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Why would anyone envy the NHS? Its problems are so glaring, even Labour can see them

"You have to shake the system by challenging it.” Credit: Christopher Furlong/Getty

"You have to shake the system by challenging it.” Credit: Christopher Furlong/Getty


January 18, 2023   12 mins

They say the first step in fixing a crisis is to recognise there is a problem. So let us give thanks for a Labour leader’s dismissal of the belief that Britain’s health service is the envy of the world — a deluded concept that, in the words of Sir Keir Starmer, is “plainly wrong”. Yes, he was adopting Blairite tactics to confound expectations with a bit of political cross-dressing, while also obviously aware of polls showing the drastic collapse of faith among voters in their once-worshiped NHS. His reform plans are rudimentary, his funding suggestions sketchy and his proposal to nationalise general practitioners seems ill-conceived. Yet this is still an important moment.

Britain has clung for so long to this weird comfort blanket, the risible idea that the rest of the world was looking with longing at a health system that has been in crisis for much of its 75-year history. For more than two decades I have argued that such blinkered worship of the NHS and deification of its staff was highly corrosive, since it frustrated reform, intimidated politicians and silenced criticism. The result has been a series of grotesque patient safety scandals — usually with agonising or fatal consequences affecting the most marginalised groups in society — and dire outcomes in many key areas, from cancer to infant mortality, compared with other rich nations.

Now the crisis has exploded, costing thousands more lives amid delays, strikes and staff shortages. Yet why is anyone surprised given the grim lack of reality that has swirled around the NHS for so long? I was a lonely voice pointing out the absurdity of Danny Boyle’s 20-minute homage to a flawed public service in the 2012 London Olympics opening ceremony with its dancing doctors and bouncing babies. Such misty-eyed myopia, especially prevalent on the Left, led to great excitement among devotees two years later when a US body ranked the NHS first among 11 health systems largely on grounds of access and efficiency. Yet even The Guardian report — headlined NHS comes top in healthcare survey — admitted that “the only serious black mark against the NHS was its poor record on keeping people alive”.

This failure to prevent needless deaths felt to me like a rather fundamental failing for a health service. It was confirmed by a damning inquiry by four respected think tanks to mark the NHS’s 70th birthday which found Britain had among the worst “amenable mortality” levels — when people die from potentially preventable conditions — among 18 similar nations. They pointed out how 117 out of every 100,000 Britons died avoidably in one year under study, compared with just 78 in best-performing France. This pivotal report also found Britain spending almost the average on health for rich nations. Since then, NHS England alone has seen its funding rise another £38bn.

My personal puncturing of the NHS mythology came with the birth of a daughter discovered to have profound disabilities and health concerns. This sent my family hurtling into the hell of its underbelly, glimpsing the arrogance, inertia, insensitivity and waste lurking beneath the sanctified image. I have never forgotten our first visit to Great Ormond Street and hearing a receptionist cheerily say “Didn’t anyone tell you — your appointment’s been cancelled?” to a desperately-worried young couple who had travelled down from the north-east with their tiny sick baby. Then came years of battling bureaucracy — answering the same questions over and over again — while witnessing blunders, fighting lethargy and dealing with medical egos.

As the parent of another disabled child told me after watching that risible Olympic spectacle, how sickening to endlessly hear mantras of praise for the NHS from people whose lives were not engulfed in a daily struggle against its inertia and ineptitude to protect the life of someone precious. Today, we do everything possible to keep my daughter out of hospital. Yet she has survived almost into her thirties despite a life-threatening condition thanks to my wife’s strength, the wonders of medicine and the support of many superb carers, doctors, nurses and therapists. We have seen both the best and the worst of our system over the years.

The NHS problems have been glaringly obvious for years. It is an institution created after the Second World War and designed for a different era, focused on the fight against infant mortality, infectious disease and industrial injuries. It was built around big hospitals, dominant male consultants and demands of doctors; remember Nye Bevan’s infamous pledge to “stuff their mouths with gold” to overcome opposition to his socialised system. But many of the original battles are won, our population has aged, medicine advanced and society changed. The core concerns now are those linked to ageing or disability, often involving chronic conditions with co-morbidities, alongside an explosion of obesity and mental health problems being seen from an alarmingly early age.

These are the old, complex and chronically-sick patients soaking up more than two-thirds of health spending, not the higher-profile emergencies that the NHS usually handles so adroitly if people can find an ambulance. People such as my daughter — or my father, who died, aged 97, after his long decline with dementia. This has been recognised for years. There have been repeated demands for a shift from hospitals towards expanded community services that combine primary and secondary care services. Now Labour is reheating Lord Darzi’s proposal for London polyclinics and applying a version of it nationwide to unite GPs, diagnostics, therapists, community nursing and mental health teams under one roof — but he first raised this idea 15 years ago.

The harsh truth is that far from being the envy of the world, no one setting up a health system would adopt our current system. I know eastern European carers so horrified by the NHS that they fly home if needing to see a doctor or dentist. As a journalist investigating care, patient safety and mental health provision, I have written about too many disturbing, routine and fatal failings in the NHS heart. One government study sparked by Sara Ryan, a mother who became a campaigner after her teenage son died in terrible circumstances, found citizens with learning disabilities likely to die 26 years earlier than their peers — with medical errors involved in one in eight of the fatalities examined.

My exposĂ©s of the barbaric treatment of autistic people and citizens with learning disabilities, let down by a dysfunctional care system and stuffed into abusive detention in hideous psychiatric units for many years, led to five inquiries, endless promises of action, personal awards — but nothing changed. Other victims of NHS failures tend to be elderly people, as revealed most notoriously with the inquiry into hundreds of deaths in disgraceful conditions in two mid-Staffordshire hospitals, and female patients. “Our healthcare system disproportionately fails to listen to women and keep them safe”, admitted the Government last two years ago in response to three more horrific treatment scandals.

Now we face the question of how to salvage a health service that seems to have reached breaking point on so many fronts. Sadly, much of this debate remains glib, self-serving or stuck in the past. It is dominated by doctors, with constant calls for more cash and complaints about their pressures while they pose as protectors of the NHS. Yet we should not forget that when Tony Blair drove up health spending, much of the money was grabbed by GPs. A British Medical Association negotiator later said their salaries soared 60% in three years as he boasted how the Government let them drop out-of-hours cover in return for a small pay cut they considered “a bit of a laugh”. Few patients laugh today when struggling to access local practices. NHS data, however, shows the number of doctors has risen almost one-third over the past 12 years of supposed Tory “austerity”.

Cash is, of course, a significant factor in health care. Yet when I first began looking into these issues at the turn of this century, I was struck to see spending levels one-fifth higher per capita in Scotland than in England and close to the European average. There were, proportionately, almost one-third more consultants, nurses, general practitioners and acute beds than south of the border. But it also had longer waiting-lists, lengthening waiting times and death rates for big killers such as heart disease, cancer and strokes among the worst in developed nations — which even a Scottish Labour minister admitted to me was not all down to drink and poor diet.

Our leaders have failed spectacularly to rise to this critical national challenge. Politicians pander to medical unions on pay, to food industry lobbyists on obesity measures, and to local voters over threatened hospital closures. They call for “reform” or “modernisation”, yet offer ideas dismally small in scale — as symbolised by Rishi Sunak’s suggestion during the Tory leadership campaign of a £10 fine for missing a GP appointment to help cure the NHS. There are broadsides against managers, who comprise an unusually small slice of a health workforce in the NHS and are essential to its smooth running; indeed, hiring a few more might relieve frontline medics of some of the bureaucracy that soaks up too much of their time, especially if they have clinical experience. Now some commentators call for a switch to a social insurance model, but inevitably fail to explain how such a huge, disruptive reform might be achieved without bureaucratic and patient chaos.

Then there is the bogeyman of “privatisation”, a thorny issue that underscores the pitiful nature of debate. Private contractors, from GPs through to caterers, cleaners and technicians, exist across the NHS. In the year before Covid, they carried out half a million elective surgeries with highest patient approval ratings. One eye surgeon told me he could perform three times more cataract operations in his private work, freed from NHS bureaucracy and the need to chat so much with patients. At the same time, some repulsive profiteers have filled the gaping holes in psychiatric services, leading to sickening abuse, needless deaths and routinely-wasted resources. They expose complacent commissioning and gross regulatory failures.

There can be good and bad in any organisation, whether public or private, and we need to harness the best of both while protecting patients far better. I was struck when visiting Hinchingbrooke Hospital in Huntingdon — briefly handed to a private firm before this unusually bold experiment was killed by political foes — to witness intriguing insights into innovation, procurement and staff empowerment. This 304-bed district hospital cut out £11m in costs over two years, which included a £3m saving by abandoning the NHS bulk purchasing system for supplies while also handing more financial responsibility to frontline staff. “You have to shake the system by challenging it,” said the doctor running the hospital, a former opponent of privatisation. “And you can only challenge it if you let fresh ideas come in.”

The painful reality is a need to build on existing foundations. Yet we cannot keep pouring in an ever-greater share of state resources to a floundering institution. The Nuffield Trust pointed out last year that the department of health and social care’s budget has doubled as a share of GDP since Margaret Thatcher took office. By the end of this parliament, it will consume four in ten pounds of the Government’s daily spending. Partly this is down to substantial population growth and amazing medical advances. But the key issue is age. The proportion of our population over 85 has doubled in three decades while the share of citizenry in their early twenties shrunk more than one fifth. These older folks use ten times more hospital resources. Now throw in all those other issues such as the post-Covid rise in long-term sick, a near-doubling in obesity over three decades and how the fastest-rising demand for social care is coming from working age adults, often with chronic and complex conditions.

Such problems, faced also by almost all other wealthy nations, are immense. But they need to be tackled since they affect the economy and millions of families. I have suggested that our new monarch has his first royal commission to grapple with the issues. But my enthusiasm waned after seeing this week’s launch of The Times health commission — an interesting and laudable idea undermined by its familiar line-up of doctors, academics, businessmen, professors and policy wonks. No patient commissioners, let alone any of the campaigners who exposed safety scandals after suffering horrors. No one from the care sector. It even includes Dame Clare Gerada, president of the Royal College of GPs, who advises a lamentable private firm behind some of those abusive detentions, regulatory failures and fatalities but refuses to discuss her role or remuneration.

There is no simple panacea. But sticking plaster politics can no longer cover the festering wounds. So I would offer three key suggestions for discussion.

First, and most important, we must stop treating social care as a second-class public service. This intensifies pressures across the NHS, yet the problems are largely ignored except through the prism of elderly bed blockers and middle-class home owners forced to sell properties to fund elderly care. When Covid struck, real-term spending on social care was £300m lower than a decade earlier despite all those billions pumped into the hallowed NHS. Local authorities were among the biggest real victims of austerity. No wonder there are catastrophic and rising staff shortages — inflamed by Brexit, as I have seen with my family — because of the appalling low pay of carers, despite their vital role in society. Yet still some fat cat firms and private equity vultures are allowed to cream off millions into tax havens.

But it is not just about pay. It is, of course, shameful that people earn more stacking shelves in a supermarket than assisting other citizens to lead their most fulfilling lives. This must be rectified. Yet I know of care jobs going unfilled for months despite paying more than twice usual rates. The pandemic exposed society’s attitudes towards elderly and disabled people when thousands of old folks were discarded from hospitals to “protect the NHS”, then blanket “Do Not Resuscitate” orders were imposed without consultation. Britain lacks compassion for its most vulnerable citizens. The Government has finally started to funnel in a bit more cash, but this societal attitude has left the care system disintegrating and hard-working staff with shockingly low status.

Corrosion of the care system not only traps elderly patients in hospital, but it leaves many desperate people with unmet needs as 14,000 requests for help are rejected daily. So conditions deteriorate, stresses shatter families and ultimately spending ends up far higher. Consider this simple equation: a teenager with undetected or unsupported autism who ends up in a secure psychiatric unit can cost the NHS ÂŁ13,000 a week and the average length of incarceration is more than five years. It would be so much cheaper and more humane to fund a functioning care system.

This links to another fundamental issue. The need to build community services adopting a more holistic approach is most pressing in mental health, where state failures, short-sighted cuts and consequent shrivelling of provision mean concerns — especially at the most serious end of the spectrum — often go untreated until they explode. Even children can wait up to three years to access services, which only fuels their anxieties and can have life-long consequences. We have ended up with a hollowed-out system that starts with overloaded GPs doling out too many drugs — and can end with people needlessly locked up in those hideously-expensive secure units that are horribly over-reliant on pharmaceutical and physical restraint.

Then, thirdly, there is the delicate issue of end-of-life care. I am opposed to euthanasia, not on moral or religious grounds but — having investigated its usage in Belgium — from fears over protection of vulnerable people and the inevitability that laws gradually become more permissive. After all, if permitted for physical pain, why not for mental suffering? I would far rather see hefty investment in our fantastic palliative care and hospices. But this is a valid debate on both ethical and financial grounds. It has been suggested in the US that one-quarter of health spending goes on people in their last year of life, although others argue the figure is lower. Certainly huge sums go to sustain patients in their fading twilight for a few more months.

The US doctor Atul Gawande has written movingly about the medicalisation of mortality and lack of dignity in death. Now this issue has been stirred up by the oncologist Ezekiel Emanuel, an adviser to two presidents, disclosing that he will reject all medical treatments from the age of 75. “Death is a loss,” he wrote. “But here is a simple truth that many of us seem to resist: living too long is also a loss.” He argues that extending life through a barrage of treatments leaves many people in a deprived and often-lonely state as they decline, so his solution is to let nature take its course. This is a radical proposal. Yet some doctors privately say they would refuse many treatments they recommend for patients nearing the end of their time. Maybe we need to talk more about the best way to die as well as saving lives.

