Main Edition
US
FR
The social contract has been ripped up (Lynsey Addario/Getty Images)
Every day, we’re told that the NHS is collapsing. It’s failing the sick and wounded at their hour of greatest need, leaving frail old people lying for hours without an ambulance, farming out patients to care homes, and forcing the chronically sick to wait years for treatment that would enable them to get on with their lives. But is this true?
Yes, I am afraid it is. I wish I could give you a more optimistic take, and embrace the prospect that swift action can turn around the dire state of the UK’s National Health Service, but the data doesn’t lie.
“This is obviously a crisis, but we have been in crisis for a very long time,” a doctor friend told me yesterday, when it was announced that strikes by NHS staff will go ahead this month. As became clear during the pandemic, the NHS has not been able to cope with normal levels of demand for years. Even before Covid struck, one in five A&E patients were not seen within four hours, while the waiting list for non-urgent treatment had grown by 50% in the previous five years.
Today’s stories of patients waiting in ambulances for hours to be admitted should sound familiar. We heard them in 2018, with the same warnings of inevitable harm to patients, both those in the ambulances, and those waiting in vain for an ambulance to come to them. Patients were already dying in ambulances, waiting for transfer into hospital, in 2021.
The British Medical Association, attacking the Prime Minister’s “baffling lack of urgency” in addressing the crisis, says that “retaining and regrowing the workforce… is our way out of this mess”. Nurses’ leaders have also pointed to understaffing as one of the reasons for their industrial action, with pay levels falling behind inflation for the past decade as one cause of that understaffing. But while it’s true that NHS spending has increased year on year since 1997, it has done so more slowly than in comparable countries.
As early as 2013, the UK was already spending less than any other G7 country except Italy on healthcare. In 2017, when France spent £3,737 per head, and Germany £4,432, we spent £2,989. In the same year the BMJ compared the NHS to healthcare in nine other high-income countries, and found the lowest per capita spending, lowest ratio of doctors and nurses to population, and below average patient outcomes in cancer survival, life expectancy, and some types of stroke and heart attack. But throwing government money at the problem now will not turn around a collapsing system overnight. Long-term refusal to deal with problems cannot be wiped out with short-term, high-profile initiatives.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
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.
SubscribeThe irreproachable St Polly of Toynbee launched into the same topic the other day with her customary impartiality and rigour – setting up the premise of her article with the sort of neutral, searching question one has come to expect of this paragon of journalistic objectivity:
“Who do you believe: the brilliant NHS staff who treated my cancer, or ministers who spin and lie?”
Catnip to the Guardian faithful. But none stopped to consider that the answer to Polly’s question was that they might both be right.
The “brilliant NHS Staff” are saying they need more money – They’re right.
Politicians are pointing out that the NHS cannot go on requiring ever more money to be poured into it, that we cannot afford it. They too are right.
Even Wes Streeting admits the system is broken. If a Tory says such a thing they will be dismissed by the media and accused of hating nurses and wanting to sell off the NHS or some such nonsense, but when a Labour Health Sec says it then maybe even the Guardian should sit up and take notice.
Why is it that, when looking at a Govt’s record on Health, journalists reporting on the NHS only ever focus on inputs, rather than outcomes? A Govt’s health policy is only measured by what monies they make available rather than the outcomes the NHS delivers.
We want a Health service to achieve better outcomes, surely? If we can do that by more efficient means, then we should.
The UK media, of both left and right, routinely praise the German model – and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy – it steers a path (in broad terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation – and that is that if the Govt tried to copy, say, the German Healthcare model in this country then Ms Toynbee, the Guardian and the BBC would go into meltdown as all their fevered dreams of “selling off the NHS” would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories want to destroy the NHS. They may have different ideas about how to improve it, and some of their ideas have certainly been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform – AND IT DOES – then we’ll get no closer to a solution. We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
The BBC & Guardian have railed against private healthcare contracts as the “tide of privatisation.” But the NHS has for many years outsourced a variety of services – in fact spending on private outsourced services rose faster under the last Labour Govt than under the coalition or Tories, but why let facts get in the way of the narrative?
Under the coalition Govt, which is when this argument really hotted up, we are actually talking about a growth from 4.5% to less than 6%. Hardly an earth-shattering increase. Yet (from both sides – and most particularly the media) the issue is weaponised to the point that no Govt dares touch it, dares even to suggest that a major reform of the whole funding model is the only thing that will save it.
I’m a huge supporter of the NHS – which means I want it to reform so it can survive.
People who pretend the NHS can limp on needing vastly more money year on year just to try and stand still do not really support the NHS. What they say they wish for, will surely bring about its demise.
Polly in her mosr recent screed glibly suggests – The government ignores the one quick fix for the NHS: good funding and decent pay for social care. For someone who has been writing about the NHS for so long that seems a childishly simple view, and one that cannot withstand the mereset scrutiny.
Would the NHS be better if more money was spent on it? In the short term, and if it was targeted, then of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term – not simply look good for whoever is currently in No 10, who’ll get the plaudits whilst saddling future generations with the cost.
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally – unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of those “brilliant NHS” workers and worthy of a C21st developed nation.
Excellent analysis, and the key point which i think emerges is that the NHS is failing because it’s politicised.
If, as seems likely, the next government is led by Keir Starmer, it’ll be interesting to see if anything changes whatsoever. It’d probably take a Labour administration to make the necessary structural changes, as the only party with the political capital to do so. We’re at the point in history when that change has become an imperative. I wonder what Toynbee would make of it, except i can’t imagine for one moment that Starmer would have the courage to initiate that change, to something closer to the more successful models. He’ll most likely just spend his time in office blaming the mess on his predecessors, and so on ad infinitum.
Exactly right.
But I’d go further than saying “the NHS is failing because it’s politicised.”
It has become almost an impossibility for any politician to criticise “Our NHS”, particularly to their core audience, whose devotion to the NHS borders on the religious.
The NHS model worked very well for quite some years. At its inception the boast that it was “The Envy of the World” might even have had a grain of truth to it. It was certainly the envy of those people around the world that couldn’t afford the level of care that British citizens were able to call on.
But we are now 74 years down that road. The system that was introduced in 1948 was workable in 1948 and for quite some time after – but that time is long past. In its current guise – and with the entirely changed demographic it seeks to serve – the NHS is no longer delivering on its promise and no amount of extra funding will address that fundamental shortcoming.
Tackling the criminal waste and inefficiency of this organisation is key – and introducing elements of privatisation, or charging monies for certain aspects NEED to be part of the equation if the NHS is to survive, yet that self-evident truth is lost in the political blame game. At every election I’ve ever witnessed, voters are exhorted to “SAVE THE NHS” by voting Labour because those hated Tory Scum are planning to sell it off or otherwise destroy it. Given that the Tories have been in power for probably twice as long as Labour in the post war period and the NHS is still with us, either the Tories are really bad at this whole ‘selling off the NHS’ policy or it is simply not true and is just a rather crude, dog-whistle message that Labour knows will play well to those who don’t stop to think about it for more than a second.
But the NHS is such a sacred cow that Govts run shy of actually fundamentally shifting the model. The supposed “root and branch” reforms of the last 30 years have only really tinkered in the margins because any Govt knows that a genuine reform would engender so much negative publicity and criticism that they’d hand their opponents the keys to No 10.
Of the friends I have in the NHS (several GPs and one Hospital Trust Administrator among them) not one – NOT ONE – thinks the current model has a hope of lasting in the long term.
Why is it that the bien pensants of the liberal left are always praising the “social democratic” model of “our EU partners” and yet when it comes to the NHS we should not even try to emulate any of the EU models of healthcare – which have a significant private sector input?
Why, if the NHS is such a shining beacon to the world, is it a model that is copied by absolutely no one else?
In 1948 the Labour Government – bless – thought that after a few years the cost of the NHS would decrease because the country would be so much healthier.
Very true. Bevan was aghast when he realised that that was wrong, and that people were using more and more medicine, doctors, nurses, treatments etc
Very true. Bevan was aghast when he realised that that was wrong, and that people were using more and more medicine, doctors, nurses, treatments etc
No one has mentioned that, if you are any sort of professional, the NHS is just a terrible place to work. Nothing about the proliferation of managers and other hangers on. It is a corrupt self-serving system.
Well said!
Well said!
The NHS may not have been sold off but the ongoing reform to every aspect of management, introduction of the internal market and procurement have complexified things so we now experience an ongoing battle between professionals and management, with associated bean counters as an inherent part of our system. There is no easy solution funding or otherwise but I am sure that improving social care and public health initiatives will greatly ease demand in the wider context and reduce burden on NHS provision. Debate about the causes of the increasingly severe numbers of acute and chronic mental health crises, especially affecting young people, supporting people for 20 years after they have been shot or broken their spines in a skiing accident, and just knowing how many millions is being spend on round the clock care for these individuals, not to mention the drain on workforce is worth highlighting. Then of course those middle class people who are really good at challenging eligibility for free healthcare for their relative who has dementia v those who haven’t got a clue. Lack of suitable housing which has stymied the brilliant initiatives 20 years ago which enabled people to receive complex care at home rather than in hospitals or being bunged off to sad care homes, all these pressures add up. What we need is a debate about the NHS as it has become embedded in our society as a solution for all ills, as the Police are also now being used and are similarly now dysfunctional. We now need to invest in the community in terms of decent housing, not all owner occupied, social care and civic infrastructure which all act as preventers of poor health- there is plenty of research to show this. The NHS can then concentrate on what it is brilliant at which is healthcare and clinical research.
In 1948 the Labour Government – bless – thought that after a few years the cost of the NHS would decrease because the country would be so much healthier.
No one has mentioned that, if you are any sort of professional, the NHS is just a terrible place to work. Nothing about the proliferation of managers and other hangers on. It is a corrupt self-serving system.
The NHS may not have been sold off but the ongoing reform to every aspect of management, introduction of the internal market and procurement have complexified things so we now experience an ongoing battle between professionals and management, with associated bean counters as an inherent part of our system. There is no easy solution funding or otherwise but I am sure that improving social care and public health initiatives will greatly ease demand in the wider context and reduce burden on NHS provision. Debate about the causes of the increasingly severe numbers of acute and chronic mental health crises, especially affecting young people, supporting people for 20 years after they have been shot or broken their spines in a skiing accident, and just knowing how many millions is being spend on round the clock care for these individuals, not to mention the drain on workforce is worth highlighting. Then of course those middle class people who are really good at challenging eligibility for free healthcare for their relative who has dementia v those who haven’t got a clue. Lack of suitable housing which has stymied the brilliant initiatives 20 years ago which enabled people to receive complex care at home rather than in hospitals or being bunged off to sad care homes, all these pressures add up. What we need is a debate about the NHS as it has become embedded in our society as a solution for all ills, as the Police are also now being used and are similarly now dysfunctional. We now need to invest in the community in terms of decent housing, not all owner occupied, social care and civic infrastructure which all act as preventers of poor health- there is plenty of research to show this. The NHS can then concentrate on what it is brilliant at which is healthcare and clinical research.
It’s true there could be quite a bit of advantage to moving to a western European equivalent of Social Insurance and better alignment of public hospitals with local govt as they have too. In many regards it would still be a direct tax though we’d all see on payslips etc, but better hypothecated and less chance politicians interfere. But that tax, short term at least, would look like a rise as you’d move it from more indirect taxation.
The problem is much like that Tories have grappled with on Social Care for 13yrs. Most know what needs to be done, the Dilnot report was extremely thorough etc. But our politics is too myopic and politicians worry more about short term electoral prospects. Everyone though has some responsibility for this – the yah-boo commentators, the media and ourselves as voters I guess.
Maybe it’s only when real crisis occurs we face up collectively to what must be done differently. Hopefully so.
Is it not also true that the NHS achieved remarkable things during the pandemic (e.g. faster vaccination than any of the EU countries?). If so, does that not mean that a centralised system does have significant advantages on occasion over a decentralised one?
Can’t say that Stephan – it’s not permitted by the Unherd bubble lol
Vaccinating the population is. not remarkable and as I understand it this was a success because it was organised outside Government.
If the response of the NHS should be remembered for anything it should be Tik-Tok videos of dancing NHS staff and the outrage that greeted the posting of videos showing hospitals ad deserted as our schools
I have a friend who was ward sister on a respiratory ward – she got Covid twice and had to be signed off with PTSD. I doubt that she would be impressed by your facile bullshit.
Vaccines were developed by publicly-funded academic research, and administered under the auspices of the NHS. It was indeed a remarkable achievement.
So AZ, Pfizer, Moderna et al had no skin in the game and took no commercial risks?
Obviously they did – I don’t know about taking much of a risk though.
Not much risk in knocking up a product that government mandates every citizen must have.
Plus thousands of volunteers
Obviously they did – I don’t know about taking much of a risk though.
Not much risk in knocking up a product that government mandates every citizen must have.
Plus thousands of volunteers
Not vaccines, and didn’t do much for most of the population. Largely a huge scam to transfer public money into corporate hands.
In what way are these vaccines not vaccines, and what can you show me that says that they didn’t and don’t work?
Of course he can’t. He’s seen the light and the likes of you and me are ignorant sheeple, not worth bothering with.
Bivalent boosted yet?
Bivalent boosted yet?
At least these vaccines stopped people dying from covid and did reduce infection rates somewhat. I suppose that the sudden decrease in mortality from covid after the introduction of vaccines was a coincidence?
Of course he can’t. He’s seen the light and the likes of you and me are ignorant sheeple, not worth bothering with.
At least these vaccines stopped people dying from covid and did reduce infection rates somewhat. I suppose that the sudden decrease in mortality from covid after the introduction of vaccines was a coincidence?
In what way are these vaccines not vaccines, and what can you show me that says that they didn’t and don’t work?
So AZ, Pfizer, Moderna et al had no skin in the game and took no commercial risks?
Not vaccines, and didn’t do much for most of the population. Largely a huge scam to transfer public money into corporate hands.
Actually the administration of delivering the vaccine into folks arms was an NHS task done well.
The task of generating the UK vaccine in first place was a joint scientific/NHS/Industry achievement with Kate Bigham the maestro who pulled it together.
And the thousands of volunteers day and night?
And the thousands of volunteers day and night?
I have a friend who was ward sister on a respiratory ward – she got Covid twice and had to be signed off with PTSD. I doubt that she would be impressed by your facile bullshit.
Vaccines were developed by publicly-funded academic research, and administered under the auspices of the NHS. It was indeed a remarkable achievement.
Actually the administration of delivering the vaccine into folks arms was an NHS task done well.
The task of generating the UK vaccine in first place was a joint scientific/NHS/Industry achievement with Kate Bigham the maestro who pulled it together.
The NHS is now reaping the costs of that very fast jab campaign that lacked the very basics of safety scrutiny, such that there were more reported adverse events in the first year of the Covid jabs re the Yellow Card system than in the previous 40 combined. Also, as what’s done in the first 72 hours following first symptoms of a virus is key to subsequent well being, such as the administration of antivirals, what the hell was the NHS doing with it’s lame ‘go away and see if things get worse’ response?
It’s reaping the benefit of a combined flu and RSV epidemic together with the long waiting lists caused by covid. The vaccines have nothing to do with it. Stop believing everything you see on GB News and YouTube.
I don’t believe that GB News or YouTube has any control over the data to be found on VAERS or the Yellow Card adverse event reporting systems. Covid didn’t cause long waiting lists – poor decision making by people, many with ties to the pharmaceutical industry, were the root cause here. As for RSV, before the 1950s, people weren’t subject to this virus – it was imported from about 200,000 chimpanzees shipped in from Africa to take part in the early polio vaccine trials, many conducted by Jonas Salk himself. He alone caused the death of about 17,000 chimpanzees, and was ultimately responsible for introducing the human race to this respiratory virus.
I have read the reports of potential adverse events and would remind you that the publishers point out that association is not causation and that when millions of people are involved, uncommon events are bound to happen by chance. There has not been a massive increase of deaths because of the vaccines full stop.
With regard to chimpanzees, the virus was first detected in them but was actually common long before that time in Humans. Please read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154630/
I have read the reports of potential adverse events and would remind you that the publishers point out that association is not causation and that when millions of people are involved, uncommon events are bound to happen by chance. There has not been a massive increase of deaths because of the vaccines full stop.
With regard to chimpanzees, the virus was first detected in them but was actually common long before that time in Humans. Please read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154630/
I don’t believe that GB News or YouTube has any control over the data to be found on VAERS or the Yellow Card adverse event reporting systems. Covid didn’t cause long waiting lists – poor decision making by people, many with ties to the pharmaceutical industry, were the root cause here. As for RSV, before the 1950s, people weren’t subject to this virus – it was imported from about 200,000 chimpanzees shipped in from Africa to take part in the early polio vaccine trials, many conducted by Jonas Salk himself. He alone caused the death of about 17,000 chimpanzees, and was ultimately responsible for introducing the human race to this respiratory virus.
It’s reaping the benefit of a combined flu and RSV epidemic together with the long waiting lists caused by covid. The vaccines have nothing to do with it. Stop believing everything you see on GB News and YouTube.
Vaccines that no-one needed and may be related to the sudden increase in strokes and heart attacks?
Has there been a sudden increase in these two? Mortality has certainly increased, but I should think that hospitals closing and subsequent issues with ambulance delays may be more important in the increase in mortality. Do you have any evidence that more people are suffering from these two events, or are you relying on the mortality figures to guide you?
Has there been a sudden increase in these two? Mortality has certainly increased, but I should think that hospitals closing and subsequent issues with ambulance delays may be more important in the increase in mortality. Do you have any evidence that more people are suffering from these two events, or are you relying on the mortality figures to guide you?
Can’t say that Stephan – it’s not permitted by the Unherd bubble lol
Vaccinating the population is. not remarkable and as I understand it this was a success because it was organised outside Government.
If the response of the NHS should be remembered for anything it should be Tik-Tok videos of dancing NHS staff and the outrage that greeted the posting of videos showing hospitals ad deserted as our schools
The NHS is now reaping the costs of that very fast jab campaign that lacked the very basics of safety scrutiny, such that there were more reported adverse events in the first year of the Covid jabs re the Yellow Card system than in the previous 40 combined. Also, as what’s done in the first 72 hours following first symptoms of a virus is key to subsequent well being, such as the administration of antivirals, what the hell was the NHS doing with it’s lame ‘go away and see if things get worse’ response?
Vaccines that no-one needed and may be related to the sudden increase in strokes and heart attacks?
Is it not also true that the NHS achieved remarkable things during the pandemic (e.g. faster vaccination than any of the EU countries?). If so, does that not mean that a centralised system does have significant advantages on occasion over a decentralised one?
The NHS if failing because of the fundamental flaw that it was set up to serve the interests of the people who work in it and not the patients
I doubt that the GPs of 1947 would agree with you.
They would undoubtedly agree with him. As Nye Bevan famously said, in order to get the GPs to agree to join the NHS he had to “stuff their mouths with gold”.
I think the ‘stuff their mouths with gold’ remark refers to consultant distinction awards that GPs have never received.
I think the ‘stuff their mouths with gold’ remark refers to consultant distinction awards that GPs have never received.
To my eternal shame i once worked in the NHS so I know whereof what I speak
They would undoubtedly agree with him. As Nye Bevan famously said, in order to get the GPs to agree to join the NHS he had to “stuff their mouths with gold”.
To my eternal shame i once worked in the NHS so I know whereof what I speak
Yes, I keep applying for the post of Head of Wellbeing on a salary of £120,000 and tell them I’m well and being of sound mind and vote Tory but get no replies
I doubt that the GPs of 1947 would agree with you.
Yes, I keep applying for the post of Head of Wellbeing on a salary of £120,000 and tell them I’m well and being of sound mind and vote Tory but get no replies
True – UK politics is great stand up material for EU countries. Who runs the hospitals? Surgeons? Nurses? (rich white kid from Oxbridge, studied politics) Prisons? (er, same) Schools (er….) and so on. Also riffs on “Dog Licence” and “TV Licence” get great laughs in southern and eastern Europe. The amazing thing is the politicos and their civil servants actually believe they can run hospitals, prisons etc. Normal people realise how long it took them to mast er their profession they understand there’s no simple answer to complex problems. At least we have parts of the NHS suitable for our political class- Broadmoor and Rampton for instance.
Exactly right.
But I’d go further than saying “the NHS is failing because it’s politicised.”
It has become almost an impossibility for any politician to criticise “Our NHS”, particularly to their core audience, whose devotion to the NHS borders on the religious.
The NHS model worked very well for quite some years. At its inception the boast that it was “The Envy of the World” might even have had a grain of truth to it. It was certainly the envy of those people around the world that couldn’t afford the level of care that British citizens were able to call on.
But we are now 74 years down that road. The system that was introduced in 1948 was workable in 1948 and for quite some time after – but that time is long past. In its current guise – and with the entirely changed demographic it seeks to serve – the NHS is no longer delivering on its promise and no amount of extra funding will address that fundamental shortcoming.
Tackling the criminal waste and inefficiency of this organisation is key – and introducing elements of privatisation, or charging monies for certain aspects NEED to be part of the equation if the NHS is to survive, yet that self-evident truth is lost in the political blame game. At every election I’ve ever witnessed, voters are exhorted to “SAVE THE NHS” by voting Labour because those hated Tory Scum are planning to sell it off or otherwise destroy it. Given that the Tories have been in power for probably twice as long as Labour in the post war period and the NHS is still with us, either the Tories are really bad at this whole ‘selling off the NHS’ policy or it is simply not true and is just a rather crude, dog-whistle message that Labour knows will play well to those who don’t stop to think about it for more than a second.
But the NHS is such a sacred cow that Govts run shy of actually fundamentally shifting the model. The supposed “root and branch” reforms of the last 30 years have only really tinkered in the margins because any Govt knows that a genuine reform would engender so much negative publicity and criticism that they’d hand their opponents the keys to No 10.
Of the friends I have in the NHS (several GPs and one Hospital Trust Administrator among them) not one – NOT ONE – thinks the current model has a hope of lasting in the long term.
Why is it that the bien pensants of the liberal left are always praising the “social democratic” model of “our EU partners” and yet when it comes to the NHS we should not even try to emulate any of the EU models of healthcare – which have a significant private sector input?
Why, if the NHS is such a shining beacon to the world, is it a model that is copied by absolutely no one else?
It’s true there could be quite a bit of advantage to moving to a western European equivalent of Social Insurance and better alignment of public hospitals with local govt as they have too. In many regards it would still be a direct tax though we’d all see on payslips etc, but better hypothecated and less chance politicians interfere. But that tax, short term at least, would look like a rise as you’d move it from more indirect taxation.
The problem is much like that Tories have grappled with on Social Care for 13yrs. Most know what needs to be done, the Dilnot report was extremely thorough etc. But our politics is too myopic and politicians worry more about short term electoral prospects. Everyone though has some responsibility for this – the yah-boo commentators, the media and ourselves as voters I guess.
Maybe it’s only when real crisis occurs we face up collectively to what must be done differently. Hopefully so.
The NHS if failing because of the fundamental flaw that it was set up to serve the interests of the people who work in it and not the patients
True – UK politics is great stand up material for EU countries. Who runs the hospitals? Surgeons? Nurses? (rich white kid from Oxbridge, studied politics) Prisons? (er, same) Schools (er….) and so on. Also riffs on “Dog Licence” and “TV Licence” get great laughs in southern and eastern Europe. The amazing thing is the politicos and their civil servants actually believe they can run hospitals, prisons etc. Normal people realise how long it took them to mast er their profession they understand there’s no simple answer to complex problems. At least we have parts of the NHS suitable for our political class- Broadmoor and Rampton for instance.
Excellent comment. The endless reheated, partisan, simplistic rubbish from the likes of Toynbee are part of the problem. A health system that works best for everyone, from the poorest upwards, should be the sole consideration. A specific funding model dating from the 1940s should not be sacrosanct if it’s no longer fit for purpose. One thing everyone can agree on: this is now really urgent. But what government will have the courage and foresight to deal with it?
Excellent, Paddy.
Question is what do you ignore? Lots.
First its a Beveridge system where insurance, supply and regulation are combined. The recipe for a disaster. Solution is a Bismark system where those three legs are split
Second, you ignore the treat now pay later costs. Pensions
On social care again the cause of the mess is that socialist pension ponzi. People have been asset stripped so cannot pay for social care. The debts are too large for the tax payers to fund, so social care is screwed.
The next problem is the NHS as a religion. ie. If you lose the NHS, you will get the US system. Actually on the avoidable deaths count, that is an improvement. Instead go Swiss or Dutch, 1 or 2 in the world. The NHS doesn’t make divison one. Second you would be back in Victorian times. Yeah right, as if the rest of the wold is stuck there.
The NHS is dead as are significant numbers of its patients as a result of its treatment. But the victim pays.
You have hit the nail on the head and most sensible people would agree if only we could take the “politics”out of it!
I am afraid you are being illogical. The evidence clearly shows that the UK spends less on health care than other countries. A further problem is that the spending has fluctuated with above inflation increases over certain periods following by below inflation increases. On top of that there have been many attempts to reorganise the system in an attempt to increase efficiency.
The core problem remains insufficient, erratic funding and it seems perverse to focus on changing the system yet again before addressing the the funding issue.
One often missed area is primary care, where funding has been severely constrained. This chronic underfunding of GP services has had a particularly damaging effect by sabotaging preventative care and increasing the load on hospitals.
My wife and I are medical doctors and after austerity was introduced in 2010 we could see that the NHS was doomed. We took out private insurance for our family and will continue to rely on this. A two tier system is inevitable as long as we keep electing Tories.
The evidence shows the opposite. But I nowadays cant bothered to point out again and again the facts. See my earlier post.
Ah yes, Anton, those years of vicious Tory Austerity – by which you presumably mean those merciless and savage cuts that saw public spending wantonly slashed from £610 billion in 2015 to only £870 billion a year pre-Covid?
(I suppose it would be pointless to remind you that Alistair Darling was promising “harder and deeper” cuts in the run-up to the 2015 election?)
Rather than pretend it is only a question of underfunding, maybe you might consider the waste you (presumably) see around you in the NHS.
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem – and might lead Politicians and Health professionals towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all. Surely you would agree?
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis.
Spot on the nail Paddy. I really pity those who are so blinded by their love-fest with the NHS that they cannot see that fundamental reform is the only way to save it for future generations.
Agreed
Agreed
Spot on the nail Paddy. I really pity those who are so blinded by their love-fest with the NHS that they cannot see that fundamental reform is the only way to save it for future generations.
Two points:
We do not spend less on health care than major comparators, we spend more, for less effect; and
It is entirely logical to change the system because it delivers such poor results for such high expenditure
Don’t forget that the Private Funding Initiative well used by Tony Blair is still costing Health Trusts in England over £2 Billion in Interest payments a year and will continue to do so for many years to come.
Try reading this. We are in the same ballpark as most other countries: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=OE
The evidence shows the opposite. But I nowadays cant bothered to point out again and again the facts. See my earlier post.
Ah yes, Anton, those years of vicious Tory Austerity – by which you presumably mean those merciless and savage cuts that saw public spending wantonly slashed from £610 billion in 2015 to only £870 billion a year pre-Covid?
(I suppose it would be pointless to remind you that Alistair Darling was promising “harder and deeper” cuts in the run-up to the 2015 election?)
Rather than pretend it is only a question of underfunding, maybe you might consider the waste you (presumably) see around you in the NHS.
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem – and might lead Politicians and Health professionals towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all. Surely you would agree?
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis.
Two points:
We do not spend less on health care than major comparators, we spend more, for less effect; and
It is entirely logical to change the system because it delivers such poor results for such high expenditure
Don’t forget that the Private Funding Initiative well used by Tony Blair is still costing Health Trusts in England over £2 Billion in Interest payments a year and will continue to do so for many years to come.
Try reading this. We are in the same ballpark as most other countries: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=OE
John Pilger made an excellent documentary called “The Dirty War on the NHS”. Just google or YouTube for it.
Did the NHD pay for private treatment for its staff in those days?
Did the NHD pay for private treatment for its staff in those days?
Cracking post Paddy.
By the way, you wouldn’t happen to comment BTL at the guardian woud you? If you don’t already maybe give it a go – it would be a very wecome voice of sanity amongst all the drivel. (I would though estimate a very short spell until the censors shut your account down 🙂 )
I spent several years commenting on the Guardian site – (under the name LastOfThePelicans.) Sheer intellectual masochism on my part, I know.
In my mind (on my more optimistic days) I was on a mission to civilise – to persuade people that neither side is ‘evil’ – that the “other side” merely have a different approach to finding solutions. But on my more lucid days I probably realised it was a lost cause and I was merely shouting into the wind.
There are plenty of excellent, reasonable posters on the G, trying to introduce a reasoned counter-narrative, but they are ganged-up on and shouted down by the Guardian faithful, annoyed at the interruption to their daily 2-minute hate.
Eventually I was banned – not for anything I’d written per se, but for copying and pasting extracts from earlier Guardian articles where the author had taken a position 180 degrees out from the one they were currently espousing. The moderators didn’t like me exposing the elasticity of their writers’ principles and that their outrage might be put on, just a little bit. Polly Toynbee, Simon Jenkins and the ludicrous Marxist 3rd former, Owen Jones were, unsurprisingly, the worst culprits.
Not reading CIF every day has, for the last six months, been good for the soul.
I do recognise the moniker. Too bad for everyone else over at the G that they are now unable to enjoy your perspectives. Account shutdown seems very much an inevitability if the ‘journalists’ over there are contradicted too much.
I don’t doubt that last bit for a second!
Paddy, great stuff. You might want to give the comments section at The Spectator a whirl.You’d need to subscribe but the are some very cheap introductory offers so you could check it out.
Your well informed command of detail would be most welcome there. As with all commenting sections we have a small minority of fruitcakes for amusement, but it’s a fast moving and lively group.
Thank you. I’m already a regular poster at the Speccie – and have been for years – under the name “Finknottle” – (all my older posting accounts are PG Wodehouse references).
The Spectator posters are probably closer to my own way of thinking, so i get far less push-back. I don’t mind trying to make the case for a minority viewpoint – but i did find the Guardian exhausting simply due to the level of hate one receives if one dares to counter the prevailing G orthodoxy.
For all that you might encounter trenchant postions at the Spectator, it is as nothing when compared to the vitriol over at the Guardian.
Now that Quillette has died the ‘death of a thousand cuts’ (though that might be a typo) – the Spectator and Unherd are – in my humble opinion – the best, most reasonable commenting sites available, for those few of us that give a damn.
Thank you. I’m already a regular poster at the Speccie – and have been for years – under the name “Finknottle” – (all my older posting accounts are PG Wodehouse references).
The Spectator posters are probably closer to my own way of thinking, so i get far less push-back. I don’t mind trying to make the case for a minority viewpoint – but i did find the Guardian exhausting simply due to the level of hate one receives if one dares to counter the prevailing G orthodoxy.
For all that you might encounter trenchant postions at the Spectator, it is as nothing when compared to the vitriol over at the Guardian.
Now that Quillette has died the ‘death of a thousand cuts’ (though that might be a typo) – the Spectator and Unherd are – in my humble opinion – the best, most reasonable commenting sites available, for those few of us that give a damn.
This has also been my exact experience posting in the Guardian comments section.
When I read the Guardian there were plenty of intelligent comment highlighting the absurdity of many of the views expressed in the articles but increasingly anything that was directly critical of the stupidities advanced in the articles became deleted and eventually any articles that the Guardian knew would attract critical attention from previous experience disallowed comment altogether. I keep a wary eye on Unherd’s policies regarding comment.
I can imagine that quoting extracts from Guardian articles to expose the inconsistencies of the author’s views would be particularly provoking to the censors.
I keep reading Unherd not simply for the articles, and there are some excellent writers among some dross, but for the sort of intelligent detailed commentary you supply so regularly as well as many other commentors both intelligent and humorous.
I do recognise the moniker. Too bad for everyone else over at the G that they are now unable to enjoy your perspectives. Account shutdown seems very much an inevitability if the ‘journalists’ over there are contradicted too much.
I don’t doubt that last bit for a second!
Paddy, great stuff. You might want to give the comments section at The Spectator a whirl.You’d need to subscribe but the are some very cheap introductory offers so you could check it out.
Your well informed command of detail would be most welcome there. As with all commenting sections we have a small minority of fruitcakes for amusement, but it’s a fast moving and lively group.
This has also been my exact experience posting in the Guardian comments section.
When I read the Guardian there were plenty of intelligent comment highlighting the absurdity of many of the views expressed in the articles but increasingly anything that was directly critical of the stupidities advanced in the articles became deleted and eventually any articles that the Guardian knew would attract critical attention from previous experience disallowed comment altogether. I keep a wary eye on Unherd’s policies regarding comment.
I can imagine that quoting extracts from Guardian articles to expose the inconsistencies of the author’s views would be particularly provoking to the censors.
I keep reading Unherd not simply for the articles, and there are some excellent writers among some dross, but for the sort of intelligent detailed commentary you supply so regularly as well as many other commentors both intelligent and humorous.
I spent several years commenting on the Guardian site – (under the name LastOfThePelicans.) Sheer intellectual masochism on my part, I know.
In my mind (on my more optimistic days) I was on a mission to civilise – to persuade people that neither side is ‘evil’ – that the “other side” merely have a different approach to finding solutions. But on my more lucid days I probably realised it was a lost cause and I was merely shouting into the wind.
There are plenty of excellent, reasonable posters on the G, trying to introduce a reasoned counter-narrative, but they are ganged-up on and shouted down by the Guardian faithful, annoyed at the interruption to their daily 2-minute hate.
Eventually I was banned – not for anything I’d written per se, but for copying and pasting extracts from earlier Guardian articles where the author had taken a position 180 degrees out from the one they were currently espousing. The moderators didn’t like me exposing the elasticity of their writers’ principles and that their outrage might be put on, just a little bit. Polly Toynbee, Simon Jenkins and the ludicrous Marxist 3rd former, Owen Jones were, unsurprisingly, the worst culprits.
Not reading CIF every day has, for the last six months, been good for the soul.
Private treatment costs an arm & a leg here; my father’s knee replacement was £15,000, that’s a deposit for a small house. If it was say £3,000, then ordinary people could consider accessing treatment outside the NHS, but it isn’t and they can’t. I would gladly pay for treatment if it was affordable. Here in the UK, we have the worst of both worlds when it comes to access to healthcare.
What would make medical care affordable is free market competition, no insurance companies, no government monies. Fat chance.
You’re free to pay for your operation if you wish, you don’t have to use insurance companies so I fail to see how it’s not free market competition
You’re free to pay for your operation if you wish, you don’t have to use insurance companies so I fail to see how it’s not free market competition
What would make medical care affordable is free market competition, no insurance companies, no government monies. Fat chance.
The Tories despise the NHS on principle. It’d be very odd if they didn’t.
Absolute bullocks!
I’m an unapologetic Tory voter, and I have never, ever, despised the NHS, nor have I ever wanted to shut it down. Universal healthcare is essential to all those of us who cannot afford private healthcare. Destroying the NHS would be self-harm.
Do try harder to engage a few brain cells.
Absolute bullocks!
I’m an unapologetic Tory voter, and I have never, ever, despised the NHS, nor have I ever wanted to shut it down. Universal healthcare is essential to all those of us who cannot afford private healthcare. Destroying the NHS would be self-harm.
Do try harder to engage a few brain cells.
You compare superior German model with NHS poorer outcomes, citing growth in investment for NHS and implying that NHS failures are not about money at all. And yet, here are some facts most are unaware of.
Healthcare expenditure per person, 2017 (ons.gov.uk):
UK: £2,989
Germany: £4,432
France: £3,737
Sweden: £3,990
We spend on healthcare less per capita than any other developed European country.
Improving efficiency can only work to a degree, there are some fundamentals one cannot get around. In the UK in 2020 per 1000 population there are 3 physicians (versus 4.5 for Germany), and 2.43 hospital beds (versus 7.82 in Germany). (health.org.uk)
In fact, given how little NHS is funded comparing to Germany, one might argue that NHS’ results and efficiency are close to a miracle as they are.
None of what follows is to denigrate the work done by Doctors and Nurses. But half of the problem is the inability to be able to speak out against waste and inefficiency across the organisation, without someone accusing you of hating nurses or some such twaddle.
Taking the emotion out of the argument would be a start. Just look at some of the figures and see if you think them justifiable.
PFI, actually introduced under Major’s Govt as a way to take some capital spending off the books, was ramped up under Blair & Brown, who saw PFIs as a panacea for all additional spending they wanted to announce without having to fund it. Their “cure” turned out to be, in some cases, more dangerous than the disease.
Some hospital trusts are still spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal.
No wonder Blair & Brown found it easy to fund the NHS when they were putting future generations on the hook to cover the costs rather than paying for it out of the budget.
Of course we need an NHS to be properly run and that requires managers but when you see that over the Blair/Brown years the spending on managers in the NHS went from £189,922,000 in the 1997/98 budget to £1,041,803,000 in the 2009/10 budget, an increase of 449%, you have to ask, “Was that money well spent? Did it proportionally improve the service in any noticeable way?”
Waste and inefficiency in the NHS are scandalous….
But don’t take it from me – listen to Prof Keith Willett, medical director for acute care, who urged staff to stop “fuming” when the system “grinds to a halt” and instead do more to prevent beds being blocked by patients who should have been discharged.
He said too many surgeons were left unable to operate – sometimes on a daily basis – because of a failure to tackle bedblocking, with beds filled by those unable to discharged for want of help at home.
“To have highly skilled surgeons, anaesthetists and nurses sitting around waiting for patients is clearly a ridiculous waste of resources,” He told surgeons to stop “bemoaning” the problem and do more to solve it, with better planning to identify what their own patients need to be discharged swiftly. None of that requires extra resources.
“It will take a rearrangement of time and resource but nothing extra – except the willingness and time to think it through with colleagues” .
Try some of these figures ….
Spending £160 million per annum prescribing aspirin, paracetemol and ibuprofen – all of which can be bought by the recipient at a supermarket for a FRACTION of the cost.
Lord Carter in a report on NHS inefficiencies wrote “Most trusts ‘don’t know what they buy, how much they buy, and what they pay for goods and services’, .. If all the ‘unwarranted variations’ were eradicated, an astonishing £5 billion of the £55.6 billion spent annually by acute hospitals could be saved in the next three years, he concluded.
£220 million wasted each year paying over the odds for energy. Because no one cares to negotiate for the lower tarriffs on offer.
£430 million spent on management consultants
The list goes on and on ….
Paddy, I spent 15 years doing PFI projects. They get a bad press. Building a new hospital should be paid for by future generations. They last 20 – 25 years. The cost of capital was higher than state funding but that was the cost of transferring risks. Principally building hospitals to time and budget and providing long term maintenance and support services to a budget. Some contracts were a disaster, early contracts were expensive (a new market). A number of comlanies went bust from accepting those risks – they were very real.
Sadly I also had 15 years of experience of Government and NHS Trust procurement and I weep recalling some of the stupidity and waste. It turned me from a born socialist to a conservative.
Dr Thomas Sowell frequently tells the story of what turned him from a Marxist to a conservative – it wast working in a government department.
Dr Thomas Sowell frequently tells the story of what turned him from a Marxist to a conservative – it wast working in a government department.
Excellent arguments as usual. Just as an example of waste, I was in A/E with what turned out to be pericarditis. At one point my temperature spiked. The nurse said I’ll just give you some paracetamol for that. The next think she was injecting it into my IV line. I asked her why she had given me it intravenously rather than oralyl and she said she didn’t know, that’s what they always do. I don’t know the cost of IV paracetamol but I doubt if it’s much less than 100 times more expensive than the generic tablets. I shan’t detail the chaos on the overnight observation ward and the many failures that continued in the following 24 hours. Fortunately I wasn’t seriously ill and I managed to escape the following day.
Paddy, I spent 15 years doing PFI projects. They get a bad press. Building a new hospital should be paid for by future generations. They last 20 – 25 years. The cost of capital was higher than state funding but that was the cost of transferring risks. Principally building hospitals to time and budget and providing long term maintenance and support services to a budget. Some contracts were a disaster, early contracts were expensive (a new market). A number of comlanies went bust from accepting those risks – they were very real.
Sadly I also had 15 years of experience of Government and NHS Trust procurement and I weep recalling some of the stupidity and waste. It turned me from a born socialist to a conservative.
Excellent arguments as usual. Just as an example of waste, I was in A/E with what turned out to be pericarditis. At one point my temperature spiked. The nurse said I’ll just give you some paracetamol for that. The next think she was injecting it into my IV line. I asked her why she had given me it intravenously rather than oralyl and she said she didn’t know, that’s what they always do. I don’t know the cost of IV paracetamol but I doubt if it’s much less than 100 times more expensive than the generic tablets. I shan’t detail the chaos on the overnight observation ward and the many failures that continued in the following 24 hours. Fortunately I wasn’t seriously ill and I managed to escape the following day.
Sorry. There is much more up to date information available than 2017. Why did you choose that? Check ONs website that will show a completely different picture – bang up to date.
Because very often articles written in 2020 or later use statistics for 2017 or about for their graphs and tables.
I just checked the latest statistics available from OCED website – the article dated 2020 refers to statistics for “2019 or nearest year” and it is largely the same as I cited for 2017 – the UK spends less per capita on their healthcare than any other developed European country.
Because very often articles written in 2020 or later use statistics for 2017 or about for their graphs and tables.
I just checked the latest statistics available from OCED website – the article dated 2020 refers to statistics for “2019 or nearest year” and it is largely the same as I cited for 2017 – the UK spends less per capita on their healthcare than any other developed European country.
I would add to Paddy Taylor’s observations the fact that it is perhaps unsurprising that richer countries can afford to spend more on a better health system. The UK has fallen down the per capita income rankings – particularly given that we seem to have lost count of exactly how many people are drawing on the resources of the NHS.
A great conclusion to Paddy Taylor’s comment combined with my figures.
There is a perception that the UK is among the richest countries in Europe/in the world and people largely expect to have the same level of healthcare, education etc. as the best performing European countries.
The truth is we can’t really afford it.
A great conclusion to Paddy Taylor’s comment combined with my figures.
There is a perception that the UK is among the richest countries in Europe/in the world and people largely expect to have the same level of healthcare, education etc. as the best performing European countries.
The truth is we can’t really afford it.
None of what follows is to denigrate the work done by Doctors and Nurses. But half of the problem is the inability to be able to speak out against waste and inefficiency across the organisation, without someone accusing you of hating nurses or some such twaddle.
Taking the emotion out of the argument would be a start. Just look at some of the figures and see if you think them justifiable.
PFI, actually introduced under Major’s Govt as a way to take some capital spending off the books, was ramped up under Blair & Brown, who saw PFIs as a panacea for all additional spending they wanted to announce without having to fund it. Their “cure” turned out to be, in some cases, more dangerous than the disease.
Some hospital trusts are still spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal.
No wonder Blair & Brown found it easy to fund the NHS when they were putting future generations on the hook to cover the costs rather than paying for it out of the budget.
Of course we need an NHS to be properly run and that requires managers but when you see that over the Blair/Brown years the spending on managers in the NHS went from £189,922,000 in the 1997/98 budget to £1,041,803,000 in the 2009/10 budget, an increase of 449%, you have to ask, “Was that money well spent? Did it proportionally improve the service in any noticeable way?”
Waste and inefficiency in the NHS are scandalous….
But don’t take it from me – listen to Prof Keith Willett, medical director for acute care, who urged staff to stop “fuming” when the system “grinds to a halt” and instead do more to prevent beds being blocked by patients who should have been discharged.
He said too many surgeons were left unable to operate – sometimes on a daily basis – because of a failure to tackle bedblocking, with beds filled by those unable to discharged for want of help at home.
“To have highly skilled surgeons, anaesthetists and nurses sitting around waiting for patients is clearly a ridiculous waste of resources,” He told surgeons to stop “bemoaning” the problem and do more to solve it, with better planning to identify what their own patients need to be discharged swiftly. None of that requires extra resources.
“It will take a rearrangement of time and resource but nothing extra – except the willingness and time to think it through with colleagues” .
Try some of these figures ….
Spending £160 million per annum prescribing aspirin, paracetemol and ibuprofen – all of which can be bought by the recipient at a supermarket for a FRACTION of the cost.
Lord Carter in a report on NHS inefficiencies wrote “Most trusts ‘don’t know what they buy, how much they buy, and what they pay for goods and services’, .. If all the ‘unwarranted variations’ were eradicated, an astonishing £5 billion of the £55.6 billion spent annually by acute hospitals could be saved in the next three years, he concluded.
£220 million wasted each year paying over the odds for energy. Because no one cares to negotiate for the lower tarriffs on offer.
£430 million spent on management consultants
The list goes on and on ….
Sorry. There is much more up to date information available than 2017. Why did you choose that? Check ONs website that will show a completely different picture – bang up to date.
I would add to Paddy Taylor’s observations the fact that it is perhaps unsurprising that richer countries can afford to spend more on a better health system. The UK has fallen down the per capita income rankings – particularly given that we seem to have lost count of exactly how many people are drawing on the resources of the NHS.
You say: The “brilliant NHS Staff” are saying they need more money – They’re right.
I ask ”do they?” – £132 bn in 2016 and near £200bn today but they need ”even more money” – Money clearly hasnt solved the annual problems of the NHS being on its knees.
Forgive me, but are you not confusing Staffing costs with Operating costs?
The former exarcerbated by inflation-hit wage scales and the need for recruitment
The latter driven by myriad factors around changing demographics (not least, life expectancy) etc and made worse by chronic institutional waste and inefficiency.
I am neither referring to staffing nor operating costs – but the total sum spent on The NHS by the tax payer in each of those years I mentioned.
Check ONS for clarity.
Rob,
Not wishing to be argumentative but you do have to separate them out. They are very different considerations and you’re not being clear-eyed about the ongoing funding issues unless you approach both elements differently.
A balance must be struck or there is no way to allocate funds accordingly.
Rob,
Not wishing to be argumentative but you do have to separate them out. They are very different considerations and you’re not being clear-eyed about the ongoing funding issues unless you approach both elements differently.
A balance must be struck or there is no way to allocate funds accordingly.
I am neither referring to staffing nor operating costs – but the total sum spent on The NHS by the tax payer in each of those years I mentioned.
Check ONS for clarity.
Forgive me, but are you not confusing Staffing costs with Operating costs?
The former exarcerbated by inflation-hit wage scales and the need for recruitment
The latter driven by myriad factors around changing demographics (not least, life expectancy) etc and made worse by chronic institutional waste and inefficiency.
Dear Paddy, you analysis is likely technically correct but there is one elephant in the room: NHS stands for health service. It does very little to create health in the population. Of yes, it does preventative medicine = making diagnoses earlier but that is not the same as creating health. The NHS as much as our medical authorities (who should look a bit harder at themselves than shouting at the government) are caught in a model of ‘treating illness’ a model that serves an economy relating to illness : investment mainly in research that can provide financial returns. Health does not pay as it reduces illness = makes less money for the illness industry.
No country in the world can afford the current ‘modern illness care model with all its technical and other services attached to it’.
In stead of pumping money in the the current NIS (national illness service) which will suit de industry that helped building it, the government should pump money in providing good education and good living conditions and non-chemically grown and prepared food for the population. ALL evidence shows that the main causes for illness are: lac of education, lack of good housing, lack of good food, (these result in people having a purpose in life) . but investing in this does not suit the lobby…
I read in past week an article that said that pharmaceutical corps don’t want to create cures but treatments. If they develop something that cures they deprive themselves of years and years of income from treatments.
As for your main point, that the entire system is based on illness rather than health, I could not agree more. However, for profit corporations have much to answer for here. In Australia for example, moves by governments to label foods according to how good they are for health are stymied by food industry lobbyists.
I read in past week an article that said that pharmaceutical corps don’t want to create cures but treatments. If they develop something that cures they deprive themselves of years and years of income from treatments.
As for your main point, that the entire system is based on illness rather than health, I could not agree more. However, for profit corporations have much to answer for here. In Australia for example, moves by governments to label foods according to how good they are for health are stymied by food industry lobbyists.
“Only an idiot could imagine the Tories want to destroy the NHS.” Sadly an enormous amount of otherwise very sensible left-leaning people absolutely believe this to be the case. Saying that they’re all idiots just can’t be true, it would be like saying that everybody who voted for Brexit is a racist xenophobe (mind you a lot of them believe that, too)
What a great analysis…really needs an article of its own!
I’m a consultant in the NHS and I agree with most of the comments here. I now regard the NHS as an obstacle to better healthcare. The problem summarised is the people with responsibility (clinicians) have no power (over staffing, budgets etc) and those with power have no responsibility (politicians decision makers etc don’t get sued/struck off). I believe I could deliver a better, cheaper service if I could run my department as a private company so that I could decide staffing, where and when surgery and clinics are done etc. I hope (in vain) I can do this before my pay reaches 50% of 2008 levels (my personal exit point).
There’s definitely an issue with staffing & the hard truth is that next to nothing has been done in the lat 10yrs to train sufficient quantities of doctors & nurses. Instead NHS managers have trotted off (with implicit ministerial approval) to poach the best from poorer countries who can ill afford to lost them. But there’s another issue that plagues the NHS – romanticisation. There’s a (mistaken) belief that it’s the best in the world. Maybe 60 or 70 yrs ago that was true, but its not been true for decades. Any politician who tinkers is accused of “privatising our NHS”. All the models elsewhere, especially around Europe are using private sector facilities to deliver care. The question is how best to harness that, without lining the pockets of venture capitalists, something the UK seems to be uniquely good at.
Hmmmm. You do realise that this means that the Labour Party has to admit, to itself, that perhaps, just perhaps, their single great achievement is a complete dud………..?
Excellent analysis, and the key point which i think emerges is that the NHS is failing because it’s politicised.
If, as seems likely, the next government is led by Keir Starmer, it’ll be interesting to see if anything changes whatsoever. It’d probably take a Labour administration to make the necessary structural changes, as the only party with the political capital to do so. We’re at the point in history when that change has become an imperative. I wonder what Toynbee would make of it, except i can’t imagine for one moment that Starmer would have the courage to initiate that change, to something closer to the more successful models. He’ll most likely just spend his time in office blaming the mess on his predecessors, and so on ad infinitum.
Excellent comment. The endless reheated, partisan, simplistic rubbish from the likes of Toynbee are part of the problem. A health system that works best for everyone, from the poorest upwards, should be the sole consideration. A specific funding model dating from the 1940s should not be sacrosanct if it’s no longer fit for purpose. One thing everyone can agree on: this is now really urgent. But what government will have the courage and foresight to deal with it?
Excellent, Paddy.
Question is what do you ignore? Lots.
First its a Beveridge system where insurance, supply and regulation are combined. The recipe for a disaster. Solution is a Bismark system where those three legs are split
Second, you ignore the treat now pay later costs. Pensions
On social care again the cause of the mess is that socialist pension ponzi. People have been asset stripped so cannot pay for social care. The debts are too large for the tax payers to fund, so social care is screwed.
The next problem is the NHS as a religion. ie. If you lose the NHS, you will get the US system. Actually on the avoidable deaths count, that is an improvement. Instead go Swiss or Dutch, 1 or 2 in the world. The NHS doesn’t make divison one. Second you would be back in Victorian times. Yeah right, as if the rest of the wold is stuck there.
The NHS is dead as are significant numbers of its patients as a result of its treatment. But the victim pays.
You have hit the nail on the head and most sensible people would agree if only we could take the “politics”out of it!
I am afraid you are being illogical. The evidence clearly shows that the UK spends less on health care than other countries. A further problem is that the spending has fluctuated with above inflation increases over certain periods following by below inflation increases. On top of that there have been many attempts to reorganise the system in an attempt to increase efficiency.
The core problem remains insufficient, erratic funding and it seems perverse to focus on changing the system yet again before addressing the the funding issue.
One often missed area is primary care, where funding has been severely constrained. This chronic underfunding of GP services has had a particularly damaging effect by sabotaging preventative care and increasing the load on hospitals.
My wife and I are medical doctors and after austerity was introduced in 2010 we could see that the NHS was doomed. We took out private insurance for our family and will continue to rely on this. A two tier system is inevitable as long as we keep electing Tories.
John Pilger made an excellent documentary called “The Dirty War on the NHS”. Just google or YouTube for it.
Cracking post Paddy.
By the way, you wouldn’t happen to comment BTL at the guardian woud you? If you don’t already maybe give it a go – it would be a very wecome voice of sanity amongst all the drivel. (I would though estimate a very short spell until the censors shut your account down 🙂 )
Private treatment costs an arm & a leg here; my father’s knee replacement was £15,000, that’s a deposit for a small house. If it was say £3,000, then ordinary people could consider accessing treatment outside the NHS, but it isn’t and they can’t. I would gladly pay for treatment if it was affordable. Here in the UK, we have the worst of both worlds when it comes to access to healthcare.
The Tories despise the NHS on principle. It’d be very odd if they didn’t.
You compare superior German model with NHS poorer outcomes, citing growth in investment for NHS and implying that NHS failures are not about money at all. And yet, here are some facts most are unaware of.
Healthcare expenditure per person, 2017 (ons.gov.uk):
UK: £2,989
Germany: £4,432
France: £3,737
Sweden: £3,990
We spend on healthcare less per capita than any other developed European country.
Improving efficiency can only work to a degree, there are some fundamentals one cannot get around. In the UK in 2020 per 1000 population there are 3 physicians (versus 4.5 for Germany), and 2.43 hospital beds (versus 7.82 in Germany). (health.org.uk)
In fact, given how little NHS is funded comparing to Germany, one might argue that NHS’ results and efficiency are close to a miracle as they are.
You say: The “brilliant NHS Staff” are saying they need more money – They’re right.
I ask ”do they?” – £132 bn in 2016 and near £200bn today but they need ”even more money” – Money clearly hasnt solved the annual problems of the NHS being on its knees.
Dear Paddy, you analysis is likely technically correct but there is one elephant in the room: NHS stands for health service. It does very little to create health in the population. Of yes, it does preventative medicine = making diagnoses earlier but that is not the same as creating health. The NHS as much as our medical authorities (who should look a bit harder at themselves than shouting at the government) are caught in a model of ‘treating illness’ a model that serves an economy relating to illness : investment mainly in research that can provide financial returns. Health does not pay as it reduces illness = makes less money for the illness industry.
No country in the world can afford the current ‘modern illness care model with all its technical and other services attached to it’.
In stead of pumping money in the the current NIS (national illness service) which will suit de industry that helped building it, the government should pump money in providing good education and good living conditions and non-chemically grown and prepared food for the population. ALL evidence shows that the main causes for illness are: lac of education, lack of good housing, lack of good food, (these result in people having a purpose in life) . but investing in this does not suit the lobby…
“Only an idiot could imagine the Tories want to destroy the NHS.” Sadly an enormous amount of otherwise very sensible left-leaning people absolutely believe this to be the case. Saying that they’re all idiots just can’t be true, it would be like saying that everybody who voted for Brexit is a racist xenophobe (mind you a lot of them believe that, too)
What a great analysis…really needs an article of its own!
I’m a consultant in the NHS and I agree with most of the comments here. I now regard the NHS as an obstacle to better healthcare. The problem summarised is the people with responsibility (clinicians) have no power (over staffing, budgets etc) and those with power have no responsibility (politicians decision makers etc don’t get sued/struck off). I believe I could deliver a better, cheaper service if I could run my department as a private company so that I could decide staffing, where and when surgery and clinics are done etc. I hope (in vain) I can do this before my pay reaches 50% of 2008 levels (my personal exit point).
There’s definitely an issue with staffing & the hard truth is that next to nothing has been done in the lat 10yrs to train sufficient quantities of doctors & nurses. Instead NHS managers have trotted off (with implicit ministerial approval) to poach the best from poorer countries who can ill afford to lost them. But there’s another issue that plagues the NHS – romanticisation. There’s a (mistaken) belief that it’s the best in the world. Maybe 60 or 70 yrs ago that was true, but its not been true for decades. Any politician who tinkers is accused of “privatising our NHS”. All the models elsewhere, especially around Europe are using private sector facilities to deliver care. The question is how best to harness that, without lining the pockets of venture capitalists, something the UK seems to be uniquely good at.
Hmmmm. You do realise that this means that the Labour Party has to admit, to itself, that perhaps, just perhaps, their single great achievement is a complete dud………..?
The irreproachable St Polly of Toynbee launched into the same topic the other day with her customary impartiality and rigour – setting up the premise of her article with the sort of neutral, searching question one has come to expect of this paragon of journalistic objectivity:
“Who do you believe: the brilliant NHS staff who treated my cancer, or ministers who spin and lie?”
Catnip to the Guardian faithful. But none stopped to consider that the answer to Polly’s question was that they might both be right.
The “brilliant NHS Staff” are saying they need more money – They’re right.
Politicians are pointing out that the NHS cannot go on requiring ever more money to be poured into it, that we cannot afford it. They too are right.
Even Wes Streeting admits the system is broken. If a Tory says such a thing they will be dismissed by the media and accused of hating nurses and wanting to sell off the NHS or some such nonsense, but when a Labour Health Sec says it then maybe even the Guardian should sit up and take notice.
Why is it that, when looking at a Govt’s record on Health, journalists reporting on the NHS only ever focus on inputs, rather than outcomes? A Govt’s health policy is only measured by what monies they make available rather than the outcomes the NHS delivers.
We want a Health service to achieve better outcomes, surely? If we can do that by more efficient means, then we should.
The UK media, of both left and right, routinely praise the German model – and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy – it steers a path (in broad terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation – and that is that if the Govt tried to copy, say, the German Healthcare model in this country then Ms Toynbee, the Guardian and the BBC would go into meltdown as all their fevered dreams of “selling off the NHS” would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories want to destroy the NHS. They may have different ideas about how to improve it, and some of their ideas have certainly been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform – AND IT DOES – then we’ll get no closer to a solution. We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
The BBC & Guardian have railed against private healthcare contracts as the “tide of privatisation.” But the NHS has for many years outsourced a variety of services – in fact spending on private outsourced services rose faster under the last Labour Govt than under the coalition or Tories, but why let facts get in the way of the narrative?
Under the coalition Govt, which is when this argument really hotted up, we are actually talking about a growth from 4.5% to less than 6%. Hardly an earth-shattering increase. Yet (from both sides – and most particularly the media) the issue is weaponised to the point that no Govt dares touch it, dares even to suggest that a major reform of the whole funding model is the only thing that will save it.
I’m a huge supporter of the NHS – which means I want it to reform so it can survive.
People who pretend the NHS can limp on needing vastly more money year on year just to try and stand still do not really support the NHS. What they say they wish for, will surely bring about its demise.
Polly in her mosr recent screed glibly suggests – The government ignores the one quick fix for the NHS: good funding and decent pay for social care. For someone who has been writing about the NHS for so long that seems a childishly simple view, and one that cannot withstand the mereset scrutiny.
Would the NHS be better if more money was spent on it? In the short term, and if it was targeted, then of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term – not simply look good for whoever is currently in No 10, who’ll get the plaudits whilst saddling future generations with the cost.
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally – unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of those “brilliant NHS” workers and worthy of a C21st developed nation.
The problem with the NHS, like the problem with housing or roads or sewers, is that the system can’t respond to population increases. The unprecedented growth in the UK’s population since 2004 has not resulted in a corresponding rise in tax revenue (because the immigrants are low paid) and so we have more people chasing the same services. Do that for 20 years and you end up here.
Correct. But the now desperate supporters of this crumbling 1940s monster monolith will NEVER speak of the huge impact of uncontrolled mass migration via free movement of peoples. They just talk about the oldies. The NHS demanded we be imprisoned for two years to save it and its shame at having got rid of hospital beds for efficiency, and now it is broken by its insane covid-only obsession. It resisted tech in favour of fax machines, allowed greed to envelop the Bye Bye at 55 no show 100k GPs, turned itself into a fully feminized (1m out of 1.2m) workforce in a country without childcare provision, making modern health care work impossible & ‘anti women’. It is a Third World horror story. Stop talking about the NHS as our religion. Only BBC propaganda sustains this grubby cynical lie.
Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out – because they were younger.
The biggest issue for the NHS is an aging population and the failure to sort Social care. That is not driven at all by recent immigration. Who’s going to work in Social care for minimum wage? Yep you got it – immigrants.
Now I concur immigration not been well managed too, especially recently. Needs proper plan and proper national discussion, esp if we aren’t going to raise wages and train more of our own.
Nonetheless your practical suggestions?
Don’t know how old you are, but I’ll place a bet – if you/we live long enough we’ll be v grateful for that non indigenous kind care worker who comes to help us with toileting etc when we are frail and old and can’t manage ourselves. Remember that.
People still glibly insist that “Immigrants put in more than they take out.” A statement that has been roundly and soundly debunked many times over – though probably never reported on the BBC or Guardian as it defies the Blairite orthodoxy on the benefits of limitless immigration.
Young, able-bodied immigrants do, indeed, contribute more than they extract.
However, factor in their spouses, their off-spring, the fact that these once-young migrants will age and no longer contribute, not to mention the monies that migrants receive that are sent overseas and not spent here, or the child benefit that was being paid for children living in other EU countries and the picture becomes rather different.
Nobody seems to be able to agree on anything like an exact figure but overall migration to the UK is a massively greater cost to the exchequer than a benefit. Any increase in GDP has to be weighed against the size of population and the provision of services.
So, when you say “Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out ” ….. take a look at some of the most comprehensive research done pre the 2016 referendum:
….The OECD found an average annual net fiscal cost of £4.3 billion in the years 2007 to 2009. Thus, on average, EU migrants paid £4.3 billion less in taxes than they received in benefits and services.
…. Centre for Research and Analysis on Migration (CReAM) at University College London found that all migrants were a net fiscal cost of £14.8 billion in the financial year 2011/12.
…. Using similar methodology to CReAM, research by Migration Watch UK found that all migrants were a net fiscal cost of £13 billion in 2014/15.
…… Recent migrants from non-EU countries were also a net cost to the Exchequer in both analyses. CReAM estimated a net cost of £2.2 billion in 2011/12 meanwhile Migration Watch estimated a cost of £3.8 billion in 2014/15.
By all means lets have the debate, but let us be clear : You cannot possibly sustain a generous welfare state whilst you do not have control of immigration.
Immigration has had an enormous impact on Britain, much of it very positive – but to pretend it has come at no cost or that the rise in population due to immigration has had no negative impact on the provision of healthcare is ludicrous.
It is impossible to find effective solutions when ideology blinds you to one of the more obvious causes of a problem.
Superb. And so scary. The dogma and Groupthink mania that holds both university ‘researchers’ AND the BBC ‘journalists’ in thrall mean we are being fed a diet of Newspeak lies about the cost benefits of mass uncontrolled migration and multiculturalism. We cannot access and share Truth on anything to do with them. It triggers their terror/ phobia about any form of discrimination. Our society is more and more akin to a stale 1970s socialist Soviet satellite country like East Germany. No free speech. A detached self enriching ruling Politburo/Blob presiding over a warped sick economy clinging to political nostrums they know have failed. An unhappy increasingly oppressed people who KNOW the truth but have lost all faith in the System and stay stumm to avoid the prying state police.
Plus you have to be earning 35000 £p.a. To be a net contributor.
I would just add that the last time I checked you had to earn £48K pa to be a net contributor the UK assuming no dependents.
I assume some immigrants are net contributors but not very many.
Slightly narrow judgment on contribution isn’t it? Firstly how many Businesses making sufficient to pay tax reliant on low wages and providing you/I with services we want/need? Secondly VAT, all other non direct taxes etc, often more regressive.
Not so clear cut is it when you actually have to think about it.
There is a debate here but it’s more complicated than over simplistic calculations and presentations.
That was the conclusion of the study.
Since there is no VAT on food and only 5% on energy most people pay still contribute very little.
What other indirect taxes do you think those earning less than £48K actually pay or did this thought just pop into your head?
Low wage immigration keeps the wages for the rest of us down. It is just a Ponzi scheme and it will crash.
It really is that simple
That was the conclusion of the study.
Since there is no VAT on food and only 5% on energy most people pay still contribute very little.
What other indirect taxes do you think those earning less than £48K actually pay or did this thought just pop into your head?
Low wage immigration keeps the wages for the rest of us down. It is just a Ponzi scheme and it will crash.
It really is that simple
Slightly narrow judgment on contribution isn’t it? Firstly how many Businesses making sufficient to pay tax reliant on low wages and providing you/I with services we want/need? Secondly VAT, all other non direct taxes etc, often more regressive.
Not so clear cut is it when you actually have to think about it.
There is a debate here but it’s more complicated than over simplistic calculations and presentations.
Yep it’s about the balance. But also some of what you’ve quoted about seems a little selective. For example the CReAM authors actually said – ‘Our analysis thus suggests that – rather than being a drain on the UK’s fiscal system – immigrants arriving since the early 2000s have made a net contributions to its public finances, a reality that contrasts starkly with the view often maintained in public debate’.
Thing is it’s not actually a straight-forward calculation and many assumptions have to be made.
Fascinating of course though that Truss-economics seemed to indicate we needed quite a bit for growth, hence the spasms on the Right about exactly what we do need to do.
At some point let’s hope a sensible debate can occur.
CReAM’s analysis looked at contributions to the exchequer, against what was taken from the exchequer in the form of various benefits.
However it did not factor in the costs of providing services. Added to which, CReAM was working on 2011 figures that proved a huge underestimation. The ONS in 2021 revised their figures quite dramatically – they’d long suggested net inward migration stood at approx 300, 000 per year. When EU residents started registering, the ONS revised that figure upwards – their latest ‘best guess’ is that a million extra people are added every 19 months.
If you take immigration figures and add to those the children born to immigrants you will find that fully 82% of the population increase since 2001 has been due to immigration.
I’m not someone who gets overly twitchy at the thought of immigration – as long as we have control over who we allow in and grant the right to stay. But numbers really do matter. Every additional child requires schooling, every additional family requires housing, every rise in population has an attendant cost – it is only when you factor all that against what is added to the coffers or to GDP that you can assess the cost/benefit.
Yep a debate isn’t there about the right level.
The issue for us is our population isn’t replacing currently on it’s own. Whether that’s an issue part of the debate and broader understanding needed. Our demographic issues aren’t as acute as say the Germans, but they may head that way medium term. How many youngsters now starting families later, or at all, due to cost of living problems? Not a quick fix whatever the diagnosis. That replacement rate is then an increasing issue for tax revenue and labour force. Maybe some AI and other societal changes can make a difference and allow a sensible contraction, but we haven’t got those yet.
Slightly separate but on assumption we do need a reasonable amount of immigration, I do wish there was a well considered naturalisation process if you want to settle permanently. Albeit not easy to determine what ‘basics’ that should cover other than obvious decent command of the language (can’t be too onerous of course or we’ll all start failing it!)
Yep a debate isn’t there about the right level.
The issue for us is our population isn’t replacing currently on it’s own. Whether that’s an issue part of the debate and broader understanding needed. Our demographic issues aren’t as acute as say the Germans, but they may head that way medium term. How many youngsters now starting families later, or at all, due to cost of living problems? Not a quick fix whatever the diagnosis. That replacement rate is then an increasing issue for tax revenue and labour force. Maybe some AI and other societal changes can make a difference and allow a sensible contraction, but we haven’t got those yet.
Slightly separate but on assumption we do need a reasonable amount of immigration, I do wish there was a well considered naturalisation process if you want to settle permanently. Albeit not easy to determine what ‘basics’ that should cover other than obvious decent command of the language (can’t be too onerous of course or we’ll all start failing it!)
CReAM’s analysis looked at contributions to the exchequer, against what was taken from the exchequer in the form of various benefits.
However it did not factor in the costs of providing services. Added to which, CReAM was working on 2011 figures that proved a huge underestimation. The ONS in 2021 revised their figures quite dramatically – they’d long suggested net inward migration stood at approx 300, 000 per year. When EU residents started registering, the ONS revised that figure upwards – their latest ‘best guess’ is that a million extra people are added every 19 months.
If you take immigration figures and add to those the children born to immigrants you will find that fully 82% of the population increase since 2001 has been due to immigration.
I’m not someone who gets overly twitchy at the thought of immigration – as long as we have control over who we allow in and grant the right to stay. But numbers really do matter. Every additional child requires schooling, every additional family requires housing, every rise in population has an attendant cost – it is only when you factor all that against what is added to the coffers or to GDP that you can assess the cost/benefit.
And if we got rid of HS2 there would be much more money available – and didn’t have to pay£4.5 billions putting dinghy boat immigrants in 4 star hotels – and stopped sending enormous – who knows how much but far north if £7 billion to Ukraine – money spent on EDI – Exclusion of white people – Discrimination against white people – Inequity for white people – unconscious bus training throughout the institutions – the list goes on.
Superb. And so scary. The dogma and Groupthink mania that holds both university ‘researchers’ AND the BBC ‘journalists’ in thrall mean we are being fed a diet of Newspeak lies about the cost benefits of mass uncontrolled migration and multiculturalism. We cannot access and share Truth on anything to do with them. It triggers their terror/ phobia about any form of discrimination. Our society is more and more akin to a stale 1970s socialist Soviet satellite country like East Germany. No free speech. A detached self enriching ruling Politburo/Blob presiding over a warped sick economy clinging to political nostrums they know have failed. An unhappy increasingly oppressed people who KNOW the truth but have lost all faith in the System and stay stumm to avoid the prying state police.
Plus you have to be earning 35000 £p.a. To be a net contributor.
I would just add that the last time I checked you had to earn £48K pa to be a net contributor the UK assuming no dependents.
I assume some immigrants are net contributors but not very many.
Yep it’s about the balance. But also some of what you’ve quoted about seems a little selective. For example the CReAM authors actually said – ‘Our analysis thus suggests that – rather than being a drain on the UK’s fiscal system – immigrants arriving since the early 2000s have made a net contributions to its public finances, a reality that contrasts starkly with the view often maintained in public debate’.
Thing is it’s not actually a straight-forward calculation and many assumptions have to be made.
Fascinating of course though that Truss-economics seemed to indicate we needed quite a bit for growth, hence the spasms on the Right about exactly what we do need to do.
At some point let’s hope a sensible debate can occur.
And if we got rid of HS2 there would be much more money available – and didn’t have to pay£4.5 billions putting dinghy boat immigrants in 4 star hotels – and stopped sending enormous – who knows how much but far north if £7 billion to Ukraine – money spent on EDI – Exclusion of white people – Discrimination against white people – Inequity for white people – unconscious bus training throughout the institutions – the list goes on.
People still glibly insist that “Immigrants put in more than they take out.” A statement that has been roundly and soundly debunked many times over – though probably never reported on the BBC or Guardian as it defies the Blairite orthodoxy on the benefits of limitless immigration.
Young, able-bodied immigrants do, indeed, contribute more than they extract.
However, factor in their spouses, their off-spring, the fact that these once-young migrants will age and no longer contribute, not to mention the monies that migrants receive that are sent overseas and not spent here, or the child benefit that was being paid for children living in other EU countries and the picture becomes rather different.
Nobody seems to be able to agree on anything like an exact figure but overall migration to the UK is a massively greater cost to the exchequer than a benefit. Any increase in GDP has to be weighed against the size of population and the provision of services.
So, when you say “Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out ” ….. take a look at some of the most comprehensive research done pre the 2016 referendum:
….The OECD found an average annual net fiscal cost of £4.3 billion in the years 2007 to 2009. Thus, on average, EU migrants paid £4.3 billion less in taxes than they received in benefits and services.
…. Centre for Research and Analysis on Migration (CReAM) at University College London found that all migrants were a net fiscal cost of £14.8 billion in the financial year 2011/12.
…. Using similar methodology to CReAM, research by Migration Watch UK found that all migrants were a net fiscal cost of £13 billion in 2014/15.
…… Recent migrants from non-EU countries were also a net cost to the Exchequer in both analyses. CReAM estimated a net cost of £2.2 billion in 2011/12 meanwhile Migration Watch estimated a cost of £3.8 billion in 2014/15.
By all means lets have the debate, but let us be clear : You cannot possibly sustain a generous welfare state whilst you do not have control of immigration.
Immigration has had an enormous impact on Britain, much of it very positive – but to pretend it has come at no cost or that the rise in population due to immigration has had no negative impact on the provision of healthcare is ludicrous.
It is impossible to find effective solutions when ideology blinds you to one of the more obvious causes of a problem.
Therein lies the main issue with having an open border policy. Of course, it would be ideal to offer world class healthcare to every human being on the planet. As it would to also have a 2 bedroom flat, 2 automobiles, color television and a 2 week paid, all-inclusive holiday in the Caribbean. Somewhere along the line, politicians convinced enough of us that world-class healthcare is a basic human right. I’m not arguing that it is not. However, providing such benefits would require a vastly different economic model, one which includes a strictly enforced totalitarian approach. Unless you sign up for this, or it is enforced against your will, it will simply never happen in a free society. Like Thomas Sowell proclaimed, “There are no solutions. There are only tradeoffs.”
And going green and having to import all of our fuel and energy – with associated costs – is in no way sensible.
And going green and having to import all of our fuel and energy – with associated costs – is in no way sensible.
Correct. But the now desperate supporters of this crumbling 1940s monster monolith will NEVER speak of the huge impact of uncontrolled mass migration via free movement of peoples. They just talk about the oldies. The NHS demanded we be imprisoned for two years to save it and its shame at having got rid of hospital beds for efficiency, and now it is broken by its insane covid-only obsession. It resisted tech in favour of fax machines, allowed greed to envelop the Bye Bye at 55 no show 100k GPs, turned itself into a fully feminized (1m out of 1.2m) workforce in a country without childcare provision, making modern health care work impossible & ‘anti women’. It is a Third World horror story. Stop talking about the NHS as our religion. Only BBC propaganda sustains this grubby cynical lie.
Plenty of economic evidence immigrants, esp the EU workers, contributed more in tax than they took out – because they were younger.
The biggest issue for the NHS is an aging population and the failure to sort Social care. That is not driven at all by recent immigration. Who’s going to work in Social care for minimum wage? Yep you got it – immigrants.
Now I concur immigration not been well managed too, especially recently. Needs proper plan and proper national discussion, esp if we aren’t going to raise wages and train more of our own.
Nonetheless your practical suggestions?
Don’t know how old you are, but I’ll place a bet – if you/we live long enough we’ll be v grateful for that non indigenous kind care worker who comes to help us with toileting etc when we are frail and old and can’t manage ourselves. Remember that.
Therein lies the main issue with having an open border policy. Of course, it would be ideal to offer world class healthcare to every human being on the planet. As it would to also have a 2 bedroom flat, 2 automobiles, color television and a 2 week paid, all-inclusive holiday in the Caribbean. Somewhere along the line, politicians convinced enough of us that world-class healthcare is a basic human right. I’m not arguing that it is not. However, providing such benefits would require a vastly different economic model, one which includes a strictly enforced totalitarian approach. Unless you sign up for this, or it is enforced against your will, it will simply never happen in a free society. Like Thomas Sowell proclaimed, “There are no solutions. There are only tradeoffs.”
The problem with the NHS, like the problem with housing or roads or sewers, is that the system can’t respond to population increases. The unprecedented growth in the UK’s population since 2004 has not resulted in a corresponding rise in tax revenue (because the immigrants are low paid) and so we have more people chasing the same services. Do that for 20 years and you end up here.
If the NHS got more money it would only waste it on inclusivity training, diversity hiring and middle manager pensions. The entire thing needs to be gutted as it is beyond hope.
I think quite a few in the service would concur with the inclusivity training costs point, but it’s tiny sum in the overall. In fact I have a suspicion the reason the SoS doesn’t just close it all down, which they could, is Govt likes a headline it can use. Nonetheless point taken.
What’s your suggestion on how we replace the whole thing?
If you bear in mind that we cannot just shut everything down and that there will be terrible resistance to any change, then what we need is a political machine with enough moral strength to impose proper privatisation and remove unnecessary political ‘oversight’.
It’s very difficult to change GPs at the moment, and very difficult to shop around for speedier treatment. It is very difficult to sue for malpractice. Privatise the NHS, fund the New Health Services from insurance (like many of the continental health services) and eventually the deadwood and overmanning will be reduced as health services compete for trade.
It would take years to bear fruit and probably see the political death of many politicians – but if we don’t do something the whole shebang will collapse.
We’ll disagree ACH on whether private insurance the answer, but that aside a practical solution has to be politically deliverable. Otherwise we aren’t engaging with the challenge and it’s just an academic debate. Herein lies the problem for our politicians to some degree.
I increasingly think something in a hypothecated social insurance model, coupled with an OBR type equivalent on workforce planning to reduce political short termism. But even this really difficult to sell as folks will be worried and conflate social insurance with privatising (rightly or wrongly).
As regards GPs, I think you are missing the paradox in your comment. Most GPs remain the one element still private – they are private practitioners largely running their own business. But they are usually dependent on per capita payments from the NHS. The debate is about actually ‘nationalising’ them so certain ways of working can be insisted upon.
I was think of the French system of state regulated health insurance which is not quite the same as purely private insurance.
As for GPs, yes they typically run their own businesses or practices but are contracted to the NHS on a capitation basis rather than a services delivered basis. GPs are paid whether they see their patients or not.
Yep something in the French system, although daresay not quite the direction the NHS detractors might welcome.
And yes the capitation payment for GPs is way out of date and needs changing. Insufficient incentives as you say. I think Govt and NHS leadership concur and have for some time, but be a proper fight with the BMA etc and they got more than enough on their plate right now.
Yep something in the French system, although daresay not quite the direction the NHS detractors might welcome.
And yes the capitation payment for GPs is way out of date and needs changing. Insufficient incentives as you say. I think Govt and NHS leadership concur and have for some time, but be a proper fight with the BMA etc and they got more than enough on their plate right now.
Some 15 years ago when I was young and had hair I worked for a US Multinational Corporation. They gave myself and my Family here in the UK assess to free private health Insurance (paid for in Benefits in Kind). One day I received a Letter from my Provider Western Provident Association who were taking Private Hospitals to task for charging £10 for a plaster that you put on cuts and were making a stand against them overcharging. I have long been back in the NHS but worry on a national scale of private insurance this profiteering would take hold.
Agree AM. Profit in itself isn’t a bad thing though, and private providers have to make a return. There is though a tendency to over treatment/’diagnostic creep’, which fine if affordable, but much less so if not. One of the reasons the UK system is macro-efficient is our doctors aren’t paid fee for service in the NHS. They are salaried (bar some GPs). So no incentive to do extra potentially needless tests etc. Because the relationship with a patient is asymmetric as regards knowledge, and often choice is pretty limited too esp for emergency care, you have to trust all the decisions. That doesn’t play entirely well in a private market and is one reason US total healthcare costs massively above the UKs as proportion of GDP, yet still so many uncovered or hugely stressed by all the clauses/sub clauses in their cover policies that can change. US is brill at leading edge care esp for those who can pay. But it isn’t a v macro efficient model at all.
Obviously the other thing in the UK is the private healthcare sector does not train any doctors or nurses. The NHS and education sector does that. So one could argue that’s a v significant cross subsidy. Same with teaching of course.
Agree AM. Profit in itself isn’t a bad thing though, and private providers have to make a return. There is though a tendency to over treatment/’diagnostic creep’, which fine if affordable, but much less so if not. One of the reasons the UK system is macro-efficient is our doctors aren’t paid fee for service in the NHS. They are salaried (bar some GPs). So no incentive to do extra potentially needless tests etc. Because the relationship with a patient is asymmetric as regards knowledge, and often choice is pretty limited too esp for emergency care, you have to trust all the decisions. That doesn’t play entirely well in a private market and is one reason US total healthcare costs massively above the UKs as proportion of GDP, yet still so many uncovered or hugely stressed by all the clauses/sub clauses in their cover policies that can change. US is brill at leading edge care esp for those who can pay. But it isn’t a v macro efficient model at all.
Obviously the other thing in the UK is the private healthcare sector does not train any doctors or nurses. The NHS and education sector does that. So one could argue that’s a v significant cross subsidy. Same with teaching of course.
I was think of the French system of state regulated health insurance which is not quite the same as purely private insurance.
As for GPs, yes they typically run their own businesses or practices but are contracted to the NHS on a capitation basis rather than a services delivered basis. GPs are paid whether they see their patients or not.
Some 15 years ago when I was young and had hair I worked for a US Multinational Corporation. They gave myself and my Family here in the UK assess to free private health Insurance (paid for in Benefits in Kind). One day I received a Letter from my Provider Western Provident Association who were taking Private Hospitals to task for charging £10 for a plaster that you put on cuts and were making a stand against them overcharging. I have long been back in the NHS but worry on a national scale of private insurance this profiteering would take hold.