred idol in the land by daring his party sceptics to defy the deity they must all worship. “We had to act,” he wrote at the weekend. “Because if we did not our health service would have been overwhelmed.” The bespectacled cabinet office minister, who once acted in a film as a priest, went on to deliver a chilling sermon about a broken health service filled with overflowing wards, struggling staff, cancelled operations and dying patients if his blasphemous critics did not bow down in faithful obedience to his pious demands.

Gove’s hellfire and brimstone warning was overheated guff. Yet his ploy was clear: few things strike more terror into a Tory politician than being seen as unsympathetic to doctors and nurses. Perhaps he deserves some credit for at least setting out clearly the Government’s stance, something that seems beyond his boss. Yet note how once again this Conservative administration demands complicity from citizens in its efforts to control Covid-19 on the grounds of protecting the National Health Service, just as when the pandemic’s first wave hit the country. The legacy of this obsession was the relegation of social care to secondary importance, which led to thousands of needless deaths in a sector already shattered going into this crisis.

The Government seems to have learned nothing from the carnage in care homes. Gove’s intervention followed a spending review that saw another £6bn bunged to the NHS while social care — starved of cash over the past decade despite surging demand — was swept aside. One Tory bigwig boasted on Twitter how real term spending on the NHS would have risen next year by an astonishing £56.4bn since his party took office in 2010.

He failed to mention, of course, that chancellor Rishi Sunak handed social care a pitiful ÂŁ300m, plus access to a further ÂŁ700m through local tax rises that will be soaked up in rising wages. This may, however, finally nudge spending on adult care over the ÂŁ22.4bn high water mark seen in the year David Cameron became prime minister.

If councils cannot support old folks with dementia and other citizens with complex needs, extra pressure lands on health services, showing the hollow hypocrisy of those ceaseless chants of devotion to the NHS. That fall in social care spending occurred during a decade of rising demand in a growing and ageing population, with additional need coming especially from disabled adults who account now for almost half the spending. “It is hard to believe this level of underfunding could have been tolerated yet it was — at least in part because social care is used by far fewer people than the NHS and does not enjoy the same degree of public recognition,” said Simon Bottery, a Senior Fellow at the King’s Fund think tank.

Spot on. Yet there is no sign still of the chimeric plan to salvage social care that Boris Johnson promised he had in his pocket when he entered Downing Street last year. Part of the problem is under-funding, which leaves desperate people abandoned in their time of immense need and overburdened staff paid insulting sums. And Brexit has made the staffing shortages more acute.

Yet there is also stealthy profiteering by secretive firms based in tax havens and laden with debt that needs sorting, not least since they shift provision away from poorer parts of the country while their economies of scale lead to bigger “homes”. No other part of the state is more in need of reform, no other public service so failing the citizenry, yet no other sector is treated with such dismissive contempt by politicians.

The only public sector workers handed a pay rise by Sunak were those secular saints slaving away on the NHS frontline. Yes, many of them have performed heroically during this pandemic and deserve our gratitude — but so have other public servants. It is hard to see why a general practitioner pocketing a six-figure salary in Devon is more deserving than a junior police officer spending her days pounding the streets of Bolton or Birmingham to enforce the Government’s byzantine Covid rules.

Behind this distorted policy lies sentimental worship of a public service that was corrosive even before a pandemic inflamed the problem. I watched a re-run of the London Olympic opening ceremony during the first lockdown; that chunk filled with dancing doctors, nurses in old-fashioned uniforms and kids bouncing on hospital beds looks even more absurd now.

Despite the intensity of Britain’s devotion to the NHS, there is nothing unique about universal healthcare in a rich European nation; every country in western Europe has it, as does almost every country in eastern Europe. And like it or not, our health service often has worse outcomes than its neighbours on key indicators such as amenable mortality (when people die from potentially preventable conditions), brain strokes, many cancers, even infant mortality. For all the impressive efficiency and improved productivity, it is naĂŻve to think that the NHS’s problems are all down to money, whatever medical trade unions may claim.

This blinkered veneration ends up not just overshadowing the unloved social care sector but harming patients. It might sound sacrilegious but not every health worker is a hero, however dedicated the majority. Consecration of a public service that instills such fear of criticism in politicians impedes proper focus on profound issues of fairness, outcomes and patient safety. Yet there are systemic flaws that tend with sickening inevitability to injure — and sometimes kill — those most in need of help, such as the very old, the very young and those with disabilities.

Ask yourself why Matt Hancock, the flailing health and social care secretary, allows thousands of people with autism and learning disabilities to be locked up in abusive hellholes where they are routinely sedated and stuffed into solitary cells, even fed through hatches like wild animals? Why do we have a psychiatric system so reliant on pharmaceutical and physical restraint? Why is so little done about profiteering private firms earning vast sums while delivering dismal services? Why is diagnosis of autism in girls so dire, despite the devastating consequences when they develop eating disorders or slash their bodies as their mental health deteriorates?

Last week I spoke to another frightened mother trying to stop her daughter being destroyed; this woman was a medic, yet felt powerless against a cruel system that left a traumatised teenager with autism and special needs asking why she was being punished in a secure hospital for the “crime” of being sick? Yet again, it showed to me how Britain has moved on less than it likes to think from the days of Bedlam. Yet where is the outcry as lives are devastated due to the deficiencies in care and inhumane denial of human rights that lies deep in the heart of our beloved health service?

Then there are the mistakes. These are, sadly, inevitable in a huge and highly-pressurised institution that is reliant on human endeavour. Yet look at every major patient safety scandal in recent years and they all have a common narrative of bereaved families and/or brave whistleblowers having to fight against a system that sought to close ranks, cover-up lethal bungles and crush those seeking the truth to protect others from heartache.

There is a lengthening list of these shameful sagas: hundreds of haemophiliacs dying from contaminated blood; elderly patients dying in squalor in mid-Staffordshire hospitals; babies dying during cardiac surgery due to lax safety measures in Bristol; more paediatric deaths amid a cover-up in Morecambe Bay.

We learned that hundreds of people with learning disabilities die annually in the health service even before the pandemic due to mistakes and prejudice, thanks to the campaigning zeal of a mother whose teenage son drowned in horrific circumstances in a supposed place of sanctuary.

Earlier this year there was a devastating report into three separate health scandals that exposed a series of blunders by the NHS, regulators and private hospitals. It followed a superb investigation by Baroness Cumberlege, who talked to 700 people about pelvic mesh implants that led to agony for thousands of female patients after childbirth and two drugs that left children with disabilities. She spoke in stark terms about the suffering of these medically-injured families, pointing out that many of the horrific problems could have been avoided. Instead a defensive, disjointed and badly-regulated system was shown to lack leadership, ignore patient concerns and perpetuate mistakes. It was chilling to see how complaints from wounded women were brushed aside by patronising men in positions of power.

The same embedded issues in a “culture of avoidance and denial” were seen again when another inquiry this year disclosed how a rogue breast surgeon subjected more than 1,000 patients to unnecessary and damaging procedures over 14 years before he was stopped and jailed. Lethal maternity failings are being investigated in Shrewsbury and Telford Hospital NHS Trust, which may turn out to be the worst patient safety scandal in NHS history, with dozens of deaths and brain-damaged babies. A probe has been launched into infant deaths in two Kent hospitals that only emerged thanks to the extraordinary tenacity of another traumatised family.

This is the flip side of sanctifying the NHS. We see again and again the dangers of placing this vital public service on a pedestal that calcifies its defences against accountability, criticism or dissent. Compare how a less hallowed institution like the airline industry demands a safety culture while the health service, impervious to criticism, leaves a trail of wrecked lives behind its culture of denial and cover-up. Soaring costs of compensation are a factor — but legal bills would fall sharply if medics and managers stopped seeking to silence those raising concerns and politicians ensured aggrieved parties had less need to spend years in weary battles for justice.

Last week another horror story emerged when Anne and Graeme Dixon were vindicated by a damning report after 19 long and lonely years struggling to get answers over the avoidable death of their infant daughter in the face of obfuscation. The couple were let down by every arm of the state meant to help them: the local health commissioners, the coroner, the police, the NHS chief executive, the parliamentary ombudsman. Then another inquiry was launched on Monday into a series of deaths involving care failures by Essex Partnership University Trust; once again, this is only taking place thanks to the courage of another bereaved parent called Melanie Leahy whose son died aged 20 in a secure mental health unit.

These people are unheralded heroes, fighting through their pain to help others avoid similar trauma. We need to protect patients, not sanctify the institution and place halos on all the staff. As the Dixons said, families should not “have to suffer the hell we’ve been through to learn the truth”. Instead politicians keep ordering inquiries, issuing reports and saying they have learned lessons each time there is another tragedy.

Then they speedily return to spouting their complacent platitudes and praising the NHS while doing nothing to tackle lethal systemic flaws and toxic power imbalances that riddle the health and care systems. It is so much easier to applaud, emote and spew out hollow words than to take any real action that might actually stop suffering and save lives. No wonder they make so many people sick.


Ian Birrell is an award-winning foreign reporter and columnist. He is also the founder, with Damon Albarn, of Africa Express.

ianbirrell

Join the discussion


Rejoignez des lecteurs partageant les mĂȘmes idĂ©es qui soutiennent notre journalisme en devenant abonnĂ©s payants.

Subscribe

To join the discussion in the comments, become a paid subscriber.

Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.

Subscribe
Subscribe
Notify of
guest

280 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments
Steve Craddock
Steve Craddock
3 years ago

I think the NHS as it stands has become a kind of moral and financial cancer in our society. Some of the staff are seemingly happy to ruthlessly exploit their position when people are at their most vulnerable and to hold to ransom the sick and the dying to try and get a wage rise. Most recently the NHS staff have been directly bestowed with politburo levels of benefits in civil society from fawning businesses keen to bask in the government mandated cult. Jump in front of the prolls queuing for food, who incidently pay your wages, sure no problem, free mobile data, great pensions, fantastic job security; yeah ok fill your boots. Oh, as service you need us to destroy our livelihoods more, loose our homes, stop us from congregating, ruin our mental health, further damage our economy all because 7 months notice is still not enough time for the NHS to get its act together. Fine, what more do you need from us? OK, the economy is now officially in the toilet, but you now want a 3.1% wage rise as you did such a great job. It is almost as if curing lots of sick people isn’t part of the NHS’s core purpose. Time for a change; no more homage or blind worship. Let’s not clap for the NHS, its not actually a diety, its health outcomes are that not great, and the sacrifices it seems to demand seem to be never ending. Instead, let’s celebrate the working people in all the private sectors where the wealth of the country is actually generated and who through their continued toil pay for all the public sectors. Once that is done let’s turn a rational eye towards the NHS and see where we can improve it. I suggest we create a panel of everyday people like the climate one but with a constantly refreshed invite like jury service may be, to find out what we need our core health care system to be providing in the 21st century and how it should funded.
(Edited to correct typos)

Andy Yorks
Andy Yorks
3 years ago
Reply to  Steve Craddock

You can’t ‘improve’ the NHS. It is rotten to the core. It was founded on lies and on theft.