There are many other ways to improve the NHS. Technology is one obvious way to reduce the workload for medics and avoid mistakes. Although GPs have largely switched to effective digital records, many hospitals remain in the dark ages. Blair blew £12bn on a bungled attempt to integrate systems. When Jeremy Hunt became health secretary in 2012, the NHS was the world’s biggest buyer of fax machines so he pledged to make it paperless by 2018. Then his successor Matt Hancock failed in his own pledge to ban them by 2020. Some hospitals have several IT systems; such is the confusion, they rely on paper. It is claimed junior doctors can spend almost half their time on tasks that could be largely automated.

Last year, I reported on Estonia’s impressive embrace of digital government. This includes a fully-digitalised health service — ironically, based on Blair’s abandoned system. Any medic can instantly access a patient’s history anywhere, drugs get automatically cross-checked for safety — yet patients control their records. If they want to seek a second opinion, they can block a look at their initial diagnosis. And they can track treatment and spending in a system similar to the NHS, which helps reduce padding of bills and reminds them that every call, consultation or test has a cost. Peeter Ross, a radiologist and e-health expert, admitted there was resistance at first. “Doctors are trained to think they’re the experts who make decisions but this is patient data,” he said. “We must be equal partners. This works better for us all.”

This underlines the need for cultural change, increasingly recognised by many doctors, especially from younger generations — and this includes the urgent need to drive out a toxic culture of cover-up. The NHS should cherish, rather than crush, whistle-blowers raising concerns. Any system reliant on human beings will make mistakes, especially when under pressure. But it needs to learn the lessons to avoid subsequent grief and pain. This is recognised by the airline industry. But the NHS reaction is all too often to silence complainants, sweep concerns under the carpet and summon lawyers from fear of litigation. This can result in long, drawn out and distressing legal battles. The only beneficiaries are lawyers, who pocketed about one quarter of the £2.5bn spent by the NHS last year settling claims.

There are many other incremental ideas to help revive the NHS. But let us celebrate this moment as Labour finally accepts that the NHS is a flawed institution rather than a shining light of British exceptionalism. Reality is dawning in Westminster in response to the growing public and professional anxiety. We need to have honest discussions about how our country funds and runs our health and care systems — and who it serves. Some solutions are obvious, such as more effective use of technology and transparency. Others stray into the difficult terrain of payments, profits and even the meaning of life and death. One thing is clear, though: salvation for the NHS must revolve around patients, not just professionals.


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

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Russell Hamilton
Russell Hamilton
1 year ago

I would once have agreed with the author, but have become more aware that what people on ‘the left’ (like myself) expect is that we should all be living in the Garden of Eden. That the government should spend ever more on … just about everything.

I’m not sure what we should do about teenagers with ‘undetected’ autism – mass screening? The definitions of these conditions seem to be ever expanding. Australia has a 10-year-old disability insurance scheme which appears to be heading for bankruptcy due to autism alone.

People need to be more realistic about what is possible – we can’t consume the mountains of junk/snack food all around us, mostly sit all day, be increasingly alone, treated as a ‘human resource’ at work, and expect to be happy & healthy. Sometimes we have to cope with unpleasant symptoms or struggle with disability. Perhaps we need to prioritise care for the young and healthy, and let people who are dying, and wish to control their own death, do it. Utopia isn’t coming any time soon.

Last edited 1 year ago by Russell Hamilton
Walter Marvell
Walter Marvell
1 year ago

Remember the Left were proposing to make access to free healthcare a legal human right? The idea (and base lie) of NHS exceptionalism has been inculcated by decades of propaganda on the BBC via hosts of TV dramas and hero doc docs. Grubby cynical politicians of all parties including the Tories have genuflected to this creaking Fax using monolith. But then they locked us up and wrecked our economy to protect it – not us. ‘NHS First’. So people clapped and now are dying in droves to spare the blushes of a patently outmoded over bureaucratized institution. Name the idiot managers who got rid of hospital beds in the service of efficiency targets. We had near 300,000 in the late 80s. 144,000 a few years later. No more. Look to France and Germany and end this utter nightmare.

Tony Price
Tony Price
1 year ago
Reply to  Walter Marvell

I suspect that you haven’t read the article fully.

Dominic S
Dominic S
1 year ago
Reply to  Walter Marvell

As our population expands at an extraordinary rate, thanks to pretty much untrammeled immigration, the beds and service available from the NHS has withered to a poor and pathetic excuse for a health service.
No wonder that I heard a doctor say today that his primary health aim is to stay away from doctors.

Dominic A
Dominic A
1 year ago
Reply to  Dominic S

Maybe….and without high immigration the NHS would far deeper in the hole – almost 20% of their clinicians are immigrants, ditto care homes. Moreover, the average NHS spend on immigrants is lower than for Brit borns. Finally, the govt/NHS has not properly policed their service supply – a lot of people get treated no questions asked, no bills given.

Last edited 1 year ago by Dominic A
JJ Barnett
JJ Barnett
1 year ago
Reply to  Dominic A

“…without high immigration the NHS would far deeper in the hole – almost 20% of their clinicians are immigrants, ditto care homes.”

I think this might be faulty logic. You seem to be suggesting that high ongoing immigration is required, in order to obtain foreign staff to do those circa 20% of roles in the NHS and care sector.

But those two things are actually not linked, unless we want them to be. Most nations around the world decide who comes into their country, and offer visas and citizenship pathways to the types of immigrants they need/want, without accepting people by the million and hoping some are doctor’s who will apply to work in the NHS.

Australia needs engineers, so they offer visas to people with engineering skills, or coming to the country to study engineering (and afterwards work in this field). If you’re not an engineer, or on the list of professions they prioritise, you’re not eligible for those immigration pathways.

I think that is fair. It’s their country, they can choose who comes in. In fact, this was basically the default mode of thinking for all countries — only rather recently have we had major orgs and governments pushing open borders, and relentless high immigration without sorting.

We seem to be constantly boxed in by the notion that you either buy the whole bag of skittles, or you have none. That’s a false binary. If we know we need green and yellow skittles, why are we randomly buying whole bags full of skittles on the off chance they have green and yellow ones? — Would it not make more sense to sort for the green and yellow ones?

Peter Hall
Peter Hall
1 year ago
Reply to  JJ Barnett

In 2021 there were 29,000 applicants for medical and dentistry degrees and 9000 places. This is because of a rationing deal struck with the BMA. Why not give a place to every uk citizen who passes an assessment examination and wants to study? Why ration supply when the return on investment is so good (on average a medical degree costs ÂŁ170k to supply and that doctor pays lifetime taxes of ÂŁ1.5m to ÂŁ2.0m . Some go onto develop world leading companies.

Julian Pellatt
Julian Pellatt
1 year ago
Reply to  JJ Barnett

What about the significant exodus of British-born doctors and other medics who’ve left this country to work in far better conditions and higher pay elsewhere in the world than they are faced with in the NHS?

Peter Hall
Peter Hall
1 year ago
Reply to  JJ Barnett

In 2021 there were 29,000 applicants for medical and dentistry degrees and 9000 places. This is because of a rationing deal struck with the BMA. Why not give a place to every uk citizen who passes an assessment examination and wants to study? Why ration supply when the return on investment is so good (on average a medical degree costs ÂŁ170k to supply and that doctor pays lifetime taxes of ÂŁ1.5m to ÂŁ2.0m . Some go onto develop world leading companies.

Julian Pellatt
Julian Pellatt
1 year ago
Reply to  JJ Barnett

What about the significant exodus of British-born doctors and other medics who’ve left this country to work in far better conditions and higher pay elsewhere in the world than they are faced with in the NHS?

JJ Barnett
JJ Barnett
1 year ago
Reply to  Dominic A

“…without high immigration the NHS would far deeper in the hole – almost 20% of their clinicians are immigrants, ditto care homes.”

I think this might be faulty logic. You seem to be suggesting that high ongoing immigration is required, in order to obtain foreign staff to do those circa 20% of roles in the NHS and care sector.

But those two things are actually not linked, unless we want them to be. Most nations around the world decide who comes into their country, and offer visas and citizenship pathways to the types of immigrants they need/want, without accepting people by the million and hoping some are doctor’s who will apply to work in the NHS.

Australia needs engineers, so they offer visas to people with engineering skills, or coming to the country to study engineering (and afterwards work in this field). If you’re not an engineer, or on the list of professions they prioritise, you’re not eligible for those immigration pathways.

I think that is fair. It’s their country, they can choose who comes in. In fact, this was basically the default mode of thinking for all countries — only rather recently have we had major orgs and governments pushing open borders, and relentless high immigration without sorting.

We seem to be constantly boxed in by the notion that you either buy the whole bag of skittles, or you have none. That’s a false binary. If we know we need green and yellow skittles, why are we randomly buying whole bags full of skittles on the off chance they have green and yellow ones? — Would it not make more sense to sort for the green and yellow ones?

Dominic A
Dominic A
1 year ago
Reply to  Dominic S

Over the last 40 years the UK population has gone from from 56 to 67 million – an increase of 20% – Whilst Dept of Health and share spending has gone up 400% – in real terms, over the same period (Nuffield Trust).

Julian Pellatt
Julian Pellatt
1 year ago
Reply to  Dominic A

I understand that most of that population increase is attributed to immigration, legal and illegal. I’ve seen some estimates of today’s population are as high as 80 million, with estimates of illegal immigration factored into consideration.
The old age profile of the UK population is certainly a significant issue; but mass immigration is too, as is the under-provision of adult social care.

Julian Pellatt
Julian Pellatt
1 year ago
Reply to  Dominic A

I understand that most of that population increase is attributed to immigration, legal and illegal. I’ve seen some estimates of today’s population are as high as 80 million, with estimates of illegal immigration factored into consideration.
The old age profile of the UK population is certainly a significant issue; but mass immigration is too, as is the under-provision of adult social care.

Dominic A
Dominic A
1 year ago
Reply to  Dominic S

Maybe….and without high immigration the NHS would far deeper in the hole – almost 20% of their clinicians are immigrants, ditto care homes. Moreover, the average NHS spend on immigrants is lower than for Brit borns. Finally, the govt/NHS has not properly policed their service supply – a lot of people get treated no questions asked, no bills given.

Last edited 1 year ago by Dominic A
Dominic A
Dominic A
1 year ago
Reply to  Dominic S

Over the last 40 years the UK population has gone from from 56 to 67 million – an increase of 20% – Whilst Dept of Health and share spending has gone up 400% – in real terms, over the same period (Nuffield Trust).

Billy Bob
Billy Bob
1 year ago
Reply to  Walter Marvell

We can look to the Germans, if you wish to pay an extra 20% per capita for the health service, with the gap being as high as 33% a little over 5 years ago. Between 2015-2019 the Germans also spent over treble compared to the UK on hospital infrastructure to increase capacity. France I believe also costs more per capita but only covers 80% of the costs.
I’m not saying the NHS doesn’t have problems, but simply swapping to the continental model without the extra funding, increasing infrastructure or fixing social care so hospitals can actually discharge patients will fix nothing

Last edited 1 year ago by Billy Bob
Anna Bramwell
Anna Bramwell
1 year ago
Reply to  Billy Bob

Crazy figures. UK is up there with the fourth highest spenders. A few years ago Germany spent about 10% more than Britain: the balance is now reversed. And Germany’s management costs are 10% not 48% of the whole

Anna Bramwell
Anna Bramwell
1 year ago
Reply to  Billy Bob

Crazy figures. UK is up there with the fourth highest spenders. A few years ago Germany spent about 10% more than Britain: the balance is now reversed. And Germany’s management costs are 10% not 48% of the whole

Tony Price
Tony Price
1 year ago
Reply to  Walter Marvell

I suspect that you haven’t read the article fully.

Dominic S
Dominic S
1 year ago
Reply to  Walter Marvell

As our population expands at an extraordinary rate, thanks to pretty much untrammeled immigration, the beds and service available from the NHS has withered to a poor and pathetic excuse for a health service.
No wonder that I heard a doctor say today that his primary health aim is to stay away from doctors.

Billy Bob
Billy Bob
1 year ago
Reply to  Walter Marvell

We can look to the Germans, if you wish to pay an extra 20% per capita for the health service, with the gap being as high as 33% a little over 5 years ago. Between 2015-2019 the Germans also spent over treble compared to the UK on hospital infrastructure to increase capacity. France I believe also costs more per capita but only covers 80% of the costs.
I’m not saying the NHS doesn’t have problems, but simply swapping to the continental model without the extra funding, increasing infrastructure or fixing social care so hospitals can actually discharge patients will fix nothing

Last edited 1 year ago by Billy Bob
Tony Taylor
Tony Taylor
1 year ago

I like the watertight way the Aussie NDIS classifies Autism:

“Level 1 – requires support. Level 2 – requires substantial support. Level 3 – requires very substantial support.”

Xaven Taner
Xaven Taner
1 year ago

I entirely agree. No health service, no matter how well run, can compensate for a chronically sick society.

Andrew Wise
Andrew Wise
1 year ago
Reply to  Xaven Taner

Yea.. let’s blame the customers. The NHS would indeed be wonderful without them.

Andrew Wise
Andrew Wise
1 year ago
Reply to  Xaven Taner

Yea.. let’s blame the customers. The NHS would indeed be wonderful without them.

Dominic S
Dominic S
1 year ago

Yup, its all our fault. Obviously.
Have you not thought for a moment about the way in which government after government has acted in ways which divide people, split them apart from one another, and encourage them to live independently? From the attacks on family through moral and tax methods, to the folly of thinking that everybody can have their own house, governments have divided, for their own ideological purposes. Lockdown was the final nail in that coffin. They’ve made people dependent on them and on the services paid for from taxes, and now you’re going to claim that those poor people are personally responsible for the situation?

Russell Hamilton
Russell Hamilton
1 year ago
Reply to  Dominic S

I’m not holding people totally personally responsible – things are more complex than that. But if people don’t feel a degree of responsibility then things won’t change much. We can’t demand that the government make everything that isn’t perfect, perfect.

Because we would like more police, and better schools, more public transport and a better equipped defence force, more support for the arts etc etc. We need to be realistic about what we can afford and what should be prioritised. And we need a view of life that can cope with unfulfilled wishes.

Russell Hamilton
Russell Hamilton
1 year ago
Reply to  Dominic S

I’m not holding people totally personally responsible – things are more complex than that. But if people don’t feel a degree of responsibility then things won’t change much. We can’t demand that the government make everything that isn’t perfect, perfect.

Because we would like more police, and better schools, more public transport and a better equipped defence force, more support for the arts etc etc. We need to be realistic about what we can afford and what should be prioritised. And we need a view of life that can cope with unfulfilled wishes.

Dennis Taylor
Dennis Taylor
1 year ago

The author needs to be congradulated for and honest assesment of the British healthcare system,ours here in the US is not perfect but its a hell of a lot better than the Brits.

Kate Heusser
Kate Heusser
1 year ago
Reply to  Dennis Taylor

The US system is the bogeyman held up to frighten the UK population into further support for our creaking NHS. You’d have to provide a rabbit out of the hat to persuade us that the US system works better for the majority of America’s inhabitants than the NHS does for ordinary Brits.

Kate Heusser
Kate Heusser
1 year ago
Reply to  Dennis Taylor

The US system is the bogeyman held up to frighten the UK population into further support for our creaking NHS. You’d have to provide a rabbit out of the hat to persuade us that the US system works better for the majority of America’s inhabitants than the NHS does for ordinary Brits.

Kate Heusser
Kate Heusser
1 year ago

The ‘Left’ seems to have decided that anyone over – what, 60/70/75 – should be exterminated with as little fuss as possible for the ‘benefit’ of those somehow more deserving younger people who have not yet begun to draw down on the services into which they have spent decades paying. The ‘Left’ should be careful what it wishes, because reforms take a while to gather momentum, and may well not come into full swing until they themselves are ready for ‘society’s’ knacker’s yard.
In the meantime, the Left should re-read Brave New World and re-watch Soylent Green.

Peter Appleby
Peter Appleby
1 year ago

Things will not improve until we transition from a disease management system to a proper heath care system where health promotion is prioritised over the most profitable downstream Pharma-promoted interventions and treatments. Pharma’s deliberate dumbing down of medicine in the 20th century has left us with a legacy of doctors who don’t seem to know, for example, how to treat viruses anymore.
As for autism, it barely existed when I was young (less than 1 in 10,000), but is now expected to reach 1 in 2 in males by 2032, at current rates of increase. Pharma would have us believe that’s been caused by better diagnosis, but if their diagnoses get any better, we’ll all have to admit we were born with undiagnosed autism. In fact, autism often arises in temporal proximity to injections, which shouldn’t be too much of a surprise considering the brain inflaming contents of many of them, and before Wakefield came along, Merck listed autism as a possible side effect of their MMR jab, and the Vaccine Injury Compensation Programme in the States had already paid out over 70 times for this very connection.
Imagine the costs of looking after a severely autistic person for life, or for treating any of the 1200 plus illnesses Pfizer listed as possible side effects of their hurried novel Covid Jab. So my prescription for saving the NHS is to ‘First Do No Harm’ and to better promote healthy lifestyles, but these obvious changes will inevitably be fiercely resisted because it will affect Pharma’s bottom line.

DenialARiverIn Islington
DenialARiverIn Islington
1 year ago

If people of “the Left” actually realise that the Garden of Eden doesn’t exist and is simply the product of a flawed view of the world; why do you remain a person of the left? Doesn’t make rational sense.

Walter Marvell
Walter Marvell
1 year ago

Remember the Left were proposing to make access to free healthcare a legal human right? The idea (and base lie) of NHS exceptionalism has been inculcated by decades of propaganda on the BBC via hosts of TV dramas and hero doc docs. Grubby cynical politicians of all parties including the Tories have genuflected to this creaking Fax using monolith. But then they locked us up and wrecked our economy to protect it – not us. ‘NHS First’. So people clapped and now are dying in droves to spare the blushes of a patently outmoded over bureaucratized institution. Name the idiot managers who got rid of hospital beds in the service of efficiency targets. We had near 300,000 in the late 80s. 144,000 a few years later. No more. Look to France and Germany and end this utter nightmare.

Tony Taylor
Tony Taylor
1 year ago

I like the watertight way the Aussie NDIS classifies Autism:

“Level 1 – requires support. Level 2 – requires substantial support. Level 3 – requires very substantial support.”

Xaven Taner
Xaven Taner
1 year ago

I entirely agree. No health service, no matter how well run, can compensate for a chronically sick society.

Dominic S
Dominic S
1 year ago

Yup, its all our fault. Obviously.
Have you not thought for a moment about the way in which government after government has acted in ways which divide people, split them apart from one another, and encourage them to live independently? From the attacks on family through moral and tax methods, to the folly of thinking that everybody can have their own house, governments have divided, for their own ideological purposes. Lockdown was the final nail in that coffin. They’ve made people dependent on them and on the services paid for from taxes, and now you’re going to claim that those poor people are personally responsible for the situation?

Dennis Taylor
Dennis Taylor
1 year ago

The author needs to be congradulated for and honest assesment of the British healthcare system,ours here in the US is not perfect but its a hell of a lot better than the Brits.

Kate Heusser
Kate Heusser
1 year ago

The ‘Left’ seems to have decided that anyone over – what, 60/70/75 – should be exterminated with as little fuss as possible for the ‘benefit’ of those somehow more deserving younger people who have not yet begun to draw down on the services into which they have spent decades paying. The ‘Left’ should be careful what it wishes, because reforms take a while to gather momentum, and may well not come into full swing until they themselves are ready for ‘society’s’ knacker’s yard.
In the meantime, the Left should re-read Brave New World and re-watch Soylent Green.

Peter Appleby
Peter Appleby
1 year ago

Things will not improve until we transition from a disease management system to a proper heath care system where health promotion is prioritised over the most profitable downstream Pharma-promoted interventions and treatments. Pharma’s deliberate dumbing down of medicine in the 20th century has left us with a legacy of doctors who don’t seem to know, for example, how to treat viruses anymore.
As for autism, it barely existed when I was young (less than 1 in 10,000), but is now expected to reach 1 in 2 in males by 2032, at current rates of increase. Pharma would have us believe that’s been caused by better diagnosis, but if their diagnoses get any better, we’ll all have to admit we were born with undiagnosed autism. In fact, autism often arises in temporal proximity to injections, which shouldn’t be too much of a surprise considering the brain inflaming contents of many of them, and before Wakefield came along, Merck listed autism as a possible side effect of their MMR jab, and the Vaccine Injury Compensation Programme in the States had already paid out over 70 times for this very connection.
Imagine the costs of looking after a severely autistic person for life, or for treating any of the 1200 plus illnesses Pfizer listed as possible side effects of their hurried novel Covid Jab. So my prescription for saving the NHS is to ‘First Do No Harm’ and to better promote healthy lifestyles, but these obvious changes will inevitably be fiercely resisted because it will affect Pharma’s bottom line.

DenialARiverIn Islington
DenialARiverIn Islington
1 year ago

If people of “the Left” actually realise that the Garden of Eden doesn’t exist and is simply the product of a flawed view of the world; why do you remain a person of the left? Doesn’t make rational sense.

Russell Hamilton
Russell Hamilton
1 year ago

I would once have agreed with the author, but have become more aware that what people on ‘the left’ (like myself) expect is that we should all be living in the Garden of Eden. That the government should spend ever more on … just about everything.

I’m not sure what we should do about teenagers with ‘undetected’ autism – mass screening? The definitions of these conditions seem to be ever expanding. Australia has a 10-year-old disability insurance scheme which appears to be heading for bankruptcy due to autism alone.

People need to be more realistic about what is possible – we can’t consume the mountains of junk/snack food all around us, mostly sit all day, be increasingly alone, treated as a ‘human resource’ at work, and expect to be happy & healthy. Sometimes we have to cope with unpleasant symptoms or struggle with disability. Perhaps we need to prioritise care for the young and healthy, and let people who are dying, and wish to control their own death, do it. Utopia isn’t coming any time soon.

Last edited 1 year ago by Russell Hamilton
Stephen Walsh
Stephen Walsh
1 year ago

We don’t train enough doctors; haven’t for years. Doctors in their late 40s now started university in the early 1990s. Then, as now, there were too few medical training places, dictated by a government imposed quota system. This was partly to save money, as medical degrees are vastly more expensive to deliver than arts degrees, and partly to bolster the incomes and prestige of the medical profession. Many of the medical places which did exist were sold off to highly paying students from east and South Asia in particular; this suited the UK medical profession very well, as there would be less competition for them, and universities profited also. Since then, the population has increased and aged, the working hours directive kicked in, and an increasingly female medical profession was no longer willing to work the long hours which were historically the norm. So an inadequate number of doctors became utterly insufficient, leading to the shipping in of doctors trained in the developing world. No doubt the design of the NHS is sub-optimal. But any system will struggle if it doesn’t train and retain enough doctors of sufficient standard. Hence overwhelmed and increasingly inaccessible GP surgeries, hence over-reliance on prescribing antidepressants and other drugs, hence missed diagnoses, hence many medical decisions being made by non-doctors, frequently not very well paid and not very bright.

Last edited 1 year ago by Stephen Walsh
Peter Hall
Peter Hall
1 year ago
Reply to  Stephen Walsh

I believe that it costs ÂŁ170,000 to train a doctor but that doctor will pay ÂŁ1.5m in tax over his or her life. What a nice return on investment! As well as all the benefits to a healthy society.Why would you restrict university places unless it is to boost the earnings of doctors?

Last edited 1 year ago by Peter Hall
Milton Gibbon
Milton Gibbon
1 year ago
Reply to  Peter Hall

The only problem with this is that in the NHS 100% of a doctor’s wages come from the taxpayer.

Billy Bob
Billy Bob
1 year ago
Reply to  Milton Gibbon

In the German system 100% of doctors wages come from the taxpayer, they simply go through a third party first

Guy Pigache
Guy Pigache
1 year ago
Reply to  Milton Gibbon

Strictly speaking only private sector workers pay tax. Public sector workers’ tax payments to government are funded by the government. Might as well pay them net and not collect tax.

Peter Hall
Peter Hall
1 year ago
Reply to  Milton Gibbon

But if private insurance and means testing was to be part of the architecture a significant component of doctors incomes would be paid by citizens rather than the state. It is crazy that AA Gill had his (sadly ineffective) treatment paid for by the state. Of course really expensive treatments should have part of their cost paid by the state but this could be partly offset by public health insurance companies which higher income citizens could buy by catastrophe insurance from.

Last edited 1 year ago by Peter Hall
Billy Bob
Billy Bob
1 year ago
Reply to  Milton Gibbon

In the German system 100% of doctors wages come from the taxpayer, they simply go through a third party first

Guy Pigache
Guy Pigache
1 year ago
Reply to  Milton Gibbon

Strictly speaking only private sector workers pay tax. Public sector workers’ tax payments to government are funded by the government. Might as well pay them net and not collect tax.

Peter Hall
Peter Hall
1 year ago
Reply to  Milton Gibbon

But if private insurance and means testing was to be part of the architecture a significant component of doctors incomes would be paid by citizens rather than the state. It is crazy that AA Gill had his (sadly ineffective) treatment paid for by the state. Of course really expensive treatments should have part of their cost paid by the state but this could be partly offset by public health insurance companies which higher income citizens could buy by catastrophe insurance from.

Last edited 1 year ago by Peter Hall
Milton Gibbon
Milton Gibbon
1 year ago
Reply to  Peter Hall

The only problem with this is that in the NHS 100% of a doctor’s wages come from the taxpayer.

Hugh Bryant
Hugh Bryant
1 year ago
Reply to  Stephen Walsh

And yet there seems no shortage of university places and government subsidies for liberal arts courses with the word ‘studies’ in their name. And no shortage of highly paid nothing jobs in the bureaucracy for those who complete them.

Graeme Cant
Graeme Cant
1 year ago
Reply to  Stephen Walsh

Yes, money saving was an influence and the other factors you mention but you missed a major factor in the doctor shortage. I think you will find a piece of research from the 70s which showed that health care demand was directly related to the number of doctors has been extraordinarily influential among policy makers in the Anglo world.

I know it produced policies inAustralia which put severe restrictions on the number of medical school places for locals. I suspect it had its effect in the UK too.

Peter Hall
Peter Hall
1 year ago
Reply to  Stephen Walsh

I believe that it costs ÂŁ170,000 to train a doctor but that doctor will pay ÂŁ1.5m in tax over his or her life. What a nice return on investment! As well as all the benefits to a healthy society.Why would you restrict university places unless it is to boost the earnings of doctors?

Last edited 1 year ago by Peter Hall
Hugh Bryant
Hugh Bryant
1 year ago
Reply to  Stephen Walsh

And yet there seems no shortage of university places and government subsidies for liberal arts courses with the word ‘studies’ in their name. And no shortage of highly paid nothing jobs in the bureaucracy for those who complete them.

Graeme Cant
Graeme Cant
1 year ago
Reply to  Stephen Walsh

Yes, money saving was an influence and the other factors you mention but you missed a major factor in the doctor shortage. I think you will find a piece of research from the 70s which showed that health care demand was directly related to the number of doctors has been extraordinarily influential among policy makers in the Anglo world.

I know it produced policies inAustralia which put severe restrictions on the number of medical school places for locals. I suspect it had its effect in the UK too.

Stephen Walsh
Stephen Walsh
1 year ago

We don’t train enough doctors; haven’t for years. Doctors in their late 40s now started university in the early 1990s. Then, as now, there were too few medical training places, dictated by a government imposed quota system. This was partly to save money, as medical degrees are vastly more expensive to deliver than arts degrees, and partly to bolster the incomes and prestige of the medical profession. Many of the medical places which did exist were sold off to highly paying students from east and South Asia in particular; this suited the UK medical profession very well, as there would be less competition for them, and universities profited also. Since then, the population has increased and aged, the working hours directive kicked in, and an increasingly female medical profession was no longer willing to work the long hours which were historically the norm. So an inadequate number of doctors became utterly insufficient, leading to the shipping in of doctors trained in the developing world. No doubt the design of the NHS is sub-optimal. But any system will struggle if it doesn’t train and retain enough doctors of sufficient standard. Hence overwhelmed and increasingly inaccessible GP surgeries, hence over-reliance on prescribing antidepressants and other drugs, hence missed diagnoses, hence many medical decisions being made by non-doctors, frequently not very well paid and not very bright.

Last edited 1 year ago by Stephen Walsh
James Surry
James Surry
1 year ago

Thanks Ian. I have worked across the NHS and Social Care, and I think this is the best analysis of the problems that I have seen written over the last few months.

Last edited 1 year ago by James Surry
James Surry
James Surry
1 year ago

Thanks Ian. I have worked across the NHS and Social Care, and I think this is the best analysis of the problems that I have seen written over the last few months.

Last edited 1 year ago by James Surry
John Howes
John Howes
1 year ago

I commenced nurse training in 1962. I retired after 49 years, a number of my colleagues encouraged me to hang on for the 50 which would have seemd meaningless to me. By that time I had held a number of management posts, worked as a Full time Union official for the Rcn and at one point during my membership I had served as a member of Council, (the governing body) during my 49 years I was involved with compromises, most of which resulted in control passing to Administrators, some talented, some charismatic, many having neither of these essentials of leadership. With the coming of Blair we gort Patricia Hewitt (formerly with Andersen consulting) then the merry dance began, we had ‘General Management’ with Roy Griffiths, under whose guidance patients became ‘customers’ who had little say in the health care purchased on their behalf.The health service became a serious of markets, buying and selling from each other. Spending on Management Consultants pre Hewitt was approximately ÂŁ900 000 yearly, it then rocketed to almost a ÂŁmillion monthly. Care became the bottom line on a spreadsheet. In my own hospital, the CEO said I can get 3 HCA’s (Health Care Assistants) Band 2 for the price of 2 Band 5 Staff Nurses. This logic has continued since I retired 11 years back. The current crisis of not enough staff has been perpetuated by generations of ‘Nursing Leaders’ who have had more concern for their corporate lifestyle than the nurses they ‘lead’. The ONS has clearly recorded large sums of money going into the health service then piddled away on vanity projects, diversity and all the minutiae of an organistion that has not only abandoned any sense of purpose, and is now unfit for pupose.

Last edited 1 year ago by John Howes
John Howes
John Howes
1 year ago

I commenced nurse training in 1962. I retired after 49 years, a number of my colleagues encouraged me to hang on for the 50 which would have seemd meaningless to me. By that time I had held a number of management posts, worked as a Full time Union official for the Rcn and at one point during my membership I had served as a member of Council, (the governing body) during my 49 years I was involved with compromises, most of which resulted in control passing to Administrators, some talented, some charismatic, many having neither of these essentials of leadership. With the coming of Blair we gort Patricia Hewitt (formerly with Andersen consulting) then the merry dance began, we had ‘General Management’ with Roy Griffiths, under whose guidance patients became ‘customers’ who had little say in the health care purchased on their behalf.The health service became a serious of markets, buying and selling from each other. Spending on Management Consultants pre Hewitt was approximately ÂŁ900 000 yearly, it then rocketed to almost a ÂŁmillion monthly. Care became the bottom line on a spreadsheet. In my own hospital, the CEO said I can get 3 HCA’s (Health Care Assistants) Band 2 for the price of 2 Band 5 Staff Nurses. This logic has continued since I retired 11 years back. The current crisis of not enough staff has been perpetuated by generations of ‘Nursing Leaders’ who have had more concern for their corporate lifestyle than the nurses they ‘lead’. The ONS has clearly recorded large sums of money going into the health service then piddled away on vanity projects, diversity and all the minutiae of an organistion that has not only abandoned any sense of purpose, and is now unfit for pupose.

Last edited 1 year ago by John Howes
Steve Murray
Steve Murray
1 year ago

I commented on a recent similar article that it’s only a Labour government that might have the political werewithal to instigate meaningful change to the NHS. The noises coming from Starmer suggests he recognises this.

Quite simply, history – and the British people – will not forgive him if he passes up the opportunity likely to be presented to him. No pressure there then; but at least a start must be made in the first year or so under his watch.

I’m not sure why the author thinks bringing GPs back into line by relieving them of Practice management roles so they can concentrate on seeing patients is a bad idea. He calls it “nationalisation” but it’s meant to be a National health service. Using loaded terms doesn’t help here. The article does, however, offer many thought-provoking insights, not least his exposure (which anyone with long experience of dealing with the system will recognise) of arrogance and medical egos getting in the way of optimal patient care. That was the most shocking thing i discovered when i started out in the NHS in 1981, and it still lies at the heart of most of the scandals we hear about today – and many that never see the light of day.

Last edited 1 year ago by Steve Murray
Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Steve Murray

I have written to my (Tory) MP asking why we are hearing these noises about reform from Starmer and not from the current government, which should be making a start on reform now instead of waiting for the inevitable arrival of a Labour government, by which time the NHS may well have descended into total collapse. Not that I trust any politician to actually do what they say they will do once they are in office……but at least making the right noises is a promising start.

Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Steve Murray

I have written to my (Tory) MP asking why we are hearing these noises about reform from Starmer and not from the current government, which should be making a start on reform now instead of waiting for the inevitable arrival of a Labour government, by which time the NHS may well have descended into total collapse. Not that I trust any politician to actually do what they say they will do once they are in office……but at least making the right noises is a promising start.

Steve Murray
Steve Murray
1 year ago

I commented on a recent similar article that it’s only a Labour government that might have the political werewithal to instigate meaningful change to the NHS. The noises coming from Starmer suggests he recognises this.

Quite simply, history – and the British people – will not forgive him if he passes up the opportunity likely to be presented to him. No pressure there then; but at least a start must be made in the first year or so under his watch.

I’m not sure why the author thinks bringing GPs back into line by relieving them of Practice management roles so they can concentrate on seeing patients is a bad idea. He calls it “nationalisation” but it’s meant to be a National health service. Using loaded terms doesn’t help here. The article does, however, offer many thought-provoking insights, not least his exposure (which anyone with long experience of dealing with the system will recognise) of arrogance and medical egos getting in the way of optimal patient care. That was the most shocking thing i discovered when i started out in the NHS in 1981, and it still lies at the heart of most of the scandals we hear about today – and many that never see the light of day.

Last edited 1 year ago by Steve Murray
Martin Bollis
Martin Bollis
1 year ago

It is impossible to reform an organisation this big. There are too many vested interests, both internally and externally, too much inertia and too much money involved.

Both politically and practically governments should stop talking about reforming the health service and start talking about task force style solutions to specific issues.

Getting elderly bed blockers out of main stream hospitals would be an obvious good place to start and the care system is not a monolithic bureaucracy so can be more easily and quickly manipulated with the right financial and regulatory stimuli.

Properly targeted and funded interventions, on key sub problems, have much more chance of freeing up the core system than “root and branch reform.”

Alison Wren
Alison Wren
1 year ago
Reply to  Martin Bollis

Well if they hadn’t sacked well over 100,000 health care workers (mostly working class women on not much more than minimum wage) because they weren’t willing to be vaccinated ( I’d wager nearly all had naturally acquired immunity) maybe we would have fewer “bed-blockers”.

JJ Barnett
JJ Barnett
1 year ago
Reply to  Martin Bollis

You’re definitely right re the sheer size of this organisation making it nearly impossible to reform. It’s like the Titanic — we can see the iceberg, we just can’t turn the ship around fast enough to avoid hitting it.

What we can’t have is a situation where the existing system collapses, which it will of it’s own accord (it’s happening now, in semi-slow motion), and will also happen if the government decide to try a complete overhaul all at once.

I like your task forces idea. I was thinking maybe the smart policy would be to propose a completely new, more decentralised system, and set it up in parallel, node by node. Start in manageable sized regions, pulling them into the new framework first. Task forces could meanwhile address the key areas of stress & failure in the NHS, to get those functioning better until the larger regions can move into the new framework. They could specifically focus on this — not only addressing the issues, but resolving them in the direction of the new system, such that they help get the most critically important parts of the NHS ready for migration, so to speak.

I think the central feature of the new system has to be that it’s decentralised. Modernising the system is great, and should be done, but a core issue with the NHS is the centralisation of power, which has caused bureaucracy to overtake mission, and has brought it to a scale that is irreformable, as you note. Over time, that will happen again in a new system, unless it’s designed from the ground up to prohibit that.

Philip K
Philip K
1 year ago
Reply to  Martin Bollis

What we can do is develop a set of key objectives, with underlying assumptions which minimise change caused by lobby groups, that we aim to achieve over a number of years. One example would be technological change – minimising admin work for medical staff, and giving a clear view off patient data. Another could be expanding social care to alleviate bed blocking. The list can go on, but must be achievable. With a clear strategy, we have a better chance of success.

Last edited 1 year ago by Philip K
Anna Bramwell
Anna Bramwell
1 year ago
Reply to  Philip K

Develop a set of key objectives
 Oh dear.

Anna Bramwell
Anna Bramwell
1 year ago
Reply to  Philip K

Develop a set of key objectives
 Oh dear.

Alison Wren
Alison Wren
1 year ago
Reply to  Martin Bollis

Well if they hadn’t sacked well over 100,000 health care workers (mostly working class women on not much more than minimum wage) because they weren’t willing to be vaccinated ( I’d wager nearly all had naturally acquired immunity) maybe we would have fewer “bed-blockers”.

JJ Barnett
JJ Barnett
1 year ago
Reply to  Martin Bollis

You’re definitely right re the sheer size of this organisation making it nearly impossible to reform. It’s like the Titanic — we can see the iceberg, we just can’t turn the ship around fast enough to avoid hitting it.

What we can’t have is a situation where the existing system collapses, which it will of it’s own accord (it’s happening now, in semi-slow motion), and will also happen if the government decide to try a complete overhaul all at once.

I like your task forces idea. I was thinking maybe the smart policy would be to propose a completely new, more decentralised system, and set it up in parallel, node by node. Start in manageable sized regions, pulling them into the new framework first. Task forces could meanwhile address the key areas of stress & failure in the NHS, to get those functioning better until the larger regions can move into the new framework. They could specifically focus on this — not only addressing the issues, but resolving them in the direction of the new system, such that they help get the most critically important parts of the NHS ready for migration, so to speak.

I think the central feature of the new system has to be that it’s decentralised. Modernising the system is great, and should be done, but a core issue with the NHS is the centralisation of power, which has caused bureaucracy to overtake mission, and has brought it to a scale that is irreformable, as you note. Over time, that will happen again in a new system, unless it’s designed from the ground up to prohibit that.

Philip K
Philip K
1 year ago
Reply to  Martin Bollis

What we can do is develop a set of key objectives, with underlying assumptions which minimise change caused by lobby groups, that we aim to achieve over a number of years. One example would be technological change – minimising admin work for medical staff, and giving a clear view off patient data. Another could be expanding social care to alleviate bed blocking. The list can go on, but must be achievable. With a clear strategy, we have a better chance of success.

Last edited 1 year ago by Philip K
Martin Bollis
Martin Bollis
1 year ago

It is impossible to reform an organisation this big. There are too many vested interests, both internally and externally, too much inertia and too much money involved.

Both politically and practically governments should stop talking about reforming the health service and start talking about task force style solutions to specific issues.

Getting elderly bed blockers out of main stream hospitals would be an obvious good place to start and the care system is not a monolithic bureaucracy so can be more easily and quickly manipulated with the right financial and regulatory stimuli.

Properly targeted and funded interventions, on key sub problems, have much more chance of freeing up the core system than “root and branch reform.”

Peter Hall
Peter Hall
1 year ago

Two other important reforms that need to be implemented. 1. The Australian system of the equivalent of an NHS card that allows patients to choose who provides their healthcare with the government reimbursing the provider at a set rate per procedure. Power is transferred from the monolith to patients. 2. Means testing of access and the end of middle class welfare for many procedures.

Guy Pigache
Guy Pigache
1 year ago
Reply to  Peter Hall

I suspect many of the “middle class” would be prepared to pay more for state healthcare. But how many would believe that they were going to get something better for that extra outlay? We don’t have hypothecated taxation in the UK.

Nuala Rosher
Nuala Rosher
1 year ago
Reply to  Guy Pigache

I would pay just to see a GP when I needed.

Nuala Rosher
Nuala Rosher
1 year ago
Reply to  Guy Pigache

I would pay just to see a GP when I needed.

Guy Pigache
Guy Pigache
1 year ago
Reply to  Peter Hall

I suspect many of the “middle class” would be prepared to pay more for state healthcare. But how many would believe that they were going to get something better for that extra outlay? We don’t have hypothecated taxation in the UK.

Peter Hall
Peter Hall
1 year ago

Two other important reforms that need to be implemented. 1. The Australian system of the equivalent of an NHS card that allows patients to choose who provides their healthcare with the government reimbursing the provider at a set rate per procedure. Power is transferred from the monolith to patients. 2. Means testing of access and the end of middle class welfare for many procedures.

Jacqueline Walker
Jacqueline Walker
1 year ago

Excellent article with a thorough analysis and proposals for solutions should be required reading for the whole country.
Does anyone which to imitate the NHS?Sadly yes, Ireland is still aiming to launch their own version expanding the reach of the woeful HSE which is way worse than the NHS already.
I would be all for digital records if I as patient had control over them, literally as in I bring them with me and allow the doctor to see them. Here you have to FOI the HSE if you want your medical records.

Eamonn Toland
Eamonn Toland
1 year ago

Having been treated for a heart attack in Dublin four years ago, the HSE is nowhere near as woeful as people make out. A&E is a horrendous bottleneck (unless you utter the magic words “chest pain”) but once inside the system there is first-class medical care. For routine checkups GP appointments can be obtained fairly quickly (often same day or following day) albeit if you are better off you will pay €60 to see a doctor.
Nearly 40% of people in the Republic of Ireland already have free access to health care through medical cards, but the NHS free-at-the-point-of-use system for all is fetishized north and south of the border, despite the fact that life expectancy in southern Ireland is now two years longer than in Northern Ireland, where GP bottlenecks and surgery waiting lists are astronomical even by comparison to the English NHS. I have come around to the idea that modest co-payments are a good thing to reduce abuse of the NHS, which frankly has been two-tiered for decades.
The English NHS, specifically Ashford Hospital near Heathrow, saved my life twenty years ago, when I had my first pulmonary embolism after long-haul air travel. I was unlucky enough to collapse just before Christmas, when the hospital was overrun with perfectly healthy older people (due to “granny dumping”) who had to be accommodated by overwhelmed staff. I was put in a disused operating theatre with lonely, dying men. At one point they forgot to feed us for 16 hours, until my wife came in to see me. When I was well enough to be transferred into a private hospital near my home, I was given a private room with cable TV and a room service menu.
The NHS is clearly in need of reform, but people need to see that change is not a slippery slope to the US model, where people take out insurance that costs 10X more than the UK equivalent simply to avoid bankruptcy in the case of an emergency. An English friend of mine who lives in California was bitten by a venomous snake in a freak accident. He was charged $30,000 for two days in intensive care, and $270,000 for two vials of anti-venom – a UK-based company had exclusive rights to the life-saving medicine in the state, and charged accordingly. Without insurance he would have been ruined.

Eamonn Toland
Eamonn Toland
1 year ago

Having been treated for a heart attack in Dublin four years ago, the HSE is nowhere near as woeful as people make out. A&E is a horrendous bottleneck (unless you utter the magic words “chest pain”) but once inside the system there is first-class medical care. For routine checkups GP appointments can be obtained fairly quickly (often same day or following day) albeit if you are better off you will pay €60 to see a doctor.
Nearly 40% of people in the Republic of Ireland already have free access to health care through medical cards, but the NHS free-at-the-point-of-use system for all is fetishized north and south of the border, despite the fact that life expectancy in southern Ireland is now two years longer than in Northern Ireland, where GP bottlenecks and surgery waiting lists are astronomical even by comparison to the English NHS. I have come around to the idea that modest co-payments are a good thing to reduce abuse of the NHS, which frankly has been two-tiered for decades.
The English NHS, specifically Ashford Hospital near Heathrow, saved my life twenty years ago, when I had my first pulmonary embolism after long-haul air travel. I was unlucky enough to collapse just before Christmas, when the hospital was overrun with perfectly healthy older people (due to “granny dumping”) who had to be accommodated by overwhelmed staff. I was put in a disused operating theatre with lonely, dying men. At one point they forgot to feed us for 16 hours, until my wife came in to see me. When I was well enough to be transferred into a private hospital near my home, I was given a private room with cable TV and a room service menu.
The NHS is clearly in need of reform, but people need to see that change is not a slippery slope to the US model, where people take out insurance that costs 10X more than the UK equivalent simply to avoid bankruptcy in the case of an emergency. An English friend of mine who lives in California was bitten by a venomous snake in a freak accident. He was charged $30,000 for two days in intensive care, and $270,000 for two vials of anti-venom – a UK-based company had exclusive rights to the life-saving medicine in the state, and charged accordingly. Without insurance he would have been ruined.

Jacqueline Walker
Jacqueline Walker
1 year ago

Excellent article with a thorough analysis and proposals for solutions should be required reading for the whole country.
Does anyone which to imitate the NHS?Sadly yes, Ireland is still aiming to launch their own version expanding the reach of the woeful HSE which is way worse than the NHS already.
I would be all for digital records if I as patient had control over them, literally as in I bring them with me and allow the doctor to see them. Here you have to FOI the HSE if you want your medical records.

F K
F K
1 year ago

Well analysed and well said. Those of us who have had the misfortune to experience the less than positive side of healthcare understand exactly what the author has highlighted (and of course there are some fantastic people out there if one is lucky enough – care and compassion!). However, the worst of it is often ego, arrogance, train track thinking, lack of effective administration on all levels, even before getting to the often lack of genuine care on offer – not at all helped by the breakdown of family and community. The author’s message needs to get out there. We need ideas for this change to the health system and perhaps the author should get together with someone like Andy Street – ex John Lewis and now mayor of Birmingham – to help the Country come up with a blueprint to help push things along. Nothing is changing and we seem to be descending to a very bad placed indeed.

F K
F K
1 year ago

Well analysed and well said. Those of us who have had the misfortune to experience the less than positive side of healthcare understand exactly what the author has highlighted (and of course there are some fantastic people out there if one is lucky enough – care and compassion!). However, the worst of it is often ego, arrogance, train track thinking, lack of effective administration on all levels, even before getting to the often lack of genuine care on offer – not at all helped by the breakdown of family and community. The author’s message needs to get out there. We need ideas for this change to the health system and perhaps the author should get together with someone like Andy Street – ex John Lewis and now mayor of Birmingham – to help the Country come up with a blueprint to help push things along. Nothing is changing and we seem to be descending to a very bad placed indeed.

Jorge Espinha
Jorge Espinha
1 year ago

Dear Brits. The wall has fallen in 1989. Mr Attlee and Co. with the best possible intentions turned the UK into the United socialist kingdoms of Great Britain, they just didn’t come around and change the name (USKGB). If it wasn’t for Tatcher the country would have gone belly up in the 80s. In a way Margareth was a bit like Lenine, she instituted the NEP that saved the USKGB and your ever-growing commissariat. Even a basket case like my country, Portugal, allows for a mixed system, people that are employed by the state use it enthusiastically ( they have a separate system, called the ADSE that allows current state-employed and state pensioners to avoid the company of proles in the state-owned hospitals). Spain which is run by lunatic Socialists has one of the best private Health systems in the world and receives thousands of paying foreigners every year in a very lucrative business of health tourism. It’s unfortunate that your so-called Conservative party is just slightly less socialist than the Labour party, the only capitalist aspect of their policy is the way they sell passports to international criminals. Isn’t it about time to follow your eastern European comrades and break the shackles of socialism?

Jorge Espinha
Jorge Espinha
1 year ago

Dear Brits. The wall has fallen in 1989. Mr Attlee and Co. with the best possible intentions turned the UK into the United socialist kingdoms of Great Britain, they just didn’t come around and change the name (USKGB). If it wasn’t for Tatcher the country would have gone belly up in the 80s. In a way Margareth was a bit like Lenine, she instituted the NEP that saved the USKGB and your ever-growing commissariat. Even a basket case like my country, Portugal, allows for a mixed system, people that are employed by the state use it enthusiastically ( they have a separate system, called the ADSE that allows current state-employed and state pensioners to avoid the company of proles in the state-owned hospitals). Spain which is run by lunatic Socialists has one of the best private Health systems in the world and receives thousands of paying foreigners every year in a very lucrative business of health tourism. It’s unfortunate that your so-called Conservative party is just slightly less socialist than the Labour party, the only capitalist aspect of their policy is the way they sell passports to international criminals. Isn’t it about time to follow your eastern European comrades and break the shackles of socialism?

Diane Tasker
Diane Tasker
1 year ago

Being further down the path to ‘old age’ although physically and mentally as active as ever, the thought of being incapacitated in any way under the prevailing NHS care system has me contacting Solicitors for Ageing to make a Living Will and set aside funding for a trip to Switzerland should the Assisted Dying Bill not succeed. 50 years of working and paying contributions is unlikely (if the current trend of ‘care for the elderly’ continues its downward spiral) to see me depart pain free and in dignity.

D Glover
D Glover
1 year ago
Reply to  Diane Tasker

This author is opposed to voluntary euthanasia. He also writes approvingly of refusing all treatment beyond the age of 75. I’m not sure how pain free and dignified we’d be if we just let our last illness take its course untreated.
Time to debate voluntary euthanasia again? If it’s OK for people with the means to reach Switzerland, why is it not OK everywhere?

Diane Tasker
Diane Tasker
1 year ago
Reply to  D Glover

The Assisted Dying Bill is currently being debated in the House of Lords – few people in this country would let their dog die a lingering death in agony in the face of a veterinary diagnosis. I agree that it’s yet another – and infinitely more cruel – disadvantage for people without the ability to raise the capital.

Diane Tasker
Diane Tasker
1 year ago
Reply to  D Glover

The Assisted Dying Bill is currently being debated in the House of Lords – few people in this country would let their dog die a lingering death in agony in the face of a veterinary diagnosis. I agree that it’s yet another – and infinitely more cruel – disadvantage for people without the ability to raise the capital.

D Glover
D Glover
1 year ago
Reply to  Diane Tasker

This author is opposed to voluntary euthanasia. He also writes approvingly of refusing all treatment beyond the age of 75. I’m not sure how pain free and dignified we’d be if we just let our last illness take its course untreated.
Time to debate voluntary euthanasia again? If it’s OK for people with the means to reach Switzerland, why is it not OK everywhere?

Diane Tasker
Diane Tasker
1 year ago

Being further down the path to ‘old age’ although physically and mentally as active as ever, the thought of being incapacitated in any way under the prevailing NHS care system has me contacting Solicitors for Ageing to make a Living Will and set aside funding for a trip to Switzerland should the Assisted Dying Bill not succeed. 50 years of working and paying contributions is unlikely (if the current trend of ‘care for the elderly’ continues its downward spiral) to see me depart pain free and in dignity.

Doug Pingel
Doug Pingel
1 year ago

Thanks for telling it like it really is.

Doug Pingel
Doug Pingel
1 year ago

Thanks for telling it like it really is.

j watson
j watson
1 year ago

Agree with quite a bit in this article and at least this Author gives some real policy suggestions. He does zero in on two themes impacting on all health systems – whether patients can flow out of secondary care efficiently because Social Care functions appropriately, and how we all recalibrate to an aging population – it’s not just the 80yrs+, it’s the fact that most 65yrs+ have two chronic conditions needing regular support and intervention. These dynamics mean we are in a different place to 15-20yrs ago.
We know there is a difference between how we individually pay for health services and how they are delivered. I doubt many think we should or could move away from ‘free at the point of delivery’. So that aspect of the NHS unlikely to change much. On delivery the theme of the last 30yrs is what is the role for plurality and competition between Providers? It’s had v mixed results with consistent attempts to increase competition. In part because fundamentally we don’t deploy much choice when an emergency, nor can every locality have plurality of Providers without some regualrly going bust. And allowing a healthcare organisation to go bust is not an easy thing for any politician to allow. (although choice of GP is there and capitation revenue does move with patient).
We have to recognise that we have dramatically slowed the rate of investment last 13 yrs and that has an impact on per capita doctors, nurses and care workers where we are now significantly behind countries we typically compare ourselves with. Doesn’t mean everything can be blamed on this but it’s material and to argue otherwise is not a serious comment.
Psychologically we don’t really want a ‘Health’ service do we? We want an ‘Illness’ service that ‘rescues’ us when we need it. I suspect a large proportion of UnHerd readers would not welcome more state intervention to push healthier lifestyles and will feel freedom of choice paramount. It may though therefore mean it is an Illness not a Health service we are favouring, so far as it relates to ourselves.

Last edited 1 year ago by j watson
Graeme Cant
Graeme Cant
1 year ago
Reply to  j watson

Unless you see ‘free at the point of delivery’ as the fundamental roadblock in the way of any effective reform, you are part of the problem.

No health – or illness – system can be provided with the capacity to satisfy every whim which is what ‘free at the point of delivery’ means. If no sorting takes place, the system’s finite capacity will be allocated by queueing and rationing.

Graeme Cant
Graeme Cant
1 year ago
Reply to  j watson

Unless you see ‘free at the point of delivery’ as the fundamental roadblock in the way of any effective reform, you are part of the problem.

No health – or illness – system can be provided with the capacity to satisfy every whim which is what ‘free at the point of delivery’ means. If no sorting takes place, the system’s finite capacity will be allocated by queueing and rationing.

j watson
j watson
1 year ago

Agree with quite a bit in this article and at least this Author gives some real policy suggestions. He does zero in on two themes impacting on all health systems – whether patients can flow out of secondary care efficiently because Social Care functions appropriately, and how we all recalibrate to an aging population – it’s not just the 80yrs+, it’s the fact that most 65yrs+ have two chronic conditions needing regular support and intervention. These dynamics mean we are in a different place to 15-20yrs ago.
We know there is a difference between how we individually pay for health services and how they are delivered. I doubt many think we should or could move away from ‘free at the point of delivery’. So that aspect of the NHS unlikely to change much. On delivery the theme of the last 30yrs is what is the role for plurality and competition between Providers? It’s had v mixed results with consistent attempts to increase competition. In part because fundamentally we don’t deploy much choice when an emergency, nor can every locality have plurality of Providers without some regualrly going bust. And allowing a healthcare organisation to go bust is not an easy thing for any politician to allow. (although choice of GP is there and capitation revenue does move with patient).
We have to recognise that we have dramatically slowed the rate of investment last 13 yrs and that has an impact on per capita doctors, nurses and care workers where we are now significantly behind countries we typically compare ourselves with. Doesn’t mean everything can be blamed on this but it’s material and to argue otherwise is not a serious comment.
Psychologically we don’t really want a ‘Health’ service do we? We want an ‘Illness’ service that ‘rescues’ us when we need it. I suspect a large proportion of UnHerd readers would not welcome more state intervention to push healthier lifestyles and will feel freedom of choice paramount. It may though therefore mean it is an Illness not a Health service we are favouring, so far as it relates to ourselves.

Last edited 1 year ago by j watson
Rachel Taylor
Rachel Taylor
1 year ago

With an organisation of this scale, it is not possible for anyone or any body to know the solution, because no-one can have the knowledge to correctly diagnose the problem, or the experience to identify a solution.
The approach taken has to be a meta-solution. What do you do if something is too big to grasp as a whole? You break the problem up into smaller chunks.
And funding is also not the linear matter it is usually supposed to be: too little, about right, too much. We don’t discuss the level of “funding” for holidays or cars or food, because the production and consumption are both part of the economy. What matters is whether the money is used productively, without excessive waste. As we know from long experience, that only happens with competition.
With any change, the obstacle is the vested interests. They act like a black hole, dragging all changes back towards the status quo.
So I think it is extremely unlikely that the system will allow any significant change, because the significant change would be to break the system up.

Mel Shaw
Mel Shaw
1 year ago
Reply to  Rachel Taylor

I have wrestled with the problem of how you would transition from the current NHS model to something closer to the social insurance model used in Europe. Unfortunately I can’t think of a way. Breaking the problem into smaller chunks might work, but all of the chunks would have to be coordinated to arrive at the same destination. As you say, there are too many vested interest to allow that to happen. My sad conclusion is that the NHS will need to get much nearer to total collapse before radical change will happen.

Mel Shaw
Mel Shaw
1 year ago
Reply to  Rachel Taylor

I have wrestled with the problem of how you would transition from the current NHS model to something closer to the social insurance model used in Europe. Unfortunately I can’t think of a way. Breaking the problem into smaller chunks might work, but all of the chunks would have to be coordinated to arrive at the same destination. As you say, there are too many vested interest to allow that to happen. My sad conclusion is that the NHS will need to get much nearer to total collapse before radical change will happen.

Rachel Taylor
Rachel Taylor
1 year ago

With an organisation of this scale, it is not possible for anyone or any body to know the solution, because no-one can have the knowledge to correctly diagnose the problem, or the experience to identify a solution.
The approach taken has to be a meta-solution. What do you do if something is too big to grasp as a whole? You break the problem up into smaller chunks.
And funding is also not the linear matter it is usually supposed to be: too little, about right, too much. We don’t discuss the level of “funding” for holidays or cars or food, because the production and consumption are both part of the economy. What matters is whether the money is used productively, without excessive waste. As we know from long experience, that only happens with competition.
With any change, the obstacle is the vested interests. They act like a black hole, dragging all changes back towards the status quo.
So I think it is extremely unlikely that the system will allow any significant change, because the significant change would be to break the system up.

Rob Nock
Rob Nock
1 year ago

Interesting that nobody really comments on the inherent problems of a socialist healthcare system: nobody wants to pay yet everyone wants it well funded.

On top of that if the patient is not the customer then they will not be treated like a King.

In the UK nobody is the customer, we are all just inconveniences for the NHS. In the US the insurance companies are King. Neither system serves the real customer.

We need to replace the NHS with a system where the patient is in control and pays for their treatment, even if they claim it from the insurance company/state.

Rob Nock
Rob Nock
1 year ago

Interesting that nobody really comments on the inherent problems of a socialist healthcare system: nobody wants to pay yet everyone wants it well funded.

On top of that if the patient is not the customer then they will not be treated like a King.

In the UK nobody is the customer, we are all just inconveniences for the NHS. In the US the insurance companies are King. Neither system serves the real customer.

We need to replace the NHS with a system where the patient is in control and pays for their treatment, even if they claim it from the insurance company/state.

Hugh Bryant
Hugh Bryant
1 year ago

Systems people have known for decades that protocol driven networks are vastly more efficient and effective than command driven monoliths.

If we knew the best way to run a school or a hospital it would make sense to run them all in the same way. But we don’t. So it doesn’t.

Hugh Bryant
Hugh Bryant
1 year ago

Systems people have known for decades that protocol driven networks are vastly more efficient and effective than command driven monoliths.

If we knew the best way to run a school or a hospital it would make sense to run them all in the same way. But we don’t. So it doesn’t.

Michael Furse
Michael Furse
1 year ago

There is a fundamental flaw in health provision as practiced in the UK. It doesn’t service health – it services sickness. Health education is seen in the main as the responsibility of educational providers, who in turn see it as a distraction from their core provision, though less of one than music, to their eternal shame.
Health education has a clear preventative effect and should be a core function of any centralised health service. There needs to be a philosophical revolution, without which no amount of tinkering will address the core issue of health consumers being in the main convinced of their rights with no concomitant responsibilities. And the medical profession, who have been fed on a diet of “the NHS is perfect if only others did things better” (more money, healthier patients, more nurses, more drugs) are as much to blame, though there are notable exceptions.
Like the UK teaching profession, the combination of poor quality leadership, excessive bureaucracy and extensive unionisation can result in very poor outcomes indeed, and like all bureaucracies, the incumbents close ranks when criticised. One might go so far as to say the bigger the bureaucracy, the tighter the ranks.

Michael Furse
Michael Furse
1 year ago

There is a fundamental flaw in health provision as practiced in the UK. It doesn’t service health – it services sickness. Health education is seen in the main as the responsibility of educational providers, who in turn see it as a distraction from their core provision, though less of one than music, to their eternal shame.
Health education has a clear preventative effect and should be a core function of any centralised health service. There needs to be a philosophical revolution, without which no amount of tinkering will address the core issue of health consumers being in the main convinced of their rights with no concomitant responsibilities. And the medical profession, who have been fed on a diet of “the NHS is perfect if only others did things better” (more money, healthier patients, more nurses, more drugs) are as much to blame, though there are notable exceptions.
Like the UK teaching profession, the combination of poor quality leadership, excessive bureaucracy and extensive unionisation can result in very poor outcomes indeed, and like all bureaucracies, the incumbents close ranks when criticised. One might go so far as to say the bigger the bureaucracy, the tighter the ranks.

Ben P
Ben P
1 year ago

“Britain has clung for so long to this weird comfort blanket, the risible idea that the rest of the world was looking with longing at a health system that has been in crisis for much of its 75-year history.”
No they haven’t Ian. That is the propaganda we have been fed by the media for seventy years.
This country is governed by MEDIA OPINION not public opinion. You lot are the opinion formers, ramming garbage down our necks like LGBTQ+-$%ÂŁ while the rest of us try and get on with our lives and avoid being splattered with this filth.
If this country is on its backside (and it is), it’s because the media have driven us there because they’re in charge.

Alison Wren
Alison Wren
1 year ago
Reply to  Ben P

The eligibility for free healthcare needs to be restricted to real health needs, not the “need” of a mentally ill female patient to construction of a pretend male organ.(NHS to offer phalloplasties
.) and other unnecessary procedures.

Janny Lee
Janny Lee
1 year ago
Reply to  Alison Wren

Quite right and a view in tune, I suspect, with the vast majority of the public. But what do we know?

Janny Lee
Janny Lee
1 year ago
Reply to  Alison Wren

Quite right and a view in tune, I suspect, with the vast majority of the public. But what do we know?

Alison Wren
Alison Wren
1 year ago
Reply to  Ben P

The eligibility for free healthcare needs to be restricted to real health needs, not the “need” of a mentally ill female patient to construction of a pretend male organ.(NHS to offer phalloplasties
.) and other unnecessary procedures.

Ben P
Ben P
1 year ago

“Britain has clung for so long to this weird comfort blanket, the risible idea that the rest of the world was looking with longing at a health system that has been in crisis for much of its 75-year history.”
No they haven’t Ian. That is the propaganda we have been fed by the media for seventy years.
This country is governed by MEDIA OPINION not public opinion. You lot are the opinion formers, ramming garbage down our necks like LGBTQ+-$%ÂŁ while the rest of us try and get on with our lives and avoid being splattered with this filth.
If this country is on its backside (and it is), it’s because the media have driven us there because they’re in charge.

Michelle Johnston
Michelle Johnston
1 year ago

Anyone who has read my previous comments on the NHS will no I am delighted with someone who sees this as primarily though not exclusively a demand problem.
Social Care. Some argue as many as 2/3 rd of beds are taken up by those who should be in it. it is far too many.
Voluntary Poor Health 8% of the budget goes to type 2 diabetics.
End of Life. I am completely with Ezekiel Emmanuel on this. Look where this ‘no one must ever die’ got us with the outbreak of a new respiratory illness.
The lack of joined-up one-stop information retrieval is a joke. When my mother was alive A & E rang me to ask what medication she was on.

Michelle Johnston
Michelle Johnston
1 year ago

Anyone who has read my previous comments on the NHS will no I am delighted with someone who sees this as primarily though not exclusively a demand problem.
Social Care. Some argue as many as 2/3 rd of beds are taken up by those who should be in it. it is far too many.
Voluntary Poor Health 8% of the budget goes to type 2 diabetics.
End of Life. I am completely with Ezekiel Emmanuel on this. Look where this ‘no one must ever die’ got us with the outbreak of a new respiratory illness.
The lack of joined-up one-stop information retrieval is a joke. When my mother was alive A & E rang me to ask what medication she was on.

Malcolm Knott
Malcolm Knott
1 year ago

My mother was refused financial help towards her care on the grounds that she was insufficiently frail i.e. did not tick enough boxes. She was dying and indeed died two days later.

Malcolm Knott
Malcolm Knott
1 year ago

My mother was refused financial help towards her care on the grounds that she was insufficiently frail i.e. did not tick enough boxes. She was dying and indeed died two days later.

John Riordan
John Riordan
1 year ago

What a brilliant essay. Well done the author.

John Riordan
John Riordan
1 year ago

What a brilliant essay. Well done the author.

Peter Lucey
Peter Lucey
1 year ago

Excellent piece. Ditto the BBC.

Peter Lucey
Peter Lucey
1 year ago

Excellent piece. Ditto the BBC.

Allison Barrows
Allison Barrows
1 year ago

Without competition and accountability, what incentivizes any institution? Government-run entities can just shrug, say they need more money, pass the blame onto some nebulous bogeyman, and lumber on failing in their duty.

Allison Barrows
Allison Barrows
1 year ago

Without competition and accountability, what incentivizes any institution? Government-run entities can just shrug, say they need more money, pass the blame onto some nebulous bogeyman, and lumber on failing in their duty.

Peter Stephenson
Peter Stephenson
1 year ago

Nice one Ian. But does anyone believe that rejigging the national milch cow will involve anyone but the backhanding, mutual backpatters who buzz in & out of the revolving doors of power, feathering their own nests while listening out for the next woke tune to dance to?

Peter Stephenson
Peter Stephenson
1 year ago

Nice one Ian. But does anyone believe that rejigging the national milch cow will involve anyone but the backhanding, mutual backpatters who buzz in & out of the revolving doors of power, feathering their own nests while listening out for the next woke tune to dance to?

Jack Martin Leith
Jack Martin Leith
1 year ago

The NHS houses four internal consultancies (and there may be others I don’t know about) providing services in the areas of process improvement, service design, organisational change and leadership development. They are:
NHS Improvement
‱ Advancing Change Team
‱ Intensive Support Teams
NHS Transformation Unit
NHS Horizons
NHS Leadership Academy
I know from personal experience as an independent innovation and change consultant that there is significant overlap in services offered, and that there is some degree of competition for business.
Would it be beneficial to merge the four consultancies, eliminate duplication, eradicate competition, and create a world-class organisation that attracts the best talent and fosters genuine transformation, by which I mean change of form?

Last edited 1 year ago by Jack Martin Leith
Graeme Cant
Graeme Cant
1 year ago

“Innovation and change consultants “ are part of the problem, not the solution.

Janny Lee
Janny Lee
1 year ago

Ye Gods! Innovation and change consultants. Your entire comment depresses me beyond measure. Protect us from the army of highly paid, irrelevant and fundamentally useless ‘consultants.’ They are part of the problem and most certainly not the solution.

Graeme Cant
Graeme Cant
1 year ago

“Innovation and change consultants “ are part of the problem, not the solution.

Janny Lee
Janny Lee
1 year ago

Ye Gods! Innovation and change consultants. Your entire comment depresses me beyond measure. Protect us from the army of highly paid, irrelevant and fundamentally useless ‘consultants.’ They are part of the problem and most certainly not the solution.

Jack Martin Leith
Jack Martin Leith
1 year ago

The NHS houses four internal consultancies (and there may be others I don’t know about) providing services in the areas of process improvement, service design, organisational change and leadership development. They are:
NHS Improvement
‱ Advancing Change Team
‱ Intensive Support Teams
NHS Transformation Unit
NHS Horizons
NHS Leadership Academy
I know from personal experience as an independent innovation and change consultant that there is significant overlap in services offered, and that there is some degree of competition for business.
Would it be beneficial to merge the four consultancies, eliminate duplication, eradicate competition, and create a world-class organisation that attracts the best talent and fosters genuine transformation, by which I mean change of form?

Last edited 1 year ago by Jack Martin Leith
Lesley van Reenen
Lesley van Reenen
1 year ago

None of this will work without assisted dying – dying with dignity.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago

Our view of death is frankly mawkish due to the pernicious influence of “you know what”. The behaviour of the National Horror Show (NHS) only seems to exacerbate this.

The ‘Ancients’ were, as you might expect, far more robust over this matter. In fact the Romans regarded suicide as quite acceptable under certain circumstances, such as political failure or military defeat.

O that it were so today!

Dustin Needle
Dustin Needle
1 year ago

They’d have to cancel Davos due to absence of attendees.

Frank McCusker
Frank McCusker
1 year ago

The Romans lol. Death culture

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Frank McCusker

What about Bobby Sands and the others?

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Frank McCusker

What about Bobby Sands and the others?

Dustin Needle
Dustin Needle
1 year ago

They’d have to cancel Davos due to absence of attendees.

Frank McCusker
Frank McCusker
1 year ago

The Romans lol. Death culture

Rasmus Fogh
Rasmus Fogh
1 year ago

It would certainly relieve pressure on the health service if old and demanding patients could be convinced to die with dignity and stop consuming resources. Not sure I would like or trust such a system, though.

Russell Hamilton
Russell Hamilton
1 year ago
Reply to  Rasmus Fogh

We have voluntary assisted dying in Western Australia, but the health profession certainly can’t ‘convince’ anyone to take up the option. The Act says: “A health care worker who provides health services or professional care services to a person must not, in the course of providing the services to the person —
(a) initiate discussion with the person that is in substance
about voluntary assisted dying; or
(b) in substance, suggest voluntary assisted dying to the
person.

Doug Pingel
Doug Pingel
1 year ago

Interesting to compare that with the Canadian model where, I believe, Medicants of all shapes and sizes are encouraged to push it.

Doug Pingel
Doug Pingel
1 year ago

Interesting to compare that with the Canadian model where, I believe, Medicants of all shapes and sizes are encouraged to push it.

Diane Tasker
Diane Tasker
1 year ago
Reply to  Rasmus Fogh

That suggestion puts a different slant on the ‘cradle to grave’ promise on the founding of the NHS

Janny Lee
Janny Lee
1 year ago
Reply to  Rasmus Fogh

Nor me.

Russell Hamilton
Russell Hamilton
1 year ago
Reply to  Rasmus Fogh

We have voluntary assisted dying in Western Australia, but the health profession certainly can’t ‘convince’ anyone to take up the option. The Act says: “A health care worker who provides health services or professional care services to a person must not, in the course of providing the services to the person —
(a) initiate discussion with the person that is in substance
about voluntary assisted dying; or
(b) in substance, suggest voluntary assisted dying to the
person.

Diane Tasker
Diane Tasker
1 year ago
Reply to  Rasmus Fogh

That suggestion puts a different slant on the ‘cradle to grave’ promise on the founding of the NHS

Janny Lee
Janny Lee
1 year ago
Reply to  Rasmus Fogh

Nor me.

Ian Barton
Ian Barton
1 year ago

It can work without assisted dying, but I’m fully on your side here, as assisted dying should be a fundamental right (for those capable of competent decisions)

Billy Bob
Billy Bob
1 year ago
Reply to  Ian Barton

I’m not against assisted dying in theory, however I’d always be worried it would end up far too lax like the Canadian system

Susan Osterwoldt
Susan Osterwoldt
1 year ago
Reply to  Billy Bob

Yes, I was going to mention our experience in Canada, with MAID (medical assistance in dying). We seem to have a few over enthusiastic providers of death, as the definition of those who qualify has expanded to include those with mental health issues, those with “home insecurity”, etc.
On the bright side (dark humour alert!) …apparently the shortage of organs for transplant has been somewhat alleviated! Shades of China…

Susan Osterwoldt
Susan Osterwoldt
1 year ago
Reply to  Billy Bob

Yes, I was going to mention our experience in Canada, with MAID (medical assistance in dying). We seem to have a few over enthusiastic providers of death, as the definition of those who qualify has expanded to include those with mental health issues, those with “home insecurity”, etc.
On the bright side (dark humour alert!) …apparently the shortage of organs for transplant has been somewhat alleviated! Shades of China…

j watson
j watson
1 year ago
Reply to  Ian Barton

I agree with the ‘right’. The practice though is much more difficult. For example people drifting into dementia – at what point do they lose capacity to make the decision?
Therefore you need a massive cultural change in Living Wills made when we are younger. Even then though the specifics we give as guidance to others on our wishes is not straightforward and our views probably change over time too.
I suspect it will increase, but the desire to live is v strong and for those not in v acute pain the take up of ‘assisted dying’ will remain v limited and quite close to the natural end of life anyway. Thus the broader ‘economics’ largely unaffected.

Last edited 1 year ago by j watson
Billy Bob
Billy Bob
1 year ago
Reply to  Ian Barton

I’m not against assisted dying in theory, however I’d always be worried it would end up far too lax like the Canadian system

j watson
j watson
1 year ago
Reply to  Ian Barton

I agree with the ‘right’. The practice though is much more difficult. For example people drifting into dementia – at what point do they lose capacity to make the decision?
Therefore you need a massive cultural change in Living Wills made when we are younger. Even then though the specifics we give as guidance to others on our wishes is not straightforward and our views probably change over time too.
I suspect it will increase, but the desire to live is v strong and for those not in v acute pain the take up of ‘assisted dying’ will remain v limited and quite close to the natural end of life anyway. Thus the broader ‘economics’ largely unaffected.

Last edited 1 year ago by j watson
Hugh Bryant
Hugh Bryant
1 year ago

cf: Canada?

Andrew Dalton
Andrew Dalton
1 year ago

In principle I agree. However, I strongly suspect abuse of such regulation and at least a possibility that it would creep toward something that removes the agency of the patient.

Justin Clark
Justin Clark
1 year ago

Don’t know why the thumbs down on Lesley’s point. I want the option in place to go with dignity when it’s right – not to be kept going at all costs.

Dominic A
Dominic A
1 year ago

I like the Thai village answer – nightly opium for the elderly, who are still part of the village life, helping out when and where they can, and being fed and watered and cared for when they cannot.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago

Our view of death is frankly mawkish due to the pernicious influence of “you know what”. The behaviour of the National Horror Show (NHS) only seems to exacerbate this.

The ‘Ancients’ were, as you might expect, far more robust over this matter. In fact the Romans regarded suicide as quite acceptable under certain circumstances, such as political failure or military defeat.

O that it were so today!

Rasmus Fogh
Rasmus Fogh
1 year ago

It would certainly relieve pressure on the health service if old and demanding patients could be convinced to die with dignity and stop consuming resources. Not sure I would like or trust such a system, though.

Ian Barton
Ian Barton
1 year ago

It can work without assisted dying, but I’m fully on your side here, as assisted dying should be a fundamental right (for those capable of competent decisions)

Hugh Bryant
Hugh Bryant
1 year ago

cf: Canada?

Andrew Dalton
Andrew Dalton
1 year ago

In principle I agree. However, I strongly suspect abuse of such regulation and at least a possibility that it would creep toward something that removes the agency of the patient.

Justin Clark
Justin Clark
1 year ago

Don’t know why the thumbs down on Lesley’s point. I want the option in place to go with dignity when it’s right – not to be kept going at all costs.

Dominic A
Dominic A
1 year ago

I like the Thai village answer – nightly opium for the elderly, who are still part of the village life, helping out when and where they can, and being fed and watered and cared for when they cannot.

Lesley van Reenen
Lesley van Reenen
1 year ago

None of this will work without assisted dying – dying with dignity.

David Whitaker
David Whitaker
1 year ago

I believe that the idea when the NHS was established was that there would be a “once-and-for-all” campaign of improving the health of the nation and that after that the effort required would be less. I suggest that there is a comparable big task to be done now, which is to improve the lifestyle of the nation: better diet, more exercise, reduce alcohol and drug consumption and so on. Once that objective has been achieved we may be able to manage with a more modestly resourced NHS.

David Whitaker
David Whitaker
1 year ago

I believe that the idea when the NHS was established was that there would be a “once-and-for-all” campaign of improving the health of the nation and that after that the effort required would be less. I suggest that there is a comparable big task to be done now, which is to improve the lifestyle of the nation: better diet, more exercise, reduce alcohol and drug consumption and so on. Once that objective has been achieved we may be able to manage with a more modestly resourced NHS.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
1 year ago

Well this is refreshing ! an UnHerd contribitor who actually knows what they are talking about and with extensive personal experience (of good and bad patient / social care) and even some possible solutions !

I share other commentator’s concerns about the accuracy of Mr Birrell’s comments on funding. Some much more nuanced and useful comments on this morning’s “More or Less” on BBC Radio 4, from Ben Zaranko from the Institute for Fiscal Studies. Available here : https://www.bbc.co.uk/sounds/play/m001h3zf  from about 7min 25sec. The full report on which this interview is based is available here : https://ifs.org.uk/publications/nhs-funding-resources-and-treatment-volumes
The 3 comments Mr Zaranko made that really stuck with me were :
⊁   there is no universal objective definition of how much care is “enough” (access, quality, service)
⊁   2010 – 2019 the annual funding to the NHS did not allow it to even “stand still” in terms of service provision in the face of an increasingly ageing population and increasing demand.
⊁   countries that spend more on their health care per capita (Sweden, Germany, France, the Netherlands) are also wealthier than the UK and are therefore ready, willing and able to raise higher taxes to pay for this increased health spending per capita.

The other two great programmes recently with wide ranging analyses of the NHS and some solutions are from the Briefing Room again on BBC Radio 4 :
The staffing crisis in the NHS https://www.bbc.co.uk/sounds/play/m001bbxm a counterfactual to Mr Zaranko’s assessment of the staffing situation (it is way more complicated than just gross numbers and there is a long history of understaffing).Are there any quick fixes ? https://www.bbc.co.uk/sounds/play/m001gx1s the short answer being “No”.
I agree with Martin Bollis that building a new health delivery sytem from scratch with a completely different funding mechanism is unrealistic and eating this elephant one mouthful at a time is the only sensible route. Unfortunately I don’t see any politicain with the required size 32 gonads springing into the boxing ring to take this on – it will be a proper marathon extending I would guess over 15 – 20 years.
I forsee just more rearrangement of deckchairs on the Titanic.

Last edited 1 year ago by Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
1 year ago

Well this is refreshing ! an UnHerd contribitor who actually knows what they are talking about and with extensive personal experience (of good and bad patient / social care) and even some possible solutions !

I share other commentator’s concerns about the accuracy of Mr Birrell’s comments on funding. Some much more nuanced and useful comments on this morning’s “More or Less” on BBC Radio 4, from Ben Zaranko from the Institute for Fiscal Studies. Available here : https://www.bbc.co.uk/sounds/play/m001h3zf  from about 7min 25sec. The full report on which this interview is based is available here : https://ifs.org.uk/publications/nhs-funding-resources-and-treatment-volumes
The 3 comments Mr Zaranko made that really stuck with me were :
⊁   there is no universal objective definition of how much care is “enough” (access, quality, service)
⊁   2010 – 2019 the annual funding to the NHS did not allow it to even “stand still” in terms of service provision in the face of an increasingly ageing population and increasing demand.
⊁   countries that spend more on their health care per capita (Sweden, Germany, France, the Netherlands) are also wealthier than the UK and are therefore ready, willing and able to raise higher taxes to pay for this increased health spending per capita.

The other two great programmes recently with wide ranging analyses of the NHS and some solutions are from the Briefing Room again on BBC Radio 4 :
The staffing crisis in the NHS https://www.bbc.co.uk/sounds/play/m001bbxm a counterfactual to Mr Zaranko’s assessment of the staffing situation (it is way more complicated than just gross numbers and there is a long history of understaffing).Are there any quick fixes ? https://www.bbc.co.uk/sounds/play/m001gx1s the short answer being “No”.
I agree with Martin Bollis that building a new health delivery sytem from scratch with a completely different funding mechanism is unrealistic and eating this elephant one mouthful at a time is the only sensible route. Unfortunately I don’t see any politicain with the required size 32 gonads springing into the boxing ring to take this on – it will be a proper marathon extending I would guess over 15 – 20 years.
I forsee just more rearrangement of deckchairs on the Titanic.

Last edited 1 year ago by Elaine Giedrys-Leeper
mike otter
mike otter
1 year ago

The worst side effects of NHS’ deification are that people who wipe bums, wash the sick & hand out pills think they are owed ÂŁ50-60k+ pa, and those that shill for big pharma are worth 120-200k. The NHS managers are on big salaries or contract rates too compared to real world, and i don’t begrudge this as much as i do for the technician level – eg doctors, nurses et al. What is clearly wrong is the number of managers and layers. A Spain /Suisse/German model will come, but when and at what cost in health and ÂŁ terms?

Last edited 1 year ago by mike otter
mike otter
mike otter
1 year ago

The worst side effects of NHS’ deification are that people who wipe bums, wash the sick & hand out pills think they are owed ÂŁ50-60k+ pa, and those that shill for big pharma are worth 120-200k. The NHS managers are on big salaries or contract rates too compared to real world, and i don’t begrudge this as much as i do for the technician level – eg doctors, nurses et al. What is clearly wrong is the number of managers and layers. A Spain /Suisse/German model will come, but when and at what cost in health and ÂŁ terms?

Last edited 1 year ago by mike otter
Alan Thorpe
Alan Thorpe
1 year ago

Socialist systems cannot be reformed, only closed down.

Alan Thorpe
Alan Thorpe
1 year ago

Socialist systems cannot be reformed, only closed down.

Milton Gibbon
Milton Gibbon
1 year ago

Great article. More like this please Unherd (solutions not problems).
A few points for the author if he ever reads this far down the comments. First he says that we are tipping our money down a black hole but then at several points demands more spending pledges – especially in social care which he wants to see folded into NHS spending equalling, surprise, surprise, more NHS spending! Either wholesale reform (and subsequent cuts in budget) is the answer or everything is fiddling around the edges. If the paperless drive has taken a decade to deliver and it still isn’t finished then there is a good argument for letting it all collapse and building again from the ground up? Second, why was there no mention of the biggest proposed shake-up of social care in a generation with Theresa May’s disastrous pay-through-house-sales idea? It was so unpopular with the public but looking back it seems the most clear-eyed and fairest way of funding what seems (to a young person) to be ever expanding senior care sector. I am against euthanasia but could get on board with the Ezekiel Emanuel idea as long as the decision was made by someone under the age of retirement. I don’t think that the euthanasia nuts would get on board with this however – as in go there and no further. Lastly, why should care workers be paid more than a supermarket stacker? One is clearly a more productive member of society – feeding both the working age population and everyone else. This is capitalism at work. If people really cared about their old age care they would save up for it so that these people weren’t paid a pittance, but they don’t, they blow their pension pots on expensive holidays in their early retirement instead (with potentially 30 years of life left). Choices.

Milton Gibbon
Milton Gibbon
1 year ago

Great article. More like this please Unherd (solutions not problems).
A few points for the author if he ever reads this far down the comments. First he says that we are tipping our money down a black hole but then at several points demands more spending pledges – especially in social care which he wants to see folded into NHS spending equalling, surprise, surprise, more NHS spending! Either wholesale reform (and subsequent cuts in budget) is the answer or everything is fiddling around the edges. If the paperless drive has taken a decade to deliver and it still isn’t finished then there is a good argument for letting it all collapse and building again from the ground up? Second, why was there no mention of the biggest proposed shake-up of social care in a generation with Theresa May’s disastrous pay-through-house-sales idea? It was so unpopular with the public but looking back it seems the most clear-eyed and fairest way of funding what seems (to a young person) to be ever expanding senior care sector. I am against euthanasia but could get on board with the Ezekiel Emanuel idea as long as the decision was made by someone under the age of retirement. I don’t think that the euthanasia nuts would get on board with this however – as in go there and no further. Lastly, why should care workers be paid more than a supermarket stacker? One is clearly a more productive member of society – feeding both the working age population and everyone else. This is capitalism at work. If people really cared about their old age care they would save up for it so that these people weren’t paid a pittance, but they don’t, they blow their pension pots on expensive holidays in their early retirement instead (with potentially 30 years of life left). Choices.

Perry de Havilland
Perry de Havilland
1 year ago

The entire premise underpinning the NHS is & always was preposterous, which is why no comparable nation has emulated the “envy of the world”. Just scrap the absurd NHS & come up with a system more like the Swiss or Dutch systems.

Perry de Havilland
Perry de Havilland
1 year ago

The entire premise underpinning the NHS is & always was preposterous, which is why no comparable nation has emulated the “envy of the world”. Just scrap the absurd NHS & come up with a system more like the Swiss or Dutch systems.

Sandy Henderson
Sandy Henderson
1 year ago

Deleted

Last edited 1 year ago by Sandy Henderson
Diane Tasker
Diane Tasker
1 year ago

BBC’s ‘More or Less’ 18 Jan on NHS – stats are shocking 
.and inexplicable!

Steven Farrall
Steven Farrall
1 year ago

De-nationalise the Damn’ thing and issue everyone with ‘health vouchers’ and let us all sort out this mess.

Steven Farrall
Steven Farrall
1 year ago

De-nationalise the Damn’ thing and issue everyone with ‘health vouchers’ and let us all sort out this mess.

James Kirk
James Kirk
1 year ago

I’ve never seen what there is to be envious about other than in its original form when it was a safety net to catch the poor and the sickly. People did not live as long then and often died undiagnosed or without the means to treat them. Cosmetic surgery was in its infancy and heart surgery rarely survivable. Cancer was a death sentence.
Take a leaf out of veterinary care’s book. If you have the money, pay for it. Limit the private sector to how much they charge.

Anna Bramwell
Anna Bramwell
1 year ago

Excellent article. I would just cavil at the idea of pre 1948 big hospitals dominating the scene. There were about double the number of hospitals before 1948 but many were cottage hospitals, oddly disfavoured by the NHS, along with the convalescent homes, also soon to be closed down.

Alex Stonor
Alex Stonor
1 year ago

It all starts before the doctors & nurses, in education. There is plenty of compassion for older & more vulnerable citizens but it isn’t being nurtured. I teach health & social care at a (privately run) 6th form college. The pandemic has led to an increase in interest in health & social care courses, but the system seems intent on thwarting the vocations of young people. T-Levels are being introduced; these call for higher academic qualifications on application but hope to deliver more highly experienced, front line carers and therapists. Btec which offer pathways to more, less academically successful students are being phased out. When will we take seriously the vocational pathways in education and stop adding unhelpful value to academic pathways that result in the vocational pathways for health, social care & the trades being seem as the route for students who have failed.

Seth Edenbaum
Seth Edenbaum
1 year ago

First starve the NHS then say “Look it’s dying!” Brilliant.
“Take out Greater London—the prosperity of which depends to an uncomfortable degree on servicing oligarchs from the Middle East and the former Soviet Union—and the U.K. is one of the poorest countries in Western Europe.”
https://www.barrons.com/articles/italy-without-the-euro-would-not-be-argentina-or-turkeyit-would-be-the-u-k-1527078883

Seth Edenbaum
Seth Edenbaum
1 year ago

First starve the NHS then say “Look it’s dying!” Brilliant.
“Take out Greater London—the prosperity of which depends to an uncomfortable degree on servicing oligarchs from the Middle East and the former Soviet Union—and the U.K. is one of the poorest countries in Western Europe.”
https://www.barrons.com/articles/italy-without-the-euro-would-not-be-argentina-or-turkeyit-would-be-the-u-k-1527078883

Frank McCusker
Frank McCusker
1 year ago

Yeah, spend 40 years wrecking something, and then complain about how bad it is. The NHS has been stealth-privatised for decades.
It has also fallen prey to the private sector disease of managerialism, whereby overpaid generalist muppets with MBAs tell medical experts what to do. The cult of managerialism is a massive inefficiency, and, ironically, it’s been imported directly from the private sector. I remember NHS hospitals in the 780s – clean, efficient – and not an MBA muppet in sight. 
The other inefficiency in today’s NHS – contractual lock-ins to over-priced drugs – is also a private sector inefficiency. There are lots of cheap-as-chips drugs with 90% of the efficacy of the in-patent drugs, but the NHS can’t go near them, due to the contractual lock-ins / excessive profiteering  by the pharma cos.  
 Britain is not a socialist country. It needs to grow some PR balls and openly admit it hates the very idea of an NHS – go full US insurance, and work-houses for the sick and indigent. You know that’s what you want folks : )   

Frank McCusker
Frank McCusker
1 year ago

Yeah, spend 40 years wrecking something, and then complain about how bad it is. The NHS has been stealth-privatised for decades.
It has also fallen prey to the private sector disease of managerialism, whereby overpaid generalist muppets with MBAs tell medical experts what to do. The cult of managerialism is a massive inefficiency, and, ironically, it’s been imported directly from the private sector. I remember NHS hospitals in the 780s – clean, efficient – and not an MBA muppet in sight. 
The other inefficiency in today’s NHS – contractual lock-ins to over-priced drugs – is also a private sector inefficiency. There are lots of cheap-as-chips drugs with 90% of the efficacy of the in-patent drugs, but the NHS can’t go near them, due to the contractual lock-ins / excessive profiteering  by the pharma cos.  
 Britain is not a socialist country. It needs to grow some PR balls and openly admit it hates the very idea of an NHS – go full US insurance, and work-houses for the sick and indigent. You know that’s what you want folks : )   

Billy Bob
Billy Bob
1 year ago

I would be interested to know where the author is getting his figures from. Every piece of info I can find on Google seems to suggest that the UK spends around 20% less per capita than France or Germany (who he compares it to) on its health system, and this was as high as 33% only 5 years ago. I’ve also had the pleasure of dealing with Hinchinbrooke, and after it’s experiment it was an absolute hellhole. They may have found millions in savings, but that seemed to have come from no longer actually treating the patients.
I am however pleased that he didn’t resort to the lazy reporting of it being too top heavy, as the foreign models spend more on admin but tend to be more efficient, maybe because it frees the doctors from tedious paperwork.
I think the NHS does well with the limited funding it has, however we expect much more from it than other countries do from theirs and on a much more limited budget. There’s no doubt reform is needed however

Stephen Walsh
Stephen Walsh
1 year ago
Reply to  Billy Bob

Comparisons of that nature are distorted by movements in exchange rates. Sterling weakened by up to 20% vs the Euro between 2016 and 2018. While health expenditure was rising in GBP terms it was falling in EUR terms and therefore looked to be falling relative to France and Germany. This was misleading. What matters is expenditure expressed in purchasing power parity. Now Sterling has recovered somewhat, but that doesn’t mean health expenditure is rising relative to Eurozone countries in any meaningful way. As I understand it, UK public health expenditure is comparable to its western European peers, but private expenditure is lower.

j watson
j watson
1 year ago
Reply to  Stephen Walsh

Yes that’s about correct on combined expenditure. but of course a percent or two against GDP has a massive multiplier effect over 10-12 years.
The data is v clear on us having less doctors, nurses and care workers per capita though. We are significantly lower than likes of France, Germany, Netherlands etc. Now that might be worsened by us not spending what money we have on the right things but even then you could sack every senior manager and not have enough to make up the difference.
In the Care sector though that argument won’t apply, it’s much more linear dynamic with how we fund social care. Fund less = Pay less = Provide less. And then if Social care malfunctions you generate a whole series of inefficiencies back up stream as hospitals and primary care have to compensate and compromise other activity as a result. Now if we could sort Social Care we might just find our NHS does much better on VFM too.

j watson
j watson
1 year ago
Reply to  Stephen Walsh

Yes that’s about correct on combined expenditure. but of course a percent or two against GDP has a massive multiplier effect over 10-12 years.
The data is v clear on us having less doctors, nurses and care workers per capita though. We are significantly lower than likes of France, Germany, Netherlands etc. Now that might be worsened by us not spending what money we have on the right things but even then you could sack every senior manager and not have enough to make up the difference.
In the Care sector though that argument won’t apply, it’s much more linear dynamic with how we fund social care. Fund less = Pay less = Provide less. And then if Social care malfunctions you generate a whole series of inefficiencies back up stream as hospitals and primary care have to compensate and compromise other activity as a result. Now if we could sort Social Care we might just find our NHS does much better on VFM too.

Martin Bollis
Martin Bollis
1 year ago
Reply to  Billy Bob

I thought this was an excellent article but that statement did stand out and made me slightly question the impartiality of the piece.

The actual words are:

“This pivotal report also found Britain spending almost the average on health for rich nations.”

“Undefined rich nations” and “average” are malleable terms in this context but didn’t damage, for me, the overall argument.

Billy Bob
Billy Bob
1 year ago
Reply to  Martin Bollis

I agree, the numerous problems with the NHS are well documented, the worst of which being a lack of social care to discharge patients to. This blocks beds, which in turn creates queues for ambulances as they are unable to offload those they pick up.
However I find comparisons to other nations healthcare systems are often blinded by ideology. Those on the left always compare it to the shambles in America which costs taxpayers a fortune and offers no cover, while those on the right compare it to the French or Germans yet fail to mention both spend around a fifth more per person on their systems (and the French only covers 80% of the costs I believe).

Julian Pellatt
Julian Pellatt
1 year ago
Reply to  Billy Bob

The Australian healthcare system seems to be very good overall. I have family and friends who live there and sing its praises. Ditto Canada.

Last edited 1 year ago by Julian Pellatt
Julian Pellatt
Julian Pellatt
1 year ago
Reply to  Billy Bob

The Australian healthcare system seems to be very good overall. I have family and friends who live there and sing its praises. Ditto Canada.

Last edited 1 year ago by Julian Pellatt
Billy Bob
Billy Bob
1 year ago
Reply to  Martin Bollis

I agree, the numerous problems with the NHS are well documented, the worst of which being a lack of social care to discharge patients to. This blocks beds, which in turn creates queues for ambulances as they are unable to offload those they pick up.
However I find comparisons to other nations healthcare systems are often blinded by ideology. Those on the left always compare it to the shambles in America which costs taxpayers a fortune and offers no cover, while those on the right compare it to the French or Germans yet fail to mention both spend around a fifth more per person on their systems (and the French only covers 80% of the costs I believe).

Mike F
Mike F
1 year ago
Reply to  Billy Bob

I would imagine the author is referring to percentage of GDP spent on health care, by which measure we are pretty average. You can only spend what you have, and if we could improve productivity we’d be able to spend more per capita on health than we do now.

j watson
j watson
1 year ago
Reply to  Mike F

Sort Social care and NHS productivity automatically rises significantly.
What we’ve got is a public policy failure to address one system – Social care – rebounding on another, Health Care.
Try getting a patient who needs a 2-3 times a day package of care discharged so you can use the bed for a cancer op. You’ll wait weeks for the assessment and then provision of the care package because Social care capacity has been crippled. Hence a bed where you might have cycled 3-5 operations and related hospital stay through it has been blocked. Extrapolate that thousands of time every day across the country. Then after discharge the care package fails, person has a fall at home trying to wash themselves when the care worker doesn’t arrive and they get re-admitted to hospital with a fractured hip and subsequent infection. And repeat.

Billy Bob
Billy Bob
1 year ago
Reply to  Mike F

We are a whole percentage point behind the Germans though. If you look at it in terms of military there is less than a percentage point between the UKs and German armed forces, but in terms of equipment and ability they are poles apart.
An increase of 1% of GDP to the healthcare budget to bring it in line with the Germans would see spending on healthcare increase by around 20%

Last edited 1 year ago by Billy Bob
j watson
j watson
1 year ago
Reply to  Mike F

Sort Social care and NHS productivity automatically rises significantly.
What we’ve got is a public policy failure to address one system – Social care – rebounding on another, Health Care.
Try getting a patient who needs a 2-3 times a day package of care discharged so you can use the bed for a cancer op. You’ll wait weeks for the assessment and then provision of the care package because Social care capacity has been crippled. Hence a bed where you might have cycled 3-5 operations and related hospital stay through it has been blocked. Extrapolate that thousands of time every day across the country. Then after discharge the care package fails, person has a fall at home trying to wash themselves when the care worker doesn’t arrive and they get re-admitted to hospital with a fractured hip and subsequent infection. And repeat.

Billy Bob
Billy Bob
1 year ago
Reply to  Mike F

We are a whole percentage point behind the Germans though. If you look at it in terms of military there is less than a percentage point between the UKs and German armed forces, but in terms of equipment and ability they are poles apart.
An increase of 1% of GDP to the healthcare budget to bring it in line with the Germans would see spending on healthcare increase by around 20%

Last edited 1 year ago by Billy Bob
Anna Bramwell
Anna Bramwell
1 year ago
Reply to  Billy Bob

Could you tell me where the figures on admin come from? NHS digital has 48% nonmedical staff, while its figures for med8cal staff include paramedics and auxiliaries. Germany spends 10% on management, and has many times the number of nurses, doctors and beds, with a decentralised system. Private hospitals in the UK spend 10% on management, the rest on medical staff. Italy’s NHS costs way less than the NHS per capita. They use pharmacies a lot, particularly to make hospital appointments following a doctor’s prescription ( their computer systems cover all hospitals in in region). They also make small charges for hospital tests and outpatient treatments. . I can c