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Faith won't keep the patient alive (Oli Scarff/AFP/Getty)
Nothing about the National Health Service makes sense. As an institution, it provokes intense appreciation, and just as intense irritation and criticism. My own feelings about it oscillate between gratitude and fury. It’s our national shame, and the envy of the world. It’s over-managed but under-managed; too expensive but not expensive enough; too safety-obsessed and not concerned enough with safety. Just this week, the NHS was reportedly “on its knees”, threatened by a proposed plan to clamp down on overseas workers in order to cut immigration — while also celebrating its 75th birthday with cake and bingo, courtesy of the King and Queen. It’s a fitting note for an institution that has spent its three-quarters of a century simultaneously perceived as in permacrisis, and also as the unassailable heart of the British post-war consensus.
“Our NHS” looms so large in our politics as to wholly justify the sardonic description of Britain as “a health service with a country attached”. And while this outsize place in the national consciousness is sometimes mocked and often puzzling, it was inevitable from its very birth. For the origin-story of the NHS contains, in germinal form, a great deal of what makes up quintessentially modern Britain. Its formation was first demanded by, and in turn helped to catalyse, what conservatives now call the “Blob”: that unaccountable ecosystem of agencies, largely state-funded and amorphously affiliated, that replaced more voluntaristic forms of civil society. It was powered by the cultural shift toward centralisation and managerialism that blossomed during the Second World War and that’s still with us today.
Crucially, baked into the origin-story of Our NHS is modern Britain’s defining feature: a desire to have our cake and eat it. This desire, by no means unique to former PM Boris Johnson, finds complicated expression in the NHS: in the global standing supposedly conferred on Britain by this institution, the opportunity it offers to display national magnanimity — and also in what its foundation and upkeep cost us in real, geopolitical hard power.
If you were to take at face value the omnipresent warnings about Tory eagerness to “dismantle the NHS”, you would think there was no healthcare at all prior to Bevan. But pre-war British health provision was a long way from non-existent — it was just decentralised. Provision was split between three main groups: voluntary hospitals, “Poor Law” institutions and local authorities.
In 1938, some 33% of hospital beds were in voluntary hospitals: a mix of charitable foundations, such as Guy’s in London and Addenbrooke’s in Cambridge, and provincial “cottage hospitals” usually run by GPs and funded by charity donations and subscription societies. Another 20% of beds in 1938 were in “Poor Law” institutions, which originated in the spartan 19th-century workhouse system, immortalised in Dickens’ Oliver Twist. Many such institutions began as workhouse infirmaries and provided most of the beds for long-term inpatients, such as the very old or chronically ill. And the remainder of hospitals, some 47%, were run by local authorities, who were responsible for maternity, dental, school health and child welfare services, sanatoria and mental hospitals. Funding for this mix was collected via some local authority taxation, supplemented by churches, charities, private subscription and mutual societies — light state intervention supplemented by charitable giving and mutual aid, and supported by civil society voluntarism and mutual support.
Enter the Blob. Even before the Second World War, a germinal Blob already existed as an emerging force in British public life, typified by the Political and Economic Planning think tank. This strikingly proto-Blairite vehicle in funding, demographics and sensibility was crewed by just the kind of figures that make up the modern chumocracy, including financiers, social reformers and company directors. It was funded by big business and already had its eye on health, calling for British provision to be transformed so as to be centred on individuals rather than institutions.
This blend of financial interests, technocracy and do-gooding has been hacking away at the eccentric pre-existing thickets of organic civil society for decades now, with tacit or overt state support. But perhaps the single most salient moment in its formalisation as a serious force in British public life was the Second World War. During these six years of emergency collectivism, any meaningful barrier between private, voluntarist and state effort collapsed into a single national war effort; and nowhere were its results more pronounced than in British healthcare. By 1938, Britain was expecting a war and, in preparation, the Ministry of Health formed a regionalised Emergency Hospital Service to coordinate care for injured servicepeople and air-raid victims. It took some months of negotiation to persuade the voluntary hospitals to participate. But once their assent was secured, all worked together during the war.
And this Emergency Health Service, in turn, laid the managerial foundations for the National Health Service, for example by centralising data-gathering, performance standards and pay scales. And in the aftermath of war, Attlee’s Labour government seized the opportunity provided by those foundations. For as medical historian Nick Hayes shows, even before the war, Left-wing activists disliked the hodgepodge of charities and contributory schemes which funded healthcare schemes for the working class. Aneurin Bevan even denounced the “indignity” of nurses collecting money for charitable hospitals.
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SubscribeI lived in Britain for many years and still in some ways wish I did…but not for the NHS. As sacred cows goes it must be the biggest and most cumbersome. One of the many mistakes David Cameron made was in around 2010 when he became a cheerleader for the NHS, leveraging his personal experience with a disabled child to pump up the emotion surrounding ‘our NHS’. It was naked politics; the NHS had to be seen to be safe in Tory hands. Well, it’s now as big as Greece and not as efficient. There are better ways of doing health: France, Germany, even Australia (where all the newly minted British doctors want to come). A gimlet-eyed look at the competition and some steel in reform might just achieve something. It’s time to slay the sacred cow.