Fraser Bailey
Fraser Bailey
3 years ago
Reply to  Andy Yorks

It is certainly rotten to the core. Its model could be salvaged, but not within the belief systems that prevail in modern Britain, or by the sort of people that come to power in modern Britain.

Chris C
Chris C
3 years ago
Reply to  Andy Yorks

“Founded on lies and theft”.

Please explain.

Alan Thorpe
Alan Thorpe
3 years ago
Reply to  Chris C

It was founded on the basis that it would need a lot of money initially, but this would decrease as we all became healthier.

Chris C
Chris C
3 years ago
Reply to  Alan Thorpe

Which hasn’t happened under either the NHS, or private healthcare. The US spends 19.7% of its larger per capita GDP on healthcare, compared with 9% of GDP in Britain, and their need for healthcare doesn’t diminish either.

Quentin Vole
Quentin Vole
3 years ago
Reply to  Chris C

Why do NHS-idolaters always use the US as a comparison? Why not Germany (or practically any other European nation), which has avoided the pitfalls of the Stalinist monstrosity that is the NHS, with significantly better health outcomes as a result? It’s (almost) a mystery.

opn
opn
3 years ago
Reply to  Chris C

I suspect that Mr. Yorks is thinking of the nationalisation of hospitals, which had, before 1947, been run as local charities.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  opn

Much as nearly all state schools were built and maintained by the CoE (not a member, just being fair to them), educating millions before signing themselves away in exchange for a paper promise.

Chris C
Chris C
3 years ago
Reply to  opn

And the provision of healthcare was patchy and very skewed by wealth. Which is one of the reasons why the nation expelled even Winston Churchill in 1945. They had experienced that system of healthcare and they wanted an NHS. Whereas now they have had the NHS for 72 years and they want the NHS to continue.

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Chris C

I don’t want it to continue, it is of no use whilst GPS are hiding behind locked doors, when the only contact permissible is when they want to earn extra money by injecting patients with vaccinations..try ignoring their texts and they suddenly make the effort to contact you.

David J
David J
3 years ago
Reply to  Pauline Ivison

Visible or not, my local surgery and GPs there have been excellent to me over the last weeks, as have the hospitals in Banbury and Oxford that I have attended.
I’ve had little need for any medical attention for decades, so have been impressed by the service I have experienced.

Anna Borsey
Anna Borsey
3 years ago
Reply to  Pauline Ivison

Hear, hear!
I concur.
DO NOT ENTER! GO HOME!
it says, in HUGE red bold capitals on the entrance door to “my” local GP surgery.

Alan Hawkes
Alan Hawkes
3 years ago
Reply to  Chris C

Yes, most people want the NHS to continue, but I doubt that they want the scandals detailed above to continue as if in some sort of Faustian bargain. Perhaps they have been conditioned to believe that any other system would have a greater number of scandals. Perhaps they just cannot believe that these scandals really happened in their version of the NHS.

Jos Haynes
Jos Haynes
3 years ago
Reply to  Chris C

Anyone with experience of healthcare in another democracy llike France or Australia KNOWS how awful the NHS is and would like it abolished. Only the ignorant like you would want to keep it.

opn
opn
3 years ago
Reply to  Chris C

I was not defending Mr. Yorks, merely adding information. It should of course be remembered that all three major parties had proposals for a health service at the 1945 election, based on the plans of Sir Henry Willink, the Conservative Minister of Health, and that the Conservative plan would have been less centralised and less dependent on national government.

David J
David J
3 years ago
Reply to  Chris C

Not forgetting that an NHS was on the agenda for all main parties in 1945.
So had Churchill won that election, an NHS would still have been created.
Different perhaps, but still a National Health Service.

Terence Riordan
Terence Riordan
3 years ago
Reply to  opn

If you ever look closely you will also see that hospitals provide most of the surrounding population with pens,pencils,brown tape,plasters,fisrt ad needs etc ets never mind the losses from the catering side.

Anna Borsey
Anna Borsey
3 years ago
Reply to  Andy Yorks

 It was founded on lies and on theft.”
Eh? Was it? What lies? Theft of what precisely?

Mud Hopper
Mud Hopper
3 years ago
Reply to  Steve Craddock

‘Save The NHS’ – a mantra largely driven by the lower orders of UNISON I’m afraid.

Warren Alexander
Warren Alexander
3 years ago

Elevating any institution into some angelic form sent by heaven to save humanity is always going to be absurd.

Simply recognising that the NHS is far from perfect; that not all its staff are superb and that some are utterly incompetent; that it is too often very badly managed; that better health care systems exist in other countries would be a good place to start in considering how it can be improved.

We should also remember, that in many instances, the NHS provides excellent service and the fact that you are not asked how you are going to pay for your treatment is a mark of our civilised attitude to healthcare.

William Cameron
William Cameron
3 years ago

No one in Europe goes without health care . None of them use the NHS state run supplier model.

dehavilland
dehavilland
3 years ago

Indeed.

Kevin Ryan
Kevin Ryan
3 years ago

That’s not true.

Which European countries don’t run a fully or majority public healthcare system ? I know France, Germany, Sweden, Italy, Spain all do.

Joe Blow
Joe Blow
3 years ago
Reply to  Kevin Ryan

You are, If I have understood you correctly, conflating a health system which provides care to everyone, at an affordable price and one that insists that essentially all employees of care delivery services are state employees.

The simple fact is that there is no need for all staff to be state employees just to ensure that care is free at the point of delivery.

7882 fremic
7882 fremic
3 years ago
Reply to  Joe Blow

Excellently pointed out.

Chris C
Chris C
3 years ago
Reply to  Joe Blow

“The simple fact is that there is no need for all staff to be state employees just to ensure that care is free at the point of delivery.”

True. Just as we don’t need the police or the armed forces to be state employees. They could all be provided by agencies, like the private security firms used in Iraq which machinegun any Iraqi driving close to them, or private sector G4S who screwed up security at the London Olympics so that the public sector Army had to be called in at the last moment to get the job done.

But to avoid paying for a vast superstructure of corporate bureaucracy, buckpassing, lawyers, marketers, and profit-extraction, we employ NHS staff directly just as we employ police officers and soldiers directly. It’s more efficient that way.

Jos Haynes
Jos Haynes
3 years ago
Reply to  Chris C

Oh Ho! Clearly communism is better than any market model in meeting health needs.

You are very vocal here but you show no sign of understanding anything about the subject. Try looking up the difference between public and privae goods for a start.

Chris C
Chris C
3 years ago
Reply to  Jos Haynes

You regard the NHS as “communism”.

Try reviewing your ideological dogma that private is always better.

unconcurrentinconnu
unconcurrentinconnu
3 years ago
Reply to  Chris C

Yes, the NHS is communism. And I have experience of living in far better served countries such as France & Australia AND I have lived in communist countries. You seem to have no comparable experience. Still, your die hard socialist dogma keeps you going, though it won’t help you much when you become ill, need an urgent operation, and are kept waiting for 1-2 years.

Joe Blow
Joe Blow
3 years ago
Reply to  Chris C

It is not clear that – for healthcare – it actually is any more efficient. There’s also some data to suggest it is less so.

I am not engaging in any kind of ideological rant against the existence of a public sector. My plea is that we look empirically at comparative studies of international health policies and the effectiveness of health systems. When we do that, the NHS does not fare especially well.

Phil Thompson
Phil Thompson
3 years ago
Reply to  Chris C

I can think of no better example of a ” vast superstructure of corporate bureaucracy ” than the NHS.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Joe Blow

It is if course possible to turn the health service over to the private system. Why do you think that would generate a better outcome for the public? Would the number of patients decrease? Or the complexity of the system? Would the UK population stop ageing ?

Or would a profit-driven system be heavily incentivised to not service the most expensive, elderly, rural dwellers and those with chronic conditions?

If there’s one lesson that we should globally be learning now, it’s that the free market is Not the magic solution to all our problems.

Let me put it simply- a private company wants to make profits for it’s shareholders. Profit is money extracted from the healthcare system. The more they extract, the better for them. Can you not see the obvious contradiction between this objective and public health?

Joe Blow
Joe Blow
3 years ago
Reply to  Kevin Ryan

Let me also put it simply: the performance of the NHS compares poorly with many other countries (which also have state-funded care) in one extremely important measure: how well people with serious conditions are made better.

“…would a profit-driven system be heavily incentivised to not service the most expensive, elderly, rural dwellers and those with chronic conditions?”
It depends on how ‘purist’ you are. Even in the US (which is not a system I am advocating) the elderly get good access to care (through Medicare). Rural dwellers have challenges (as they can do in the UK – a function of geography, economy and logistics) but there are lots of financial incentives provided for rural care providers in the US.

There is a role for the public sector. The example you cite (public health) is one. Running hospitals is probably not one where it is automatically better to have the public sector do it.

There are many aspects of healthcare that are better undertaken by the private sector. Building ambulances; making ECG machines, developing pacemakers, researching drugs. I want open and informed debate about where it makes sense for everyone to be a state employee and where it does not.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Kevin Ryan

If a profit-driven system were not incentivized to provide the most expensive care to the elderly, Medicare and Medicaid would cost much less in the US. (Much of Medicare is provided through for profit companies.) Yet there’s almost no treatment or pharmaceutical the US would deny a patient in their late nineties.

Chris C
Chris C
3 years ago

Out of interest, do you think US spending on Medicare and Medicaid is excessive and should be reduced?

Bob Green
Bob Green
3 years ago
Reply to  Kevin Ryan

Profit motive drives efficiency and being sued for malpractice reduces profits, so don’t get it wrong.
Both reasons to improve what we have now.
The inefficient over staffing of the administrative side of my local hospital has to be seen to be believed.
It’s like comparing the groups of employees standing around, gossiping in Tesco with the hard working employees of Lidl.
Recent example. Two receptionists booking in patients to see one specialist for 20 minute appointments. One minutes work, nineteen minutes chatting. I watched it.

unconcurrentinconnu
unconcurrentinconnu
3 years ago
Reply to  Kevin Ryan

You are wrong. I lived for 10 years in France and paid my GP 23ñ‚¬ per visit – that was his income – the state gave him nothing (except it paid for the visits of the unemployed/ultra low income I think). I was seen by private consultants at private hospitals or institutions. And I paid them for their services as I would pay anyone. There were publicly funded hospitals but the basis of usage was the same for all. One paid one’s way, either directly or though private health insurance. The state provided a subsidy on most services – we rarely paid the full cost – which kept the cost down.

And the standard of service was better and more timely than anything I have ever experienced with the NHS.

I do not understand why people think they should be able to allocate their income to tobacco, alcohol, low life, high life, and not have to pay for health care.

dehavilland
dehavilland
3 years ago

Far from being the envy of the world, no comparable European nation follows the absurd leviathan NHS approach to healthcare. It is not a mark of civilization, it is a mark of how effectively propagandised people in UK are.

Chris C
Chris C
3 years ago
Reply to  dehavilland

We’re all out of step except you, Perry. The customers have experienced the product for 72 years and it’s very popular, but in your view the customers are wrong. An approach you would not, I guess, take if this thread were criticising people for buying books, spending money on music on holidays, etc.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  dehavilland

While it’s true that no other country has adopted a UK style NHS it’s also true that no other country has a healthcare system exactly comparable to any other country. It’s isn’t a mark against the NHS anymore than it’s a mark against the US or France that no other country has copied the US or French systems exactly. There does seem to be a defensiveness about the NHS based on the fact that it cannot be seen as less than adequate for anyone. Which is, of course, not possible. Every system has patients who are less than thrilled with their own specific healthcare outcomes. Every system fails some patients.

David J
David J
3 years ago
Reply to  dehavilland

I have no axe to grind one way or the other. But I have been treated quickly and efficiently by GPs and hospitals over the last few months. The notion that I don’t have to look for insurance get-out clauses is very reassuring.

machina22
machina22
3 years ago
Reply to  David J

Lucky you. Our GP practice is still locked away and has been since March. Phone consultations only, and no new referrals. I have personal experience of this, it’s not just some baseless rumour – a very close relative has been refused a referral for specialist heart care, despite a family history of deaths by heart attack/disease and suffering angina attacks several times this year. We were simply told to ring an ambulance next time it happens or go to A&E (who can’t refer anyway, thus making such a trip pointless and, of course, high risk if my relative were to be placed on a ward, since the hospital is one treating covid patients). Lovely.

It’s just one personal example, but I’m sure it’s being replicated elsewhere.

My heart especially cries for people who have been denied cancer care during the lockdowns. How powerless they must feel and how utterly cruel the system – from the top managers right down to the local GPs – has been to them and their families. It’s criminal negligence at best.

David J
David J
3 years ago
Reply to  machina22

Sorry to hear of your issues. For the record, my treatment has been in Oxfordshire.
GP consultations have been by phone, which I expect in 2020, but the local surgery and hospital communications have been as good as I might expect, with due care throughout for attention and explanation.

Aaron Kevali
Aaron Kevali
3 years ago

This has always shocked me, that people think that healthcare is somehow a right “becoz itz medisin innit! Ya need it t’liv!” But hang on, by that definition food, electricity, gas, and of course clothing should also be provided “free at the point of delivery”. Obviously healthcare is different (orders of magnitude more expensive, potentially) but then shouldn’t people have to contribute something? We do of course pay National Insurance, but this doesn’t distinguish between those who are healthy by choice and those who are not (smokers, drinkers, druggies and fatties being the ones I have in mind here). There should be some recognition that we are not all entitled to exactly the same treatment on exactly the same terms, no matter what.

Judy Johnson
Judy Johnson
3 years ago
Reply to  Aaron Kevali

Your prejudice against the people you assume think health caare is a right undermines your argument and does not reflect well on your nature.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Aaron Kevali

I hate to break the bad news to you, but the Marxist snowflake woke-ist Tory government already has a benefits system in place. The fat, drunk, druggy scroungers are being given free money for food, rent and electricity. They might even have some left over for clothes ñ˜Âčマ

Marion Fallon
Marion Fallon
3 years ago
Reply to  Kevin Ryan

What a pompous, ignorant comment & so clever to have a pop at “benefit scroungers”ÂĂ°ĆžËœÂ„ Think you should be on the Daily Fail page or Sun!

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Marion Fallon

Bless ya, I think he was taking the piss of me there Marion.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Marion Fallon

I was mocking Aaron Kevali’s position in my reply to him. I thought that was obvious. It seems not.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Kevin Ryan

Disgusting – they should get clothes free if they need them.
I just wish we’d provide a free gym membership, but we all it wouldn’t be used.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Aaron Kevali

Thinking of healthcare as a right is not the same thing as providing it as a right. To provide healthcare as a right, no care, regardless of expense, could be denied to patients. It would be their right to have it. The reality of course, is far from that. We have only to look at COVID care to spot NHS patients whose “right to care” was precluded by a lack of intensive care beds. In a right to care world, every COVID patient would have had access to an ICU bed if needed.

Chris C
Chris C
3 years ago

Annette, that’s clever wording, but since you are commenting from the US, you know as well as we do that in the US the primary basis of access to healthcare is ability to pay (whether paying directly, or by paying for more comprehensive or less comprehensive health insurance policies according to ability to pay the monthly premium, or by getting or not getting healthcare insurance from an employer as part of remuneration packages of different sizes) (modified of course by Medicare, Medicaid, Obamacare’s influence of the health insurance system to help the previously uninsured get insurance, and so on). In the UK, the primary basis of access to healthcare is medical need. Unless you do actually go private, in the UK your hip replacement depends on need, not on whether you have – for example – a manager’s income or a shop assistant’s income. Which of course gives the manager an incentive to press for the system to provide acceptable care for both himself and the shop assistant, rather than getting his hip replaced while the shop assistant doesn’t. Which is why the manager is liable to be as much of a supporter of the NHS as the shop assistant.

The above does not relate directly to comparisons of the NHS against Western European healthcare systems, but since you are on this thread as defending the US system (you have posted that you got your knees replaced in a week), I think it’s worth stating the facts about the difference between US and UK attitudes.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

This would have been a stellar post had I been employed when I requested and got a double knee replacement in 8 days. Knee replacements are not based solely on medical need in the UK, even people who need them medically sometimes wait 18 months. They are based on the availability of surgeons as well as operating room and hospital bed capacity. And these things depend on……wait for it…….how much money you spend.

Aaron Kevali
Aaron Kevali
3 years ago

Amen – don’t we all know it!

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

“Which of course gives the manager an incentive to press for the system to provide acceptable care for both himself and the shop assistant, rather than getting his hip replaced while the shop assistant doesn’t. Which is why the manager is liable to be as much of a supporter of the NHS as the shop assistant.”

This is indeed one of the factors that keeps the NHS barely functional in the UK.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

But the NHS is not “barely functional”. It offers a generally good and often outstanding level of care.

And a major reason for that is that it hasn’t been relegated to a sink service for people at the bottom of the pile, as some on the right would like. Politicians (and indeed healthcare professionals) are kept on a short lead by the fact that everyone sees themself, or if not themself then their parents and siblings, depending on the system. So we don’t have consultants being paid $2 million pa like my American friend’s consultant, we don’t have people turned away because their income is above a threshold for public help as happens in the US, we don’t have a state-medical-help-for-the-poor service of unclear quality (that aspect has been under-discussed in this thread) which most people don’t care about and which therefore has little political traction, and we don’t have people being refused continued treatment by their insurance company while others say “it’s your own fault, you should have gone for ShareholderReturns’R’Us Amalgamated’s gold policy rather than their silver policy”. Everyone has a stake.

You are losing contact with reality – just as you did in your post above, in which you supported fremic’s rantings by referring to the NHS’s diverse workforce as “fake-‘British’ people whom the NHS loves to employ“.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

Of course it provides good healthcare, for some individuals some of the time. Hasn’t been my experience or of those I love. And as must be repeated for the three hundred and seventy eighth time – do not want an USA-style system. Classic British response to querying the structure and setup of this leviathan – you just want people to die in A&E. By the way, fake-British is a perfectly factual way to describe many people in the United KIngdom today – pieces of paper do not determine reality. And yes, the NHS does love to employ such people preferentially, their own job ads say so. Gaslighting won’t work here Chris, and more and more people are waking up.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

Who in the US is “turned away because their income is above a threshold for public health”? Which US healthcare component are you thinking of? Medicaid? Medicare? Obamacare? Uncompensated or indigent care?

And yes you do indeed have people refused continued treatment in the NHS, particularly with cancer patients.

Colin Elliott
Colin Elliott
3 years ago

While I agree with much of what you say, I can tell you that as my wife was wheeled into a Dutch hospital, someone materialised and asked me how I would pay for it. The fact I was British was sufficient, and I know for certain that almost all invoices were eventually sent to the NHS in the UK for payment. I did not think it uncivilised, but professional.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Colin Elliott

My dad, an American, needed emergency care in Austria. He was treated without paying anything. No idea who covered the cost of his care, assume it was Austrian taxpayers.

gardner.peter.d
gardner.peter.d
3 years ago

That is an argument that has failed to convince the public ever since July 1948! Attempts to reform the NHS always, always, cost votes in elections.

Marion Fallon
Marion Fallon
3 years ago

So why have people kept voting the Tories in, when any fool knows they detest the NHS & public services? They’re just too gutless to follow their messiah, Maggie Thatcher & destroy it totally.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Marion Fallon

My God, a real life dinosaur! Marion – look up government spending stats for heaven’s sake. I assume your grandson didn’t type the comment for you, type in “NHS GDP graph” onto Google images. You sound like a daft old tribal Labor voter who hasn’t realised that every party promises mountains more money to the NHS *every* *single* *election*. And you know the sad bit? It’s actually true – but it’s never enough.

Aaron Kevali
Aaron Kevali
3 years ago

It does, it really does. It’s beyond reform and must now be accepted as a part of modern British life.

7882 fremic
7882 fremic
3 years ago

yea, yea, ‘NHS is far from perfect but still provides excellent health care’….NHS is doing health care, that is its shtick, but really it is a monster with agenda; Social engineering is the mission they actually work at. NHS IS THE FIFTH LARGEST EMPLOYER IN THE WORLD! NHS is anti British, it is all kinds of things really, but mostly it is political in an insidious way, and exceedingly good at it as the clapping insanity showed. I remember that HORRID Olympic opening – Danny Boil, an entirely hateful person designed it, and his loathing for classic Britain is unparalleled, and so he used NHS as his example of Britain.

You may tell I do not like the NHS in a similar fashion as I do not like BBC, because I think they are rats gnawing at the hull of the ship of State, and are really ‘enemies within the gates’, as Cicero described it so brilliantly. They are up to something big, and it is not for the purpose they were created for.

Chris C
Chris C
3 years ago
Reply to  7882 fremic

But after the right-wing hysteria intermission, please return to your seats for the second half of reality.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

*gasp * You go girl. The “right winger hysteric” (though not as articulate or witty as Chris C) has been schooled but nonetheless is correct. The NHS is very anti-British; a delicious irony given how much actual British adore the institution, (i.e. as opposed to fake-‘British’ people whom the NHS loves to employ).

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

I’d never describe myself as ‘woke’, very much the reverse, but I have to say, the opposition of you two right-wingers to the NHS is based on racism.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

Yawn – Chris C is a liar and a coward. Attributing diasgreements to racialist prejudice is quintessentially woke. What has either 7882 fremic or myself said that could possibly be contrued as bigoted toward ethnic minorities? What in his view does ‘right-wing’ even mean? These are just boo words to shut people down, and it doesn’t work anymore.

Anna Borsey
Anna Borsey
3 years ago

The NHS is only “free” at the point of use. ALL tax payers in the UK pay for the NHS via the taxes they are obliged to pay to the state.

Fraser Bailey
Fraser Bailey
3 years ago

For some decades now, the NHS has been an unaccountable, unaffordable, runaway mess, run primarily for the benefit of those that work for it. As Steve says below, it is a cancer.

I have said for some time that the NHS would, ultimately, destroy the country. I expected this to take another 20 years or so, but it has happened in about 8 months. Laurence Fox was both brave and correct in his strikingly articulate criticism the NHS a couple of days ago. He speaks for millions and I emailed his party – Reclaim – to tell them so.

Chris C
Chris C
3 years ago
Reply to  Fraser Bailey

“I have said for some time that the NHS would, ultimately, destroy the country. “

It’s taking a long time – over 70 years – and it’s still preferred by most people.

Meanwhile, the systems which have really damaged the country are Margaret Thatcher’s deindustrialisation of Britain in favour of her friends in the City of London during the 1980s, and the behaviour of those same friends during the 2000’s which brought the global financial system to the brink of collapse which was averted by lending them £1.1 trillion of taxpayers’ money. Hard to blame the NHS for either of those.

JR Stoker
JR Stoker
3 years ago
Reply to  Chris C

Well, no. Mrs T did indeed move Britain into the late C20th century, brought economic growth and spread the effects widely, concentrated on growth businesses not decaying ones. That is how we have managed to pay for all this modern kit in hospitals, schools, on the railways etc.

But no doubt you would prefer British industry still to build hansom cabs and steam engines, dig coal out of wet dangerous pits, and build Model T Fords

Chris C
Chris C
3 years ago
Reply to  JR Stoker

If you think destroying productive industry and replacing it with Royal Bank of Scotland was a good idea, compare Britain’s low productivity low pay economy with Germany.

In Germany, only 5% of jobs can be done by someone with the ability level of an average 11 year old. In Britain, it’s 22%. Gerneralising wildly, in Germany, graduates go into jobs in Mercedes or Siemens. In Britain, the same graduate may end up on a supermarket checkout and hope that after a couple of years they can get a clerical job in a bank.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

That says more about our inflated degrees, right? I think German manufacturing and British is like comparing Siri to Bixby. However on RBS and manufacturing, you are unfortunately correct.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

No, it says a lot about deindustrialisation by UK Governments which are only interested in financial services in the Home Counties. We don’t have a vastly inflated percentage in higher education than Germany, as far as I am aware.

Colin Elliott
Colin Elliott
3 years ago
Reply to  Chris C

In talking about the UK economy, you are selecting a pre-eminent economy for comparison, and a similar unfavourable comparison could have been made at the end of the nineteenth century.
Since you do, it is my personal observation that (a) Germany has retained a system with a range of schools and institutions of higher education which we abandoned for the political purpose of being as non-selective as possible (leaving only private education as ‘selective’), and (b) reluctance to invest, which I’ve observed in the smallest of UK businesses and in the largest.
How did Thatcher destroy productive industry? And as for RBS, I think you’re confused, since she lost power in 1990, while there were 11 years under Blair and Brown before RBS failed.

Chris C
Chris C
3 years ago
Reply to  Colin Elliott

Another difference is that German workers have statutory rights which UK workers don’t have. As someone in another multinational company said to me “when the management want to transfer work from Germany to Britain, the German staff council create a stink and half the time the work stays in Germany. When the management wants to transfer work from Britain to Germany, the British workers have no say and the work just goes. In the long term, the Germans end up with three quarters of the work, and ambitious managers learn that if they don’t want to end up with egg on their face, they take care to always conclude that a project should be done in Germany”.

Mud Hopper
Mud Hopper
3 years ago
Reply to  Chris C

You seem to have overlooked the desperate plight the UK was in during the 60s and 70s when Scargill and his like were hell-bent on holding the country to ransom. That’s when the ‘deindustrialisation’ of Britain was at its peak,

Chris C
Chris C
3 years ago
Reply to  Mud Hopper

The unions certainly did a lot of damage during the 1960s and 70s. But Thatcher did a lot of damage in the 1980s.

Neither of those, nor the banksters’ crash of 2007/8, can be blamed on the NHS which Fraser told us was ultimately going to destroy the country but has clearly not done so after 72 years, since it is costing us less in both absolute terms and in GDP % terms than Germany’s healthcare system, for example.

Marie Morton
Marie Morton
3 years ago
Reply to  Chris C

Actually more industry was lost under the Blair years – and whereas Thatcher destroyed the coal industry Blair destroyed many more profitable companies

Chris C
Chris C
3 years ago
Reply to  Marie Morton

I don’t hold a brief for Tony Blair, but if you are going to make that claim, which “profitable companies” did he destroy, and how did he do it?

I remember ICI being destroyed by management gambles on speciality chemicals which went badly wrong, and GEC similarly wrecking itself by putting all its eggs in the telecommunications basket, but I don’t see Blair at the root of those. Rover too was not destroyed by Blair. Railtrack collapsed because Blair refused to keep handing over taxpayers’ money for railway investment simply so that Railtrack management could immediately hand it over to shareholders in dividends to “maintain market confidence” – something the Tories complained about at the time, but my taxes are not given in order to maintain market confidence in tottering privatised railway companies.

Alan Thorpe
Alan Thorpe
3 years ago
Reply to  Fraser Bailey

Socialism will destroy the country, the NHS is just leading the way.

Aaron Kevali
Aaron Kevali
3 years ago

Ian Birrell just wants an AMERICAN HEALTHCARE SYSTEM. Kidding…
Jokes aside, thank God for some common sense on our frankly overrated NHS. It’s like the whole institution was personally built and run by Princess Diana, the ridiculous way people adore it. It’s not the envy of the world (though pregnant Nigerian mothers like it) and it is not good value for money. France and Germany have a far better model, much as it pains me to say it, and we should look to other systems but we are all so invested in the status quo at this point I suspect the NHS is irreformable.

Robert Forde
Robert Forde
3 years ago
Reply to  Aaron Kevali

The German system is better, is it? It must have changed since my wife was in hospital there. Incompetent medical advice, callous uninterested nurses, and general neglect were the order of the day. There were also huge disparities between the handling of emergency and chronic cases. And bills. Her problems were not sorted out until we returned to the UK and the allegedly useless NHS.

Kathryn Richards
Kathryn Richards
3 years ago
Reply to  Robert Forde

I have seen exactly the same in the UK NHS. I can give plenty of examples.
All you have proven is that in every system there are those that care, and those that don’t.
Funny how the Germans seem to have had far fewer Covid deaths, by far, than us, and without the same degree of lockdown.

Chris C
Chris C
3 years ago

They have Angela Merkel in charge, not Boris Johnson. You only need to compare the two to see why Germany is different.

Mud Hopper
Mud Hopper
3 years ago
Reply to  Chris C

Simple: the Germans ‘obey orders’: The British on the other hand are far more ‘free spirited’ plus there’s quite a few that might have a problem understanding the language.

Mark Corby
Mark Corby
3 years ago
Reply to  Chris C

Both are clinically obese. Not a good example?

Duncan Hunter
Duncan Hunter
3 years ago
Reply to  Chris C

Don’t they also record deaths differently? Putting death from viral pneumonia on the certificate rather than from or with Covid-19 is mighty effective in terms of relative standing in the grotesque international league table of comparative deaths.
Johnson may be (is) execrable , but Merkel’s star fades ever faster.

Chris C
Chris C
3 years ago
Reply to  Duncan Hunter

That’s possible, but in that case Kathryn Richards’ attempt to use the lower German Covid death rate to show that a partially-private-insurance-based healthcare system is better than the NHS falls flat on its face if the German figures aren’t accurate, doesn’t it?

Personally, actually, I’d be surprised if the German’s weren’t doing a good job with the data, but it isn’t possible to argue simultaneously that “the UK is worse because of the NHS” and “the UK isn’t worse because a liar and a charlatan is running it”. The latter two descriptions of the PM, incidentally, come from a former Chairman of the Conservative party.

Alexandra Thrift
Alexandra Thrift
3 years ago

Covid seems to be sweeping through Germany now, it just took longer to get a foothold.

Chris C
Chris C
3 years ago
Reply to  Robert Forde

I had a curious experience in Germany during a business trip some years ago which you might be able to cast light on. Having forgotten to take deodorant, I wandered into a shop in Hamburg and took a rollerball-type deodorant to the checkout.

“51 Euros bitte”.
“Sorry…. 1 Euro?”
“Nein, 51 Euro.”
“But in Britain, this would be about £1.”
“Ach, this is a shop for healthcare materials. You need to go to a supermarket.”

I did not get to the bottom of this, but I was left with the impression that if I were a member of a German healthcare scheme of some kind, the amount would be reimbursed, therefore the customer did not need to care about the crazy price and the shop was profiteering on that basis.

Any ideas?

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Robert Forde

Sorry to hear that, but then my experience was rather different. Everyone has happy stories involving the NHS, including me. But I’ve had diabolical experiences in this country that shocked me to the core. One of my friends in Britain with “OUR” NHS, who had to go private to prevent herself going blind within days/weeks due to “idiopathic allergies” – it was idiotic, not idiopathic! The private doctor identified the issue (salycate intolerance) within 24 hours and her sight was saved with massive steroid and immune therapy. Expensive but at least she can see. Strange thing is, she still loves our NHS! It’s like talking with a Jehovah’s Witness.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

Plenty of people have been damaged by private healthcare. I’ve experienced it myself, it was just about making money for them and it changed my life irrevocably for the worse (that’s all I’m prepared to disclose, sorry).

When private hospitals run into problems, they phone 999 for an NHS ambulance to take their patient to an NHS hospital.

Last year there was a damning report into safety risks in private hospitals.

But I’m glad your friend had her sight saved. Yes, NHS doctors are not infallible. Neither are private ones (often, the same people at different times of day, so how would they suddenly become more competent at 4.30pm when they turn up at the private hospital to ‘consult’ until 6.30?).

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Aaron Kevali

Did your friend go private because she couldn’t access care in a reasonable time to save her sight or because she got inadequate care? Neither would be good but inability to access timely care would be indicative of an inadequately funded system.

It’s good that people can go private to avoid this and I know that quite a few people do carry private insurance to jump the queue.

Aaron Kevali
Aaron Kevali
3 years ago

She went private for both reasons, plus the crippling physical pain and the terror of going completely and permanently blind. The relationship between funding and waiting times is not a linear one. Tell us, if more money were provided, how exactly would it be spent in such a way as to minimise waiting times? It’s a complex one, and made even more complex by the untouchability of the NHS in public discourse.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Aaron Kevali

I understand the terror and pain of waiting and I don’t blame anyone for doing what they have to in order to get out of that. But the link between waiting times and money is very clear. Insufficient medical facilities as well as too few physicians both lead to waiting times. People aren’t waiting simply because it’s customary to wait a certain length of time before being treated. Often people have to wait for surgeries for example, simply because all the operating rooms are full. More money would pay for upgraded and expanded facilities as well as more physicians. In your friend’s case, going private (more money) allowed her to jump the line in effect and gain access to a physician in a timely way that was critical in her case.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

France and Germany spend a higher proportion of their GDP on healthcare than we do, and their healthcare institutions are tottering under stresses of 21st century demands.

William Cameron
William Cameron
3 years ago
Reply to  Chris C

They spend 11% the Uk spends over 9% of GDP.

Chris C
Chris C
3 years ago

My point exactly.

Barry Wetherilt
Barry Wetherilt
3 years ago
Reply to  Chris C

I doubt the <2% difference accounts for the quality differences, more to do with the structure?

Aaron Kevali
Aaron Kevali
3 years ago

Is not our NHS tottering? We panic about overwhelming our NHS.
Are the French and Germans healthier for it? I believe they are, though there is much to attribute to culture there (Frenchmen are much less fat than we are, but they also never leave a doctor’s surgery without a prescription of some sort). And the ultimate question is not simply one of how many dump trucks of money each nation spends, but how it is spent. We spend money with great profligacy, often with very little to show for it.

Colin Elliott
Colin Elliott
3 years ago
Reply to  Aaron Kevali

Nor do the French leave a surgery before having paid a fee, or so I read.

Chris C
Chris C
3 years ago
Reply to  Colin Elliott

So they don’t enter the surgery if they can’t afford the fee.

And if the fee is paid by insurers (as I suspect is the case – France is not like the US, or pre-war Britain, where people go/went without care because they can’t afford it) then all that requiring them to pay a fee actually achieves is a lot of bureaucracy.

Barrie Clements
Barrie Clements
3 years ago

GDP may not be the best comparator but it’s the one that’s always rolled out. Does anybody have the figure per head of population

Fraser Bailey
Fraser Bailey
3 years ago
Reply to  Chris C

In Germany, the Netherlands, and many other European nations everybody is compelled to purchase private health insurance.

Chris C
Chris C
3 years ago
Reply to  Fraser Bailey

Yes. And it has its own problems. The insurers have a lot of bureaucracy due to invoicing etc. That has to be paid for.

Alan Thorpe
Alan Thorpe
3 years ago
Reply to  Aaron Kevali

America will be begging to have its healthcare system back after Obamacare made it as bad as the NHS.

Chris C
Chris C
3 years ago
Reply to  Alan Thorpe

Trump supporters have nothing to teach the UK about healthcare. America spends twice as much of its (larger, per capita) GDP on healthcare as the UK, but before Obamacare, 10,000 Americans a year were dying for lack of treatment which they couldn’t afford. In the UK, they would have got treated and they would have lived.

Jeremy Rolls
Jeremy Rolls
3 years ago

The pandemic: £400 billion pissed up the wall, because the government believed the mad Imperial College model, to stop the NHS becoming overwhelmed which was never going to happen anyway. Nice one Boris.

Andy Yorks
Andy Yorks
3 years ago
Reply to  Jeremy Rolls

I notice that bonking Ferguson has been ‘rehabilitated’ and is once again polluting the airways. Why has this idiot been allowed back on the TV and why is any one taking a blind bit of notice of him ? He has been wrong by a factor in excess of 10 on every single prediction he has ever made.

Jeremy Rolls
Jeremy Rolls
3 years ago
Reply to  Andy Yorks

Indeed. I suspect because the mainstream media and the government failed to challenge the model/narrative at the time and are now too embarrassed to admit they were wrong.

Fraser Bailey
Fraser Bailey
3 years ago
Reply to  Andy Yorks

It does indeed defy belief that Ferguson is granted any credibility and continues to pollute the airwaves. But you can say the same about Alistair Campbell, Blair, Brown and many others.

James Mason
James Mason
3 years ago
Reply to  Andy Yorks

If you need further evidence of Ferguson’s incompetence you need look no further than the Private Eye Special Report on the 2001 Foot and Mouth Scandal. What that idiot was responsible for, the damage and destruction to the rural economy and farmer’s lives, beggars belief. The report is shocking and will bring tears to your eyes.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Jeremy Rolls

I thought it was £550 billion, but when the number reaches 11 digits it kind of ceases to be within the range of human comprehension.

Mark Corby
Mark Corby
3 years ago
Reply to  Aaron Kevali

Actually if we use the ‘old’ definition of billion it’s not too bad.

The old billion, you will recall, was a million million, not a thousand million.

Thus it is really only five hundred and fifty thousand million. A snip!

Why the idiotic change given the prevalence of inflation is unclear.

Jos Haynes
Jos Haynes
3 years ago
Reply to  Mark Corby

Very strange. We use the American billion. The European (French) billion is the same as our old one. They use milliard for our (new) billion.

I still use billion in the traditional sense and spell it out because most people have no idea – it’s just a bloody large number!

William Gladstone
William Gladstone
3 years ago

The NHS staff are a substantial voting bloc on their own which is controlled by politicians plus they are difficult to criticise. This is the reality of NHS worship, Labour and Tory politicians have created this client organisation bought with taxpayer money so that it will continue to vote in Labour and/or Tory politicians.

Aaron Kevali
Aaron Kevali
3 years ago

Yes! Nobody dare criticise the damn thing, as there are over two million people who work for it.

Chris C
Chris C
3 years ago

“Labour and Tory politicians have created this client organisation bought with taxpayer money so that it will continue to vote in Labour and/or Tory politicians.”

Or, to rephrase that, people who work in the NHS and know the realities are unlikely to vote in significant numbers for headbanging right wing extremists.

Funnily enough, that’s also true for the rest of us.

But we’re all out of step except you!

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

What’s the difference between a ring-wing person and a right-wing extremist?

The reality is that when salaries are on the line, people will vote to keep the dump trunks of money coming. Understandable, even if not commendable.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

But most people are not getting an NHS salary. They are paying for the NHS salaries through their taxes without getting one themselves. And they wish to continue doing so because they experience the NHS every so often and are reasonably happy with it.

Do you think the consumers are wrong?

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Chris C

Many of the people who use the NHS do so because, despite working for 50years cannot afford to opt for private treatment. We just shut up and put up.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

No, but politicians and employees of Leviathan do get a salary eityther from the NHS or tangentially by supporting it.

As for being ‘consumers’ of medical care, I suppose I do technically eat my medicine, usually. And these I was thinking I was the more capitalistic of the two of us… Paying taxes does not make me a consumer, rather, the consumed in this case. The British people today are terrified of the alternatives, usually with tales of woe form the USA.

William Cameron
William Cameron
3 years ago

European countries all have available health services . Most of them are better than the NHS . None of them use the NHS monopoly state provider model. In most cases the state provides insurance for the patients – who then go and spend their insurance money with the doctors and hospitals of their choice. This makes sense – Insurance is paperwork and states tend to be good at paperwork. States tend to be bad at providing personal services – so European Countries do not do that.
A good exemplar is Germany . Their health service provision is largely private. Their state taxes folk and provides insurance. Their health provision is determined regionally across 16 regions (all reporting scientifically to the Robert Koch institute). There is no amateur politician like Hancock theatrically flapping about pretending to run things.
Germany has more beds per capita, more ICU beds per capita, More doctors per capita. So private proven has proved far better at being available for patients than the Uk model. In Germany patients with serious covid are hospitalised quickly. In “protect the NHS” model you have to very ill to get admitted. Germany with an 80m population has less than a quarter of UK deaths. And before anyone says its all down to money – it isnt . Germany spends little over 11% of its GDP on health services the Uk is slightlyover 9%.
The European model works – There is no NHS to worship. And Patients are viewed by doctors as an income . In the NHS model patients are viewed as a cost. And are treated accordingly.

Chris C
Chris C
3 years ago

So the difference between the UK 9% of GDP and the German 11% of GDP means that the NHS would have to be given a 22% increase in budget, at the drop of a hat, before it was comparable on GDP terms.

And that’s a German GDP which is bigger per capita anyway. They have Mercedes, BMW and Siemens, we have Primark and Carillion (collapsed).

If you want to spend the same NHS budget on a different type of health system, you are liable to get the same or worse outcomes than the NHS, if you build in lots of lawyers, marketers and shareholders to cream off money.

David Barry
David Barry
3 years ago
Reply to  Chris C

22% might explain lack ot capacity or, or more specifically perhaps, shortage of scanners. I don’t see how it explains gross incompetence across so many areas, and dishonesty.

Any organisation which thinks it is entitled to better funding should demonstrate that it already makes good use of what it already receives. The NHS doesn’t.

Chris C
Chris C
3 years ago
Reply to  David Barry

David, let’s stick to reality rather than indulging in rhetoric.

“Gross incompetence across so many areas” – can you name them? With evidence?

“Dishonesty” – yes, tragically there are some cases in Britain’s largest employer. How would there not be? Do you think that anyone is ever dishonest in healthcare systems which are more focused on profit, or lawyers, than the NHS?

David Barry
David Barry
3 years ago
Reply to  Chris C

You know perfectly well that there have been major scandals in the NHS resulting in deaths on an unacceptable scale, followed by attempted cover ups. Other commenters have referred to them in this thread so there is no need to repeat them here.

I am not falling for the “evidence” ploy simply because you do not want to face the facts. The essential point is that the NHS is nowhere near as good as its blinkered fans want to believe.

Unfortunately, I have had numerous dealings with the NHS and my experience of their administration has been horrendous. They seem to be incapable of getting anything right. If you don’t want to believe it in the absence of “evidence”, then don’t.

Chris C
Chris C
3 years ago
Reply to  David Barry

I agree that there have been scandals. But localised albeit appalling scandals (Stafford, for example) are not the “Gross incompetence across so many areas” which you stated.

There are scandals in other healthcare systems also, we occasionally hear about them, though naturally ours get more publicity here.

Similarly, there is sometimes dishonesty and cover-ups, but do you think that doesn’t happen elsewhere?

It’s unfortunate for you that your experience of the NHS is that “they seem to be incapable of getting anything right”. My own experience is that they usually get it right but sometimes they don’t. If most people in Britain had the experience that the NHS cannot get anything right, there would not be such massive support for it, which strongly suggests that your unfortunate experience of it is not common.

If I had to nominate an organisation which was incapable of getting anything right, it would be one particular department of a large organisation of my acquaintance. And 99% of my colleagues would agree with me. It’s part of a private sector company. Would you like the NHS to be moved into the private sector?

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

Possibly. Privitisation brings it’s own problems (see: modern British railways), but at present they know they don’t even have to try to deliver value for money because the bottomless pit of taxpayer money funds it, and medicine, for some inexplicable reason, should never have to account for itself financially. As I told Marion, Google NHS spending figures – it grows year on year on year. Underfunding is not the problem. Even our oh-so-inhumane Tories won’t touch it.

I understand that a lot of NHS work is now privatised anyway (cleaning contracts, food providers, etc.) and is not much better for it. As my own company knows, when dealing with local authorities, you can always charge a lot more because they a tax-payer funded.

Fiona Cordy
Fiona Cordy
3 years ago

The amount of money paid per capital on healthcare in the UK is about 75 per cent of what is paid in Germany (Office of National Statistics, a real source that I trust more than Michael Reid.) I live in Germany. Believe me, healthcare is not everything that it is cracked up to be. Parts of Germany have been showing concern lately that they don’t have enough beds for their Covid patients.

Chris C
Chris C
3 years ago

“European countries all have available health services . ……. None of them use the NHS monopoly state provider model. “

European countries all have trade unions ……. None of them have such extreme anti-union laws as Britain. In Germany, workers have a statutory right to consultation which (as anyone knows who has worked in a UK/German operation, as I have) give German workers vastly more power than in Britain.

So on your logic, the UK’s labour laws must be mistaken?

Barry Faith
Barry Faith
3 years ago

Our NHS – built on love run on fear.
Medical staff afraid to speak up. Candour and whistleblowing brings
down the senior-management hammer and good medical professionals are traduced
and sacked when they do speak up.
Appalling senior managers rely on ‘legal advice ‘ as their get-out-of-jail-free card, using large amounts of public money to defend themselves against those that care enough to speak up.
Ineffective regulators and governance across the NHS, supported by Establishment-biased Information Commissioner and tribunal judges, along with three monkeys approach of secretaries of state for health.
Rotten governance from top to bottom.

Lloyd Marsden
Lloyd Marsden
3 years ago

Whilst I agree that we shouldn’t blindly worship the NHS (and frankly, anything), I think it’s important when criticizing it to separate the largely hard working staff from the political football – they certainly aren’t saints but they do good work.

Sadly praising the NHS and pledging money to it has become an altar to which politicians throw themselves on every election cycle (one they created themselves). Meaningless financial pledges and vague talk of reform are just platitudes uttered by each party to win the support they need from their base. I don’t even begin to understand how it’s fixed but I do think that focusing on healthcare at the source by putting money into preventative measures that stop people sliding into the NHS may take away some of the pressure and allow for some change.

Tom Adams
Tom Adams
3 years ago
Reply to  Lloyd Marsden

‘…largely hard working staff…’

An assertion often made but never substantiated. The NHS has more than its share of lazy, feckless, malingering and dishonest staff.

Simon Denis
Simon Denis
3 years ago
Reply to  Tom Adams

True. I’ve seen them in action. Bossy nurses; brutal orderlies and arrogant, out-of-touch consultants. Yes, there are spots of health on this rotting organ, but they count for less and less. And why, because the system reduces the patient to the status of suppliant serf. This wouldn’t happen if the patient could balance the power which accrues to “expertise” with the power which comes from spending – or withholding – money. Time and again over the last few years, when attempting to get medical attention for elderly relatives, I have seen the complacency and indifference of our vile NHS, born of the knowledge that it has no competitors and no critics in a position of any power. Time to privatise the damned dump – as happened to British Leyland etc. Then we might get medical services which actually help us.

Robert Forde
Robert Forde
3 years ago
Reply to  Simon Denis

Or we might find ourselves with the outcomes of the USA: shorter life expectancy than us, higher infant mortality than us, sick people having to fight large insurers for life-giving drugs, bankruptcies caused by medical expenses, etc.

The trouble with this article is that it is largely anecdotal, and remains so even when it quotes facts. For example, the scandals mentioned are certainly facts, but their importance is not assessed in any way, eg, by working out what proportion of cases they represent, or comparing with other systems. Nor are they by any means unknown in privatised systems – as witness the gigantic malpractice insurance premiums paid by US doctors.

But while we’re on anecdotes, my stay in Dorchester Hospital last year saved my life, and I was treated diligently with care and sympathy throughout. Oh, and the food was pretty good, too. And no one asked me for money. All these are facts, but I wouldn’t suggest they are an objective summary of the whole system.

It’s dead easy to throw brickbats at any system. What is needed is the hard work of deciding how it should be improved. Wholesale privatisation is certainly NOT the answer.

Mark Bailey
Mark Bailey
3 years ago
Reply to  Robert Forde

Why is it always a binary choice between the NHS or the US’s healthcare system? I don’t want either.

There are numerous systems out there which do a better job; provide accountabilty; clear financing; and don’t treat patients as supplicants. What’s wrong with the Singaporean, Japanese, Spanish, German – I could go on – systems?

Katy Randle
Katy Randle
3 years ago
Reply to  Mark Bailey

Indeed. I have personal experience with the German system and found it excellent. When I fell and broke my knee in England whilst resident in Germany, I was taken to hospital for a couple of days. I tried and failed to register the fact that I was not resident in the UK. My German insurance would have covered the cost but no-one was interested in taking my details. Bonkers!

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Katy Randle

They don’t care as they think it’s not their money! Fools.

Chris C
Chris C
3 years ago
Reply to  Mark Bailey

Which of those national healthcare systems provide the magic answer by costing less than the NHS while providing higher quality healthcare, in a country with a similar society to the UK, including the major inequalities which affect the health of the UK population (poverty, homelessness, overcrowded accommodation…)?

To take one of your examples, for the NHS to match the GDP share of German healthcare, the NHS would need an overnight budget increase of 22%. Matching the absolute spending per capita in Germany would lift that to maybe a 40% increase, because German GDP per capita is higher than ours. And that’s still ignoring the fact that Germany is less unequal than the UK. How effective is treatment for high blood pressure going to be, when the UK patient is living in a hostel for the homeless and has
two young children living in the same single room while the German patient has a flat with a separate bedroom for the children?

Judy Johnson
Judy Johnson
3 years ago
Reply to  Robert Forde

An excellent and balanced comment.

Bronwen Saunders
Bronwen Saunders
3 years ago
Reply to  Robert Forde

Declaring what is NOT the answer before the various alternatives have been soberly weighed up is not a good way forward.
I live in a country where all healthcare is private ““ and it is excellent!
It is also expensive, which is only to be expected given what healthcare now entails (compared with 1948). And before you ask, those on low incomes receive help with the premiums, meaning that no one is left without coverage. Surely such a system is at least worth thinking about?

Chris C
Chris C
3 years ago

And how much is spent on healthcare, both in absolute terms and as a percentage of GDP? Higher than the UK, I expect, rendering the comparison invalid

Bronwen Saunders
Bronwen Saunders
3 years ago
Reply to  Chris C

Yes, higher than the UK. But why does that make the comparison invalid? Almost any alternative to the NHS would entail spending more on healthcare than the UK currently spends. But it would also deliver more. These are the variables that have to be weighed up.

Chris C
Chris C
3 years ago

“Almost any alternative to the NHS would entail spending more on healthcare than the UK currently spends. But it would also deliver more. These are the variables that have to be weighed up.”

Or you could just spend that increase you envisage, on the NHS itself.

Noticeably, NHS outcomes improved while Labour was increasing spending on it fast, but under the Tories since 2010 the performance has been dropping off as increases in spending (while still positive relative to retail prices) fall behind increasing demand. Under Labour, more than 95% of cancer patients started treatment within 62 days of diagnosis, and few people waited more than 4 hours in A+E. In 2019, which was before Covid came along, both those targets had begun to be missed, quarter after quarter, as the cumulative underfunding under the Tories worked through.

Bronwen Saunders
Bronwen Saunders
3 years ago
Reply to  Chris C

Except that then healthcare will remain the political football that it has been for as long as I can remember.
Furthermore, there is a danger that at least some of the extra money would go towards hiring still more overpaid but unproductive staff ““ diversity officers, PR people etc. – and that all the existing structures would be left in place, even those that are outdated and in need of reform.

Another interesting point is this: The amount we spend on essentials such as housing and food relative to total income is constantly changing. Food, for example, used to be far more expansive than it is now, whereas housing was probably cheaper as a rule. Given how much medicine has advanced over the past 50 years, surely it is only natural that healthcare, too, should now be accounting for a much larger chunk of our income than it has done hitherto?

Wulvis Perveravsson
Wulvis Perveravsson
3 years ago

It could be argued that improvements in healthcare technologies should help make treatment cheaper and more efficient.

William Cameron
William Cameron
3 years ago
Reply to  Robert Forde

Well, the USA system is hopeless. But the German, Dutch, French, Swiss, etc systems are all far better than the NHS with much better service provision and outcomes. In none of them does the state run the services.

Simon Denis
Simon Denis
3 years ago
Reply to  Robert Forde

It worked with every other service and industry it has dealt with – telecom, cars, plumbing, water and yes railways – which have experienced fewer crashes and more upgrades since the state’s involvement was withdrawn. So now – and at last – it is time to privatise health. To continue with this murderous, socialist dump a moment longer is little short of criminal iniquity.

Christopher Thompson
Christopher Thompson
3 years ago
Reply to  Simon Denis

Had a new knee recently. The nurse looking after me was Albanian. She was smart, cheerful, highly skilled, and spoke English very well. The physio, also Eastern European, was the same. As for the rest..

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Simon Denis

Very well said and I do understand your anger. Unfortunately, it will take a strong, resilient health secretary and government to sort out the NHS….. therein lies the problem.

Chris C
Chris C
3 years ago
Reply to  Pauline Ivison

How would you ‘sort it out’, Pauline?

Chris C
Chris C
3 years ago
Reply to  Chris C

Asking again: how would you ‘sort it out’, Pauline?

Andy Yorks
Andy Yorks
3 years ago
Reply to  Tom Adams

Exactly. Go to any Hospital and sit and watch what goes on. The staff are not ‘largely hard working’ and actually I would say they are more accurately ‘largely damn lazy’. Last time an elderly parent was in Hospital their treatment was callous and indifferent. On one occassion the nurse had to check pulse and oxygen levels, wheeling a machine to do so. I wouldn’t work. Why ? Because the staff were too damn lazy and stupid to plug the bl*ody thing in to charge the batteries. Ditto the other four on the ward. The reason is no one really gives a toss.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Andy Yorks

And if I may be so bold Andy, nurses are amongst the most lazy of them. Much of their work now is done by underpaid third-world “Care Assistants”, they do all that unglamorous work outside the Ward Office actually caring for patients and stuff.
I eagerly await the the downvotes.

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Aaron Kevali

No downvote from me. I’ve personally experienced vindictiveness and sly bullying of a patient and other staff by nurses who choose to work nights because it’s much quieter. God help a patient who arrives from emergency surgery to disrupt their quiet nights and conversation.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Pauline Ivison

Thank you Pauline – it has been said that civilsation lives or dies in the comment threads. Apparently my ‘right-wing’ views are not so unusual. But then I am a just a racist and USA-style apologist for abandoning the sick.

Alan Thorpe
Alan Thorpe
3 years ago
Reply to  Lloyd Marsden

Luckily, Thatcher privatised the energy companies, otherwise they would have closed down to protect themselves.

Chris C
Chris C
3 years ago
Reply to  Alan Thorpe

And we all get ripped off to pay for a vast superstructure of directors with sky high salaries, merchant banks and corporate lawyers extracting fees for advising the directors, shareholders extracting dividends, marketing, advertising, door-to-door canvassers …… with those who don’t have internet access, or don’t want to spend part of their lives toggling from one provider to another, being ripped off the most.

You have to be a real ideologue to admire the energy companies. And surprise surprise you’d like the NHS run on the same basis!

Simon Denis
Simon Denis
3 years ago
Reply to  Chris C

What a pile of tendentious, generalised bilge, relying on prejudice and forgetfulness – especially the “extracting dividends” rubbish – pure communism and so discredited as to look like a zombie point. Dividends are paid from profits and attract further investment; hence they pay for themselves and that is why the system works. You’re the ideologue – a red one; and we’ve seen through the last redoubt of your toxic ideology.

smith1169169
smith1169169
3 years ago

It’s true that many countries have medical care available for their citizens and it seems to be much better than the NHS. I really cannot get around the “Mother knows best” element of the NHS. It’s great in a crisis when you have no alternative but I know so many people who got very sick and died when to the lay person it seems they could have been managed much better early on in their illnesses. The NHS fobs people off until in many cases it’s too late.

Dave H
Dave H
3 years ago
Reply to  smith1169169

I’m a huge fan of state-funded health provision in concept but I have to agree – it often seems the main function of the front lines of the NHS is to get rid of people as fast as possible, without having to do any costly investigation.

Chris C
Chris C
3 years ago
Reply to  smith1169169

“I know so many people who got very sick and died when to the lay person it seems they could have been managed much better early on in their illnesses.”

That’s a curious statement. What role were you in, to know so many of such people?

Did you do anything about it?

And maybe “the lay person” knows less than medical staff, in reality?

Chuck Burns
Chuck Burns
3 years ago

The virus has been seized by the Left as “their opportunity”. We would have been better off to let the virus run its course like the other seasonal Corona viruses. The government bureaucrats and politicians exclaim that they are saving lives. They are liars, ignorant frauds, self serving zealot ideologues. They spew authoritative orders that have done more harm than the virus. You must connect the authoritative tyranny of the government politicians and bureaucrats with the “Great Reset”. The pandemic is a political tool to force a political agenda on the world. The Great Reset is Orwell’s 1984.

Chuck Burns
Chuck Burns
3 years ago

What alarmed me was Boris John’s positive comments about the Great Reset. He is very educated but now I suspect he is a Manchurian candidate for the Left. How can any one who believes in individual freedom support The Great Reset? How can anyone except a Leftist Marxist, Socialist, Communist, collectivist support the Great Reset and the UN agenda 30?

Mud Hopper
Mud Hopper
3 years ago

Most businesses and organisations operate on the basis of a rolling ‘review-change-implement-review’ programme over a five to six year period. The ‘cast-in-stone’ philosophy of the NHS is therefore about 70 years overdue for a root and branch restructure, but which political party will take on the task which amounts to ‘blasphemy’ of the highest order?

Chris C
Chris C
3 years ago
Reply to  Mud Hopper

The NHS has been subjected to endless reorganisations. Andrew Lansley’s in 2012 is regarded, even by Tories now, as a mistake.

Mud Hopper
Mud Hopper
3 years ago
Reply to  Chris C

NHS ‘reorganisations’ have been akin to moving the furniture around a bit. Nothing substantial actually changes.

Chris C
Chris C
3 years ago
Reply to  Mud Hopper

What would you like to change?

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Chris C

That’s the key question. To which it’s unlikely you’ll find a coherent response. This forum is largely another place for the right wing to come and rant about socialists, Muslims, wokery and the good old days. They don’t deal so much in solutions.

Stephen Collins
Stephen Collins
3 years ago
Reply to  Mud Hopper

It did cross my mind that one of the few upsides of the shambles of the last nine months may be that goodwill towards the NHS diminishes to the extent such a root and branch reform becomes politically acceptable. Boris can deny it and point to the weekly worship he led all he wants, but I do wonder if reduced goodwill was the intention all along.

Graeme Laws
Graeme Laws
3 years ago

Balance in all things. At its best, the NHS is wonderful. At its worst, it is truly awful. I suspect that most of the front line people are keen to care for their patients. I also suspect that many of them are demotivated by being over managed and under led, and as often as not unappreciated. Saturday night drunks are not usually perfectly polite. I doubt that yet another reorganisation would do much good. So the smart thing would be to look at the bits that work well, understand why they work well, and try to bring the rest closer to the best. If change is needed, start small and scale up if it works. Not revolutionary, but perhaps more likely to make a positive difference.

Fraser Bailey
Fraser Bailey
3 years ago
Reply to  Graeme Laws

A very rational approach. As such, it will never be adopted.

Alan Thorpe
Alan Thorpe
3 years ago

How can this article have been written without mentioning the actual problem in the UK – socialism? Change NHS to socialism in the title of the piece and no more needs to be said. The NHS is a beacon lighting the way to socialist failure and we now have the most socialist government in our history.

Chris C
Chris C
3 years ago
Reply to  Alan Thorpe

Ah yes, the real root of your hostility to the NHS is right-wing dogmatism.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

I thought everyone liked the NHS?

Pauline Ivison
Pauline Ivison
3 years ago
Reply to  Alan Thorpe

Spot on, and this also relates to our so called education system. I despair at the socialist claptrap our young people are having inflicted upon them by teachers who are more interested in diversity and LGBT rights than teaching anything which is actually going to benefit their futures.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Pauline Ivison

Is there any topic that railing against LGBT rights doesn’t encompass? This one, in case you’d forgotten, is the NHS and social care system

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Kevin Ryan

You misread the comment. Pauline wasn’t railing against LGBT rights. In fact, she made no comment on such rights. Her comment was about teaching and it’s apparent failings.

Chris C
Chris C
3 years ago

On a thread about the NHS not education, as Kevin pointed out.

It seems to be part of the pathology of some on the right that everything, whether it’s road congestion or the price of a tin of beans, comes down to their obsession with ‘wokeness’. In that sense, they’re as bad as the ‘woke’ people on the left whom they criticise.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Alan Thorpe

Boris Johnson, Michael Gove and Jacob Rees-Mogg sit on top of “the most socialist government in our history”

What planet are these messages being beamed to you from?

Richard Marriott
Richard Marriott
3 years ago

It is what is to be expected. A Soviet inspired institution suffers from Soviet style failings. No surprise there. What is surprising, is the veneration in which this Soviet institution is held.

Chris C
Chris C
3 years ago

Ah yes, the British are deluded because we don’t regard the NHS as “this Soviet institution”.

I guess, given that the UK armed forces (not to mention the police) are state monopolies, you must regard them too as “Soviet institutions”. So if the Warsaw Pact had attacked, the resulting conflict would have been two “Soviet institutions” fighting each other and you’d be saying ” a plague on both your houses”, yes?

Very silly.

Alex Lekas
Alex Lekas
3 years ago
Reply to  Chris C

Public safety and national defense have historically been accepted as legitimate functions of govt, perhaps the most important functions. But not everyone sees managing health care delivery in the same vein. Would you want govt in charge of automaking or food production, and if not, why not? There is no magic elixir that makes govt expert in the field of medicine.

As it is, govt often struggles with other core functions like schools, roads and infrastructure, and criminal justice. Why would anyone expect health care to be exempt from that since it is people who manage all of them, and whatever else people are, perfect isn’t it.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Alex Lekas

Perfect isn’t a realistic goal. It’s a healthcare system for a population of 67 million. For all the criticism leveled at the NHS, it’s trying to deliver an equal service to everyone, regardless of capacity to pay. Most people, at least in Europe, consider this important in a civilized and fair society. The alternative is to hand control to the free market and private sector, a system run for the shareholders and not the people. It depends what type of society you want to live in, but I don’t like the sound of yours.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Kevin Ryan

And that’s why it’s great that people in different countries can make their own decisions. Although I’d take issue with your idea that everyone in the NHS gets equal service. Much depends on your post code as well as your specific medical needs. The elderly, in particular, fair poorly in the UK while on the other hand, the US spends nearly unlimited amounts on very very elderly people. Having 91 and 92 year old parents, I can attest to this firsthand.

The alternative isn’t only to hand control to the private sector. In fact, most healthcare systems are some mix of public and private as is the US and France. The main sticking point seems to be spending but I can’t see how it harms anyone in Europe for the US to spend more on healthcare. Nor would many Americans want to reduce healthcare spending to the per capita level of the NHS. Let’s all make our own decisions.

Chris C
Chris C
3 years ago

We have made our own decision. The NHS has massive support from those who use it. Unlike the US, where the healthcare system is regarded by ordinary Americans across the political spectrum (though not Trump / Republican zealots, I grant you) as needing reform, if only it could overcome the stranglehold of vested interests and the politicians who receive donations from those vested interests to fund the election campaigns which keep them in power. What is the total political expenditure of the American Medical Association, the health insurance companies, the private hospital groups, and so on, in a big election year? Is it tens of millions of dollars , or does it extend into the hundreds of millions?

I can’t see how it harms anyone in Europe for the US to spend more on healthcare” – it doesn’t. The point is that, in a debate about the UK health system, you should accept that anything the US healthcare system achieves is achieved by spending twice as high a share of GDP on healthcare as the UK spends, and 2.5-3x as much in absolute terms per capita given that your per-capita GDP is larger than ours. And in the US you still manage to have people dying of conditions which would be treated by the NHS, and indifferent rankings in international comparisons of outcomes, and swathes of your population living in fear of unexpected medical bills which are the largest single cause of personal bankruptcy with all that that entails in terms of (for example) people losing their homes and ending up in a hostel with a plywood partition separating them from a drug user who has the music centre on at full volume at 3am. And you have a system in which healthcare access depends on income, not need. Which is anathema to us British.

So you in the US don’t really have anything to teach us, apart from how not to do it. Sorry.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

Not only do I not want to “teach” you, I don’t care what your healthcare is like. And, of course, you’re just one person. Your ire may be better directed at the many NHS users on here who don’t like the NHS and want something different. After all, I don’t have to live with it. And no one is suggesting copying it here.

Chris C
Chris C
3 years ago

I don’t care what your healthcare is like” – but you’ve posted extensively in this discussion on the future of the British NHS, and while a lot of that is about defending your view of your own country’s HC system against our criticisms, it includes your views on our healthcare including “Knee replacements are not based solely on medical need in the UK, even people who need them medically sometimes wait 18 months. They are based on the availability of surgeons as well as operating room and hospital bed capacity. And these things depend on……wait for it…….how much money you spend.“. You also mention by name UK individuals who you claim have been failed by the NHS – though I’ve replied that I don’t think they have been. I was not familiar with the names of those UK citizens, but you are. So it sounds to me as if you do care what healthcare we receive, otherwise you wouldn’t be on this thread. (Which is not to say that it isn’t stimulating to debate with you!)

“the many NHS users on here who don’t like the NHS and want something different” – and elsewhere you refer to “many posters” who criticise the NHS. I’m sorry to disappoint you, but that’s a statement about Unherd posters, not the views of the UK population generally.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

Posting here doesn’t indicate that I care how long you wait for care. It means that I don’t want to wait. Americans in general aren’t patient at waiting. I’m sure that’s no surprise to anyone. Why would you believe that I have to defend my view that I don’t want to wait? It’s not like you’re going to talk me into waiting longer for care just to save money.

Wulvis Perveravsson
Wulvis Perveravsson
3 years ago
Reply to  Alex Lekas

On an instrumental level, it makes some sense that a state healthcare system exists in order to maintain a productive workforce.

Chris C
Chris C
3 years ago
Reply to  Alex Lekas

Thanks for the view of an American Republican, Alex.

How do you propose to sort out the American healthcare system? Trump was keen on abolishing Obamacare but was powerfully opposed by John McCain, would you side with Trump or McCain?

Stanley Beardshall
Stanley Beardshall
3 years ago

Yes, good article. I spent 50 years occasionally using the NHS then the last 30 in the French system. We have to pay 60 Euros a month as a couple to top up our healthcare here, but everything thereafter is free, including optician, pharmacy, dentist, etc. In our eighties but treated with 100% care – including unlimited physio visits, nurse calls for vaccinations and blood tests and so on. Oh, by the way, all x-ray, ultrasound scan and MRI results are handed to us on completion; no waiting and no secrecy.
I would not complain about the treatment we had in the UK, but hated the way the staff were the owners of my records…

Leslie Forsyth
Leslie Forsyth
3 years ago

Straw man with a hatchet. The NHS is not worshipped. People complain about it all the time. Most NHS staff are pretty cynical about the service and its limitations. It isn’t the NHS that’s stopping social care being funded properly, it’s the Treasury under successive Governments being unable/unwilling to countenance the spending required to do it adequately. Of course bad things happen that shouldn’t, and sometimes (although less and less) the accountability takes too long. The system is run by humans after all.

William Cameron
William Cameron
3 years ago
Reply to  Leslie Forsyth

Not true . If a state monopoly provider of services is the best model why dont we use it for other needs. Its a daft model. States are invariably lousy at service provision.

Chris C
Chris C
3 years ago

“States are invariably lousy at service provision”

Not true of my local library, for example.

Aaron Kevali
Aaron Kevali
3 years ago
Reply to  Chris C

Libraries are not a life-saving service (at least not directly). And all libraries are not conglomerated under a vast singular institution – I suspect they are allowed to run fairly independently of each other.

Chris C
Chris C
3 years ago
Reply to  Aaron Kevali

The libraries are run at county level. That’s not national, but it’s a state monopoly across thousands of square miles in some counties.

The British have experienced both nationalised railways (which weren’t great, TBH) and privatised railways, since 1990. 65% of the population want the railways renationalised. That includes vast numbers of Tory-voting commuters on trains to their jobs in the City of London every morning (until Covid came along).

The British have experienced the NHS, and want more of it.

But you think we’re all wrong.

emmamaysmith3
emmamaysmith3
3 years ago

This article is rather unfocussed. It would have been better to stick to a single issue. The complaints are so wide-ranging it becomes not only impossible to answer them all, but even to consider them all.

On the topic of care homes though, that is a scandal, and a murderous one. The care home system is unfit for purpose, and this is widely recognised within social care services. There is a current of thinking that people should be kept out of care homes for as long as possible, with money better spent on home care services. Certainly that would have led both to lower infection and mortality rates among older people, and more flexible visiting for family members.

A national inquiry into care homes really must follow this pandemic.

Ian French
Ian French
3 years ago

The author touches on, in a rather throwaway mention, the problems caused by underfunding Care of the Elderly and the NHS medical provision in the UK. These issues have directly stemmed from years of intensive underfunding; Tory tinkering to meet ideological market concerns. This sustained attack, compared to the full-blooded successes of other similar systems in European nations, has left us with a car boot quality underfunded and disorganised NHS, while social Care provision and NHS services have been turfed over, at public great expense, to off-shore registered entities and financial institutions. These deliver nothing back to the public purse and provide poor rewards for people at the shitty end of the corporate stick. It is certainly is a pity that folk hold an unrealistic belief in the system we have, but the fact that it remains it is still far superior to the American exclusive system and one quite capable of excellent delivery for all as other nations in Europe have shown. If anything the poor performance of these services indicate that this country continues to be incapable of managing its decline for reasons that go well beyond individual organisations within it.

Annette Kralendijk
Annette Kralendijk
3 years ago

It seems that the NHS and its admirers fail to take into account the fact that any healthcare system has two components, price and utilization. In 1948, no one could have foreseen the utilization level of today’s NHS, much less that of any other system. People expect far more care today than they did in 1948 and there are drugs and healthcare technologies that exist today that would have been pure fantasy in 1948. Some of the more expensive drugs available in other countries are not available to patients through the NHS. That’s a trade off the NHS has made, lower costs but fewer available treatments.

Comparisons to other healthcare systems do not take into account other trade offs that are made, such as the ability to attract people to enter the practice of medicine. As an example, the US spends a comparative fortune on healthcare but has zero problem attracting people to be physicians, surgeons, dentists and nurses even at the high cost of medical/dental school in the US. That’s a trade off and it allows the US to attract top medical personnel from all over the world, because physicians and nurses in the US are paid more. In a pandemic related example, the US spends more but has adequate intensive care bed capacity when needed. The flip side is that the US spends unbelievable amounts on patients at the very end of life in a futile attempt to keep everyone alive indefinitely. This isn’t a choice the NHS has made but I’m not criticizing the US for doing so. This isn’t a defense of any one system either, I’m simply noting that these are choices all systems have to make. The NHS could make such choices as well but not if the main goal is to keep costs low.

Damian Chunilal
Damian Chunilal
3 years ago

NHS is like a relic of the former Soviet Union. It’s great for trauma medicine but terrible for many other conditions as is obvious by very poor U.K. relative patient outcomes. The way it has managed Covid is not a good story once the facts come out, if they ever will. And for medical scandals I suspect the one to beat all others will be that of faulty syringe drivers delivering overdoses of opiates to the elderly: why has that investigation gone nowhere?

No developed country has sought to replicate the U.K. model for good reason. It doesn’t work. It is time to look again at the model and see how it can be changed for a better outcome for all.

Adrian Smith
Adrian Smith
3 years ago

The NHS has been a political football ever since it was founded. The US healthcare system, which failed in a way the NHS would not have failed in New York, is even more of a political football.

Ultimately we need a serious debate on what the NHS is really for and how much we want to pay through taxation to deliver the outcomes we really want.

Should fertility treatment, albeit means tested, be free at the point of delivery? I have my views but what does the nation as a whole think.

Should trans women be able to get cervical smears free at the point of delivery? Again I have my views but what does the nation think.

How much should be expended to extend the lives of people who no longer have any prospect of a quality life? How should that be defined? Whilst age and quality of life have some correlation, age should not be the determining factor in my view but what does the nation think?

Should there be a link between how much you have contributed throughout your life through various forms of taxation and what you are entitled to in the form of health and social care towards the end of your life?

Will any of those questions ever be subjects of rational public debate? I very much doubt it. That would spoil the great game of political football politicians enjoy so much.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Adrian Smith

It was New York that failed, not any one part of healthcare. No healthcare system in the US or anywhere else can withstand sending people infected with Covid into nursing homes. Surely this is obvious. Eventually, leaders in NY will have to answer for this. Other states did not do the same fortunately.

You do make an excellent point though on how much should be spent on the aged with reduced quality of life. The US spends an incredible amount on people in their 90s. For example, is it reasonable to provide heart ablations to 92 year olds to address heart flutter? Yet that would be routine in the US. If it’s your parents, well yes, maybe it is reasonable. I agree with you that age alone should not determine who or what gets treated but the costs of treating very elderly people are going only one way.

Why would fertility treatment, but not other forms of healthcare, be means tested? To me, that smacks of singling people out for reduced or no care, like denying smokers lung cancer care. As for cervical smears, anyone with a cervix should get one. Same with prostate exams. If you have one, get it examined. Both organs get cancer. It doesn’t matter who you are, medical care should be based on what your body has and needs, not on who you are.

Chris C
Chris C
3 years ago

“It doesn’t matter who you are, medical care should be based on what your body has and needs, not on who you are.”

Yet you have made it clear on this thread that you are happy for access to medical care to be based on your ability to pay, the US way of doing things, either directly or indirectly (through ability to pay sky-high US monthly healthcare insurance premiums or through getting insurance as part of a well-paid job – with the level of cover provided depending on the job of course).

And although you will no doubt point to Medicare/Medicaid as softening the edges of the US system, your comments elsewhere here show some enthusiasm for reducing the costs of those programmes. And I note that States run by Trump-loving Republicans have a tendency to cut entitlement to Medicaid at a lower income level than Democrat-run States generally do, a point which I keep raising but you don’t respond to. But anyone who knows how many beans make five can work out the US right-wing view of programmes which look after poorer folks but the comfortably-off don’t participate in.

It’s the NHS and other European healthcare systems which treat people on the basis of “what your body has and needs, not on who you are”.

Adrian Smith
Adrian Smith
3 years ago
Reply to  Chris C

Actually that is not true, the NHS has an element of post code lottery about it.

The reason why the NHS is always in financial crisis is because it tries to do too much. If we really want it to do so much then year on year, as the population ages, the NHS and social care (it costs the NHS a fortune keeping people in hospital because there is no care home for them to go to or the patient can’t go home because the care at home package needed is not available) needs to take more and more of GDP.

Is that really what we want? Fertility treatment is already means tested. Should a trans woman (who does not have a cervix) be able to get a cervical smear on the NHS?

It is about drawing a line somewhere and the debate needs to be about where it is drawn. Some treatments / care should be available to everyone based on what their body needs, some will need to be paid for. If the state is expected to provide everything then where is the incentive to make provision for yourself and for your family to provide care in return for the care you provided them?

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Adrian Smith

Good points you make. When the NHS was founded there wasn’t any fertility treatment. Like other new medical treatments and technologies that were not available in 1948, how can a system such as the NHS accommodate not only what’s available now but what’s coming in the future? Care isn’t going to get less expensive, it’s going to get more expensive and there’s going to be much much more of it.

Also, how long did people live in 1948? Was today’s tremendous end of life care cost foreseen in 1948? Do you deny new treatments and care based on their cost or do you pump in much more money to cover them? It has to be one or the other.

Adrian Smith
Adrian Smith
3 years ago

Exactly, and there needs to be a proper public debate rather than a debate amongst self interested politicians using the NHS as a political football as that will continue the ever worsening situation we currently face of an NHS and social care system which will soak up public money like a dry sponge, whilst still failing to deliver the care people feel they are entitled to.

Hard choices need to be made and those choices need to be periodically reviewed outside of the general election process.

Annette Kralendijk
Annette Kralendijk
3 years ago
Reply to  Chris C

None of your comments reflect anything I’ve said. Perhaps you could explain what you mean by the “US healthcare system”. Here’s a hint, don’t think one size fits all, like the NHS.

Kevin Ryan
Kevin Ryan
3 years ago

Why is the NHS to blame for an underfunded social care system? I’d have thought that a civilized society would take care of both it’s sick and needy. Why does Birrell see the need to tear strips off the NHS rather than say Defence spending ?
I’d recommend that instead of watching Olympic ceremony re-runs that he watches footage from Lombardy’s overwhelmed hospitals earlier this year. He might understand the panic that Gove was feeling that the UK system was going to be next. I absolutely agree that poor social care is a scandal but I don’t see that this is an either/or conversation.

A Spetzari
A Spetzari
3 years ago
Reply to  Kevin Ryan

I see what you’re saying but really not sure that is the gist of this article.

He is agreeing with your point but from the other angle. Because the NHS is seen as a sacred cow, social care is ignored as it is politically (and socially) too sensitive to be seen to give anything other than 100% support for the NHS at all costs. He is not saying that it should be social care and not the NHS, but arguing for both.

Katy Randle
Katy Randle
3 years ago
Reply to  Kevin Ryan

I don’t think he’s criticising the NHS for the hell of it; he is rightly pointing out that while the NHS has come to be placed on a pedestal by governments of all stripes in recent decades, that prioritisation has meant it is swallowing all available resources, much to the detriment of social care, and that it is not perfect. I think it’s a perfectly reasonable point.

Kevin Ryan
Kevin Ryan
3 years ago
Reply to  Katy Randle

I still don’t get the conflation of two different arguments. Yes UK social services are shambolic in many places. I’ve experienced it myself. But why draw the conclusion that the NHS is to blame and that’s where the extra money should come from ? The UK has an ageing population. A very high percentage of healthcare cost is incurred in the last decade of life. Both parts of the system will need more money in the years to come.