Perhaps it’s a minor point, but it’s far too narrow to simply blame David Cameron. Why not “blame” Winston Churchill, Harold Macmillan, or Margaret Thatcher for that matter? If the NHS was unpopular with the public (rightly or wrongly) it would have been disbanded and perhaps replaced by a more European style insurance based system by now. Politicians don’t usually want to commit electoral suicide by seemingly ‘attacking’ a major, very visible, and emotive public service.
This public perception might now finally be starting to shift, but even so, trying to get such a huge system to metamorphose into a very different one strikes me as being fraught with enormous challenges, both in trying to maintain reasonable healthcare, and politically.
The European systems evolved very differently.
Most of us can’t get a doctor or it least it is a mighty battle. Someone told me to go round to the surgery itself to get an appointment as it was impossible on the phone. I was told a doctor would ring me and one did. She said she would text me but it never happened. If we had an insurance self financing system the doctors would be seeking us and we would save all the tax we pay to them which I think is something like 15% of our national turnover maybe more..
Most of us can’t get a doctor or it least it is a mighty battle. Someone told me to go round to the surgery itself to get an appointment as it was impossible on the phone. I was told a doctor would ring me and one did. She said she would text me but it never happened. If we had an insurance self financing system the doctors would be seeking us and we would save all the tax we pay to them which I think is something like 15% of our national turnover maybe more..
The “Greensill Schill” Cameron was always utterly shameless.
.
A talentless arrogant self-serving chancer.
.
However I will always be grateful to him for ****ing up the Remain campaign so thoroughly.
The Tories have messed up the rest by dragging their feet, even after being voted in by a large majority to sort Brexit. We are still waiting.
The Tories have messed up the rest by dragging their feet, even after being voted in by a large majority to sort Brexit. We are still waiting.
The NHS will never be in danger of improvement while a lack of money (Tory Cuts! Booo!!) is seen as the cause of all its problems. We wouldn’t accept a supermarket system run on similar socialist lines. So why do we accept such sub standard healthcare? Here are a few reasons. https://open.substack.com/pub/lowstatus/p/alternative-medicine?r=evzeq&utm_campaign=post&utm_medium=web
Perhaps it’s a minor point, but it’s far too narrow to simply blame David Cameron. Why not “blame” Winston Churchill, Harold Macmillan, or Margaret Thatcher for that matter? If the NHS was unpopular with the public (rightly or wrongly) it would have been disbanded and perhaps replaced by a more European style insurance based system by now. Politicians don’t usually want to commit electoral suicide by seemingly ‘attacking’ a major, very visible, and emotive public service.
This public perception might now finally be starting to shift, but even so, trying to get such a huge system to metamorphose into a very different one strikes me as being fraught with enormous challenges, both in trying to maintain reasonable healthcare, and politically.
The European systems evolved very differently.
The “Greensill Schill” Cameron was always utterly shameless.
.
A talentless arrogant self-serving chancer.
.
However I will always be grateful to him for ****ing up the Remain campaign so thoroughly.
The NHS will never be in danger of improvement while a lack of money (Tory Cuts! Booo!!) is seen as the cause of all its problems. We wouldn’t accept a supermarket system run on similar socialist lines. So why do we accept such sub standard healthcare? Here are a few reasons. https://open.substack.com/pub/lowstatus/p/alternative-medicine?r=evzeq&utm_campaign=post&utm_medium=web
I lived in Britain for many years and still in some ways wish I did…but not for the NHS. As sacred cows goes it must be the biggest and most cumbersome. One of the many mistakes David Cameron made was in around 2010 when he became a cheerleader for the NHS, leveraging his personal experience with a disabled child to pump up the emotion surrounding ‘our NHS’. It was naked politics; the NHS had to be seen to be safe in Tory hands. Well, it’s now as big as Greece and not as efficient. There are better ways of doing health: France, Germany, even Australia (where all the newly minted British doctors want to come). A gimlet-eyed look at the competition and some steel in reform might just achieve something. It’s time to slay the sacred cow.
I’m an American and have no skin in this particular game, but I read Unherd’s accounts of the NHS with interest because in America we deal with the same underlying issues (cost, ageing population, etc) but in a different way. We even occasionally flirt with the idea of UK-style socialized medicine.
I would say Mary Harrington has summarized the history, in-built tensions, and the challenges of the NHS as well as any other writer I’ve read.
My sense is the NHS must eventually change and make some hard decisions about the extent of care offered, especially to very old people. But never be tempted to go the purely private route. Let the US be your cautionary tale in that regard. Better to find a middle way.
The problem with finding any reform is that the British public are very wary of privatisation, having been stung in the past by the selling off various utilities and public transport. These have then ended up in a worse state, more expensive and all the while foreign shareholders extract millions of pounds in undeserved dividends.
The NHS needs reform, and in my opinion it tries to take on too much for the budget it has and stretches itself too thin. A big problem is the lack of space in the community to discharge patients to, so they end up blocking hospital beds causing horrendous backlogs and wait times. Somehow getting the health service and local care providers to join up their thinking and planning would do a lot of good
In the latter part of my 35-year NHS career, i spent (one might say wasted, looking back) many dozens of hours in meetings attempting to do precisely what you advocate in the final paragraph.
At certain points, it seemed like progress was being made (more joined-up discharge planning, starting at the point of admission by identifying the likely aftercare needs and setting the ball rolling) only for another government ‘initiative’ to move the goalposts, e.g. by restructuring community health & social care provision so that new people were brought in who didn’t understand or subscribe to the close liaisons that’d been painstakingly built up.
It’s a cliché, but the problem derives from the politicisation of the NHS (government football) and the billions wasted in maintaining the bureacracies designed to ensure nothing really changes. Until, as MH writes, it does. Something has to give, while the British public are consistently short-changed and obliged to do that very British thing: queue.
You highlight the problem of the NHS through your comment. Each time someone sensible works out a practical way of dealing with issues the top down managerialism of the organisation steps in to muck it up. Advances are made at local levels where those involved can see the issues. They can’t be imposed from above since those above can’t take account of the individual local issues that have to be negotiated to set up a practical solution. The politicians are simply responding to the latest managerial fad in implementing top down solutions.
The top down culture does not give doctors enough freedom to serve their patients. Big Pharma is involved and has gained big influence in the Health World. Doctors can lose their jobs if they don’t tow the line which works upon a system of profits for the drug makers. Until recently I got a text every week from the hospital asking me to come in for a booster. I am afraid to put my health complelely in their hands these days and take private responsibility with what I allow them to do.
The top down culture does not give doctors enough freedom to serve their patients. Big Pharma is involved and has gained big influence in the Health World. Doctors can lose their jobs if they don’t tow the line which works upon a system of profits for the drug makers. Until recently I got a text every week from the hospital asking me to come in for a booster. I am afraid to put my health complelely in their hands these days and take private responsibility with what I allow them to do.
There’s no doubt that’s frustrating, but in my experience that isn’t something that’s unique to the public sector. I’ve worked in both public and private sector and despite people claiming that the private sector is always more effective and gets things done, but from me dealings it can be just as dysfunctional and full of people unwilling to make decisions as the public sector, especially when you start dealing with the upper management types who simply seem to wander from one industry to the next without ever really having any in depth knowledge of what the job entails.
The problem is people in the end whether NHS of private. We are seeing more dishonesty these days in corporations that wasn’t apparent 30 years ago. Who can we trust?
The problem is people in the end whether NHS of private. We are seeing more dishonesty these days in corporations that wasn’t apparent 30 years ago. Who can we trust?
You highlight the problem of the NHS through your comment. Each time someone sensible works out a practical way of dealing with issues the top down managerialism of the organisation steps in to muck it up. Advances are made at local levels where those involved can see the issues. They can’t be imposed from above since those above can’t take account of the individual local issues that have to be negotiated to set up a practical solution. The politicians are simply responding to the latest managerial fad in implementing top down solutions.
There’s no doubt that’s frustrating, but in my experience that isn’t something that’s unique to the public sector. I’ve worked in both public and private sector and despite people claiming that the private sector is always more effective and gets things done, but from me dealings it can be just as dysfunctional and full of people unwilling to make decisions as the public sector, especially when you start dealing with the upper management types who simply seem to wander from one industry to the next without ever really having any in depth knowledge of what the job entails.
I am not going to defend all the utility sell-offs that happened, certainly not while Thames Water (et al) continue to pollute our rivers and beaches with apparently increasing frequency. However, anyone who claims they all ended up in a worse state has no memory of what it was like trying to get a telephone line before all miraculously changed when BT became the privatised successor entity. Our collective memory has also forgotten how dire the rail service was pre-privatisation. Customer service was not on the management menu.
We may need to change the current operating models of some of the previously-nationalised industries, but if this is to be done we need to avoid the major flaw of producer capture so evident previously, and of which the NHS (not in all its activities) is such a prime example so often today.
Telephone provision is not a fair example. The advent of electronics and fibre optics didn’t just revolutionised telephony, they were complete game changers. It was just good luck (for privateers) that it coincided with privatisation.
A primary school child will tell you that when vast profits, massive salaries and unearned dividends have to be added to the cost of providing a service it is going to cost more. When greed is included corruption and poor service will follow as night follows day.
An argument for nationalised supermarkets. I wonder how well that would work?
Bingo!
They had that in Russia under communism but enough was not on the shelves and sub starvation existed for many years. Where there is a motivation for profit people are willing to create and get things in order much better than nationalised stores which would be a form of slavery. The problems happen in private companies when things get too big and we start being controlled by the banks and other industries if we don’t agree with their politics. This happens in nationalised industries as well such as schools where teachers are sacked for having a different view than the bosses in control at the top.
Bingo!
They had that in Russia under communism but enough was not on the shelves and sub starvation existed for many years. Where there is a motivation for profit people are willing to create and get things in order much better than nationalised stores which would be a form of slavery. The problems happen in private companies when things get too big and we start being controlled by the banks and other industries if we don’t agree with their politics. This happens in nationalised industries as well such as schools where teachers are sacked for having a different view than the bosses in control at the top.
Actually telephone service is a fair example. In 1974 we moved into a flat recently vacated by another couple. They left behind their telephone and did not want to “take their number with them” and they also left the receiver behind (in those days you were only allowed Post Office telephone receivers, anyway). Obtaining telephone service therefore simply involved changing the name on the bill, and possibly turning some sort of switch in the exchange – there was no need to dig a trench or even provide a new telephone. For this simple operation we were charged something like £30 – the equivalent sum today would be £400. British Telecom was privatised in 1984, well before mobile telephones became commonplace and long before the Internet. The connection charge was not maintained by the privatised company.
Same as the Water companies some of whom sold reservoirs as building land and made large profits. The problems came when there was a dry period and they could not cope with the demand without hosepipe bans. Greediness again above the interests of the nation.
Same as the Water companies some of whom sold reservoirs as building land and made large profits. The problems came when there was a dry period and they could not cope with the demand without hosepipe bans. Greediness again above the interests of the nation.
That is true but surely competition would obviate and curtail massive profits? The danger in globalist monopolies is that they can be just as oppressive on society as communism would be.
An argument for nationalised supermarkets. I wonder how well that would work?
Actually telephone service is a fair example. In 1974 we moved into a flat recently vacated by another couple. They left behind their telephone and did not want to “take their number with them” and they also left the receiver behind (in those days you were only allowed Post Office telephone receivers, anyway). Obtaining telephone service therefore simply involved changing the name on the bill, and possibly turning some sort of switch in the exchange – there was no need to dig a trench or even provide a new telephone. For this simple operation we were charged something like £30 – the equivalent sum today would be £400. British Telecom was privatised in 1984, well before mobile telephones became commonplace and long before the Internet. The connection charge was not maintained by the privatised company.
That is true but surely competition would obviate and curtail massive profits? The danger in globalist monopolies is that they can be just as oppressive on society as communism would be.
Yes, Alan. Remember when the only way to get a new gas fire was to visit your local Gas Board showroom, where you could choose between one with or one without a lovely coal effect? Then wait six weeks to have it fitted.
A lot of these nationalised industries seem to be staffed with militant left wing Unions ready to strike if they don’t get their way. They think nothing of holding the country to ransom but were blessed with safe gold plated pensions guranteed by the state.
Telephone provision is not a fair example. The advent of electronics and fibre optics didn’t just revolutionised telephony, they were complete game changers. It was just good luck (for privateers) that it coincided with privatisation.
A primary school child will tell you that when vast profits, massive salaries and unearned dividends have to be added to the cost of providing a service it is going to cost more. When greed is included corruption and poor service will follow as night follows day.
Yes, Alan. Remember when the only way to get a new gas fire was to visit your local Gas Board showroom, where you could choose between one with or one without a lovely coal effect? Then wait six weeks to have it fitted.
A lot of these nationalised industries seem to be staffed with militant left wing Unions ready to strike if they don’t get their way. They think nothing of holding the country to ransom but were blessed with safe gold plated pensions guranteed by the state.
Unfortunately, this is like striving for the perfect Soviet tractor factory. Always theoretically possible, but never achieved.
It is always possible to devise a rational path to a better system. But, at some point, you have to concede that, if it has not happened yet, there is probably something preventing it from happening. Unless you work out what that is, you will just be next in line to devise a better tractor factory.
In the latter part of my 35-year NHS career, i spent (one might say wasted, looking back) many dozens of hours in meetings attempting to do precisely what you advocate in the final paragraph.
At certain points, it seemed like progress was being made (more joined-up discharge planning, starting at the point of admission by identifying the likely aftercare needs and setting the ball rolling) only for another government ‘initiative’ to move the goalposts, e.g. by restructuring community health & social care provision so that new people were brought in who didn’t understand or subscribe to the close liaisons that’d been painstakingly built up.
It’s a cliché, but the problem derives from the politicisation of the NHS (government football) and the billions wasted in maintaining the bureacracies designed to ensure nothing really changes. Until, as MH writes, it does. Something has to give, while the British public are consistently short-changed and obliged to do that very British thing: queue.
I am not going to defend all the utility sell-offs that happened, certainly not while Thames Water (et al) continue to pollute our rivers and beaches with apparently increasing frequency. However, anyone who claims they all ended up in a worse state has no memory of what it was like trying to get a telephone line before all miraculously changed when BT became the privatised successor entity. Our collective memory has also forgotten how dire the rail service was pre-privatisation. Customer service was not on the management menu.
We may need to change the current operating models of some of the previously-nationalised industries, but if this is to be done we need to avoid the major flaw of producer capture so evident previously, and of which the NHS (not in all its activities) is such a prime example so often today.
Unfortunately, this is like striving for the perfect Soviet tractor factory. Always theoretically possible, but never achieved.
It is always possible to devise a rational path to a better system. But, at some point, you have to concede that, if it has not happened yet, there is probably something preventing it from happening. Unless you work out what that is, you will just be next in line to devise a better tractor factory.
…a middle way between “In deep trouble” (NHS) and “Appalling for 40% of the population” (US) doesn’t sound like a great solution to me!
Where did the number 40% come from? Per CRS 2023, 40% of US health care is from government (45% if you count military) and 69% is private, mostly related to employment. Only 9% are uninsured. The major problem in US health care is disjointed care, not the amount provided.
I believe it was more than 40% in Scotland. Every town had a “Royal” hospital which was heavily endowed over the centuries by wealthy (and ordinary citizens) leaving money to their local hospital in their wills.
These endowments were all “stolen” by the government with the introduction of the NHS.
Sucked everything dry then and still want more and more cash.
Sucked everything dry then and still want more and more cash.
Sounds a reasonable sytem then but I believe Big Pharma is causing havoc there also with the top down system.
I believe it was more than 40% in Scotland. Every town had a “Royal” hospital which was heavily endowed over the centuries by wealthy (and ordinary citizens) leaving money to their local hospital in their wills.
These endowments were all “stolen” by the government with the introduction of the NHS.
Sounds a reasonable sytem then but I believe Big Pharma is causing havoc there also with the top down system.
Maybe better to look at some of the European systems or maybe Australasia.
Where did the number 40% come from? Per CRS 2023, 40% of US health care is from government (45% if you count military) and 69% is private, mostly related to employment. Only 9% are uninsured. The major problem in US health care is disjointed care, not the amount provided.
Maybe better to look at some of the European systems or maybe Australasia.
Our American system’s largest flaw is that most health insurance is tied to employment, in that insurance plans are part of a benefits package that employees must pay into. This is great for the middleman – not so much for the employee. And it’s very tough on the self-employed who must pay for expensive private plans. It was all made far worse when the HMO system (Health Maintenance Organizations) was foisted on most employers in the early 80s, forcing employees to only use doctors and medical services participating in the plans (the plans are tiered, so an hourly worker on an “affordable” plan gets minimal care and cr*p doctors, while government workers like public school teachers get premium coverage).
Gone are the days of your local GP whose office was in your neighborhood and you could make payments directly to him. No more house calls. Everything is managed; if you need to speak to an actual human, you need to go through an online “portal” and leave a detailed message, after which someone may get back to you in 24-48 hours. I broke my patella and right wrist after a bad fall last year and it took 11 days to be scheduled for surgery because I wasn’t notified by anyone that I had been scheduled a week earlier (I’m baffled as to how people get addicted to OxyContin: they did absolutely nothing to alleviate my pain).
The whole system is a mess, rigged to benefit insurance companies. And now we know that Big Pharma and medical establishments are working together to enrich themselves, patients be d*mned (just look at those willing and eager to surgically and chemically mutilate children). Best course of action? Don’t get sick, and try not to fall down.
The medical insurance companies make a profit in the 2-4% range (S&P average = 10%). Why do you think that they have a “rigged ” market?
Let me guess: you work in the industry. I, too, worked in the industry – albeit in marketing and advertising – but often had to interview and write about the actuarial realities for in-house publications, where everyone already knew what was going on. The entire model is based on being a middleman, an aggregate. Removal of patient/doctor relationships with their own agreements on how treatment and payment is handled was murdered by the HMO system. It’s been a bureaucratic f*ck up ever since. It’s indefensible, no matter what percentages you cite. Lies, d*amned lies, and statistics are, to paraphrase another clever observer of realities, facts are stubborn things, but statistics are pliable.
Greedy people at the top as in the UK. This rarely happens in small businesses which Sunak seems to ignore.
Greedy people at the top as in the UK. This rarely happens in small businesses which Sunak seems to ignore.
Let me guess: you work in the industry. I, too, worked in the industry – albeit in marketing and advertising – but often had to interview and write about the actuarial realities for in-house publications, where everyone already knew what was going on. The entire model is based on being a middleman, an aggregate. Removal of patient/doctor relationships with their own agreements on how treatment and payment is handled was murdered by the HMO system. It’s been a bureaucratic f*ck up ever since. It’s indefensible, no matter what percentages you cite. Lies, d*amned lies, and statistics are, to paraphrase another clever observer of realities, facts are stubborn things, but statistics are pliable.
A few months ago I heard an elderly lady interviewed on the radio here in UK. She did three jobs as a cleaner, working far more than full time, but could not afford health insurance because, having had cancer 20 years ago, it would cost her monthly earnings.
There is still free National Health presumably?
There is still free National Health presumably?
It probably started well before the corruption and greed got in. We are seeing similar in Britain but not as bad as the USA. Big Pharma has the governments eye and seems to have become part of the corrupt system. The nurses and doctors are mostly doing their best but they are subject to political systems over their heads.
The medical insurance companies make a profit in the 2-4% range (S&P average = 10%). Why do you think that they have a “rigged ” market?
A few months ago I heard an elderly lady interviewed on the radio here in UK. She did three jobs as a cleaner, working far more than full time, but could not afford health insurance because, having had cancer 20 years ago, it would cost her monthly earnings.
It probably started well before the corruption and greed got in. We are seeing similar in Britain but not as bad as the USA. Big Pharma has the governments eye and seems to have become part of the corrupt system. The nurses and doctors are mostly doing their best but they are subject to political systems over their heads.
The problem with finding any reform is that the British public are very wary of privatisation, having been stung in the past by the selling off various utilities and public transport. These have then ended up in a worse state, more expensive and all the while foreign shareholders extract millions of pounds in undeserved dividends.
The NHS needs reform, and in my opinion it tries to take on too much for the budget it has and stretches itself too thin. A big problem is the lack of space in the community to discharge patients to, so they end up blocking hospital beds causing horrendous backlogs and wait times. Somehow getting the health service and local care providers to join up their thinking and planning would do a lot of good
…a middle way between “In deep trouble” (NHS) and “Appalling for 40% of the population” (US) doesn’t sound like a great solution to me!
Our American system’s largest flaw is that most health insurance is tied to employment, in that insurance plans are part of a benefits package that employees must pay into. This is great for the middleman – not so much for the employee. And it’s very tough on the self-employed who must pay for expensive private plans. It was all made far worse when the HMO system (Health Maintenance Organizations) was foisted on most employers in the early 80s, forcing employees to only use doctors and medical services participating in the plans (the plans are tiered, so an hourly worker on an “affordable” plan gets minimal care and cr*p doctors, while government workers like public school teachers get premium coverage).
Gone are the days of your local GP whose office was in your neighborhood and you could make payments directly to him. No more house calls. Everything is managed; if you need to speak to an actual human, you need to go through an online “portal” and leave a detailed message, after which someone may get back to you in 24-48 hours. I broke my patella and right wrist after a bad fall last year and it took 11 days to be scheduled for surgery because I wasn’t notified by anyone that I had been scheduled a week earlier (I’m baffled as to how people get addicted to OxyContin: they did absolutely nothing to alleviate my pain).
The whole system is a mess, rigged to benefit insurance companies. And now we know that Big Pharma and medical establishments are working together to enrich themselves, patients be d*mned (just look at those willing and eager to surgically and chemically mutilate children). Best course of action? Don’t get sick, and try not to fall down.
I’m an American and have no skin in this particular game, but I read Unherd’s accounts of the NHS with interest because in America we deal with the same underlying issues (cost, ageing population, etc) but in a different way. We even occasionally flirt with the idea of UK-style socialized medicine.
I would say Mary Harrington has summarized the history, in-built tensions, and the challenges of the NHS as well as any other writer I’ve read.
My sense is the NHS must eventually change and make some hard decisions about the extent of care offered, especially to very old people. But never be tempted to go the purely private route. Let the US be your cautionary tale in that regard. Better to find a middle way.
Britain, let alone the NHS cannot manage a population of 67(?) million… but 72 million, total collapse awaits.
While the net rate of immigration is causing major problems in many areas, such as obviously housing, I don’t follow your logic here. There would be more patients, but also more staff (most of them immigrants!).
…who will also get old and sick. Importing 250-300k pa was a nonsense idea back under New Labour, now it’s unsustainable and it appears we can do nothing about it.
Tories are not much better allowing so much illegal immigration. Obviously their hearts are not in it otherwise they would deal with it. There is a catch somewhere which has not been exposed as yet.
Tories are not much better allowing so much illegal immigration. Obviously their hearts are not in it otherwise they would deal with it. There is a catch somewhere which has not been exposed as yet.
That blindingly obvious point is, as you can see, not very popular. In fact, with most migrants being fitter, healthier, smarter and more willing to work it’s a win-win situation with a very minor downside.
The same goes for housing: migrants can be trained quickly in housebuilding skills if they don’t already have them.. Unless blighty-whitey is going to make more babies and get off his fat arse there isn’t any other solution.
This comment may well be one of the lowest quality that this site has ever facilitated.
Maybe rude but the facts are correct.
Maybe rude but the facts are correct.
I don’t know why you have been marked down but it is a fact that the white population is dropping. Under the woke sexual revolution, mass abortion and people not bothering to start families the native population is not being replaced. That is a fact.
This comment may well be one of the lowest quality that this site has ever facilitated.
I don’t know why you have been marked down but it is a fact that the white population is dropping. Under the woke sexual revolution, mass abortion and people not bothering to start families the native population is not being replaced. That is a fact.
…who will also get old and sick. Importing 250-300k pa was a nonsense idea back under New Labour, now it’s unsustainable and it appears we can do nothing about it.
That blindingly obvious point is, as you can see, not very popular. In fact, with most migrants being fitter, healthier, smarter and more willing to work it’s a win-win situation with a very minor downside.
The same goes for housing: migrants can be trained quickly in housebuilding skills if they don’t already have them.. Unless blighty-whitey is going to make more babies and get off his fat arse there isn’t any other solution.
Localisation is the answer.. the NHS is top heavy, monstrously wasteful, impossibly politicised and and needs to be split up. If we in Ireland have better health outcomes than the UK (we do) then several HS to cover say a population of 5m or so will work far better. Even we are now regionalisation our mini monster fir all but high-tech / major hospitals, a system we had before.
“Globalisation” is bad even at national level! Localisation is the answer to so many of our ills these days.. too many behemoths!
Another factor is that health spending per capita in Ireland was about 17% higher than in Britain: £3510 (Ireland) vs £2990 (UK) in 2017, source – ons.gov.uk
17% is a big difference.
Ireland has much higher GDP per capita, more than twice as high; UK today is simply much poorer in comparison and cannot afford first-class healthcare.
Britain’s civilisation has been dropping ever since Cameron got in, but the seeds were probably there way before that. They just came to fruition when he got in.
Another factor is that health spending per capita in Ireland was about 17% higher than in Britain: £3510 (Ireland) vs £2990 (UK) in 2017, source – ons.gov.uk
17% is a big difference.
Ireland has much higher GDP per capita, more than twice as high; UK today is simply much poorer in comparison and cannot afford first-class healthcare.
Britain’s civilisation has been dropping ever since Cameron got in, but the seeds were probably there way before that. They just came to fruition when he got in.
While the net rate of immigration is causing major problems in many areas, such as obviously housing, I don’t follow your logic here. There would be more patients, but also more staff (most of them immigrants!).
Localisation is the answer.. the NHS is top heavy, monstrously wasteful, impossibly politicised and and needs to be split up. If we in Ireland have better health outcomes than the UK (we do) then several HS to cover say a population of 5m or so will work far better. Even we are now regionalisation our mini monster fir all but high-tech / major hospitals, a system we had before.
“Globalisation” is bad even at national level! Localisation is the answer to so many of our ills these days.. too many behemoths!
Britain, let alone the NHS cannot manage a population of 67(?) million… but 72 million, total collapse awaits.
Superb article, Mary. You reach the parts most others don’t with your perspicacity and insight.
Superb article, Mary. You reach the parts most others don’t with your perspicacity and insight.
Another unbelievably brilliant essay from Mrs Harrington – combining her usual stylistic flourishes with insight into the relationship between history, economics, foreign policy, immigration, social change, you name it.
It is asking for a lot, but I wish she could offer more potential solutions. From my perspective, it seems obvious that free healthcare for all is an economic impossibility. Nothing is free. And the best way to apportion anything that has a cost, is via a market. Either market reforms come to the NHS, or the NHS will continue its long, slow, spasm-ing death-rattle – and individual Britons who love the ‘idea’ of the NHS will continue to receive substandard medical care.
OK, not grand solutions, but 3 mid-level changes:
Sack most of the managersBan contractual lock-ins to in-patent drugs – allow the prescribing of cheap, generic drugsIf it still exists, shut down the unbelievably useless Public Health England or whatever has replaced it, as it was little more than a quango-shill for Big Vaping, and I very much doubt if its successor bodies will be any better. UK Health Security Agency and Office for Health Improvement and Disparities my foot – what on earth are such things even for?
OK, not grand solutions, but 3 mid-level changes:
Sack most of the managersBan contractual lock-ins to in-patent drugs – allow the prescribing of cheap, generic drugsIf it still exists, shut down the unbelievably useless Public Health England or whatever has replaced it, as it was little more than a quango-shill for Big Vaping, and I very much doubt if its successor bodies will be any better. UK Health Security Agency and Office for Health Improvement and Disparities my foot – what on earth are such things even for?
Another unbelievably brilliant essay from Mrs Harrington – combining her usual stylistic flourishes with insight into the relationship between history, economics, foreign policy, immigration, social change, you name it.
It is asking for a lot, but I wish she could offer more potential solutions. From my perspective, it seems obvious that free healthcare for all is an economic impossibility. Nothing is free. And the best way to apportion anything that has a cost, is via a market. Either market reforms come to the NHS, or the NHS will continue its long, slow, spasm-ing death-rattle – and individual Britons who love the ‘idea’ of the NHS will continue to receive substandard medical care.
Our political leaders on both sides have become so bent on publicly worshipping the NHS that they can no longer do anything to change it. Any change beyond tinkering at the edges will make it appear that they are attacking their own god. The service in Westminster Abbey yesterday says it all.
Our political leaders on both sides have become so bent on publicly worshipping the NHS that they can no longer do anything to change it. Any change beyond tinkering at the edges will make it appear that they are attacking their own god. The service in Westminster Abbey yesterday says it all.
Monolithic systems always fail in the end. Not sometimes. Not usually. Always.
Monolithic systems always fail in the end. Not sometimes. Not usually. Always.
Whatever reforms happen, they will only work if:
the freedoms of the market apply, where realistically possible – eg people can switch GP surgeries if they wish; surgeries can charge for no shows and control ancillary services; patients ‘pay’ for services with a personal NHS credit card; staff are not paid by rank, but by achievement and hours worked, and are not virtually unsackablethe government acts as a referee/regulator, not as executive, owner, planner, or player
You’ve hit on something fundamental there. Government cannot successfully arbitrate and regulate as well as provide. Doing so creates a honeypot for vested interests and a conflict of interest that eventually undermines everything it tries to do. That’s why only natural monopolies should be managed by the state. Healthcare is not a natural monopoly, so a form of mutualism regulated by government is a much better model.
American style? ..yer ‘havin’ larf init!
Not that old canard – there are alternatives to the American system! No-one likes or emulates the American system – not even the Americans. They repeatedly rank low on a multitude of researched comparisons.
Go away and Google the definition of ‘mutualism’.
Not that old canard – there are alternatives to the American system! No-one likes or emulates the American system – not even the Americans. They repeatedly rank low on a multitude of researched comparisons.
Go away and Google the definition of ‘mutualism’.
American style? ..yer ‘havin’ larf init!
You’ve hit on something fundamental there. Government cannot successfully arbitrate and regulate as well as provide. Doing so creates a honeypot for vested interests and a conflict of interest that eventually undermines everything it tries to do. That’s why only natural monopolies should be managed by the state. Healthcare is not a natural monopoly, so a form of mutualism regulated by government is a much better model.
Whatever reforms happen, they will only work if:
the freedoms of the market apply, where realistically possible – eg people can switch GP surgeries if they wish; surgeries can charge for no shows and control ancillary services; patients ‘pay’ for services with a personal NHS credit card; staff are not paid by rank, but by achievement and hours worked, and are not virtually unsackablethe government acts as a referee/regulator, not as executive, owner, planner, or player
Mary Harrington, as she usually does, provides yet again the most considered, reasoned, non rancorous, humane, insightful and contextual analysis of all of UnHerd’s contributors.
At the risk of sounding slightly ‘woke'(!), I do often feel that women think and write in a style that avoids what men so often appear to do, grinding their teeth and going into battle, with their real or imagined ideological enemies.
The world is complicated and there aren’t always obvious ‘goodies’ and ‘baddies’, and even if we prefer to.look at the world this way, there might be powerful historical reasons behind this.
Haven’t read much Julie Bindel, I’m guessing.
..I think she’s already married Andy?
Haven’t read much Julie Bindel, I’m guessing.
..I think she’s already married Andy?
Mary Harrington, as she usually does, provides yet again the most considered, reasoned, non rancorous, humane, insightful and contextual analysis of all of UnHerd’s contributors.
At the risk of sounding slightly ‘woke'(!), I do often feel that women think and write in a style that avoids what men so often appear to do, grinding their teeth and going into battle, with their real or imagined ideological enemies.
The world is complicated and there aren’t always obvious ‘goodies’ and ‘baddies’, and even if we prefer to.look at the world this way, there might be powerful historical reasons behind this.
Thank you Mary. Your look at pre NHS medicine is a good counter to today’s Times, according to which everyone died in childbirth, noone ever saw a doctor, and noone had any teeth or glasses. I got a surprise trying to find out how many hospitals were built after 1948. There are half the number now. Cottage hospitals and convalescent homes were all closed. And there was an interesting complaint from a Labour MP in the 1960s that Britain was building hospitals in its colonies, instead of in Britain.
Thank you Mary. Your look at pre NHS medicine is a good counter to today’s Times, according to which everyone died in childbirth, noone ever saw a doctor, and noone had any teeth or glasses. I got a surprise trying to find out how many hospitals were built after 1948. There are half the number now. Cottage hospitals and convalescent homes were all closed. And there was an interesting complaint from a Labour MP in the 1960s that Britain was building hospitals in its colonies, instead of in Britain.
The N.H.S. was cut and pasted from the Soviet Third Five-Year plan of 1938 with added Isotype.
..and all the better for that!
A particularly good example is The Little Red Engine and the Rocket by Diana Ross. The deluxe edition comes with plastic clipboard and working pencil.
A particularly good example is The Little Red Engine and the Rocket by Diana Ross. The deluxe edition comes with plastic clipboard and working pencil.
..and all the better for that!
The N.H.S. was cut and pasted from the Soviet Third Five-Year plan of 1938 with added Isotype.
Mary’s comments about pre-war health care make it sound rosy. My own family’s experience of it was far from that. Like a great many people, they could often not afford treatment and thus went without it. My maternal grandmother died because she was refused help by a doctor who demanded money upfront. The NHS changed things so that poor people could get medical treatment when needed. If it is to be replaced by a different system, caution is to be recommended–the generosity of others, personal or corporate cannot be assumed as definite.
You are so right. Berfore the NHS anyone who mattered – those with money – had no problem getting medical care. Those without mony – didn’t matter.
You are so right. Berfore the NHS anyone who mattered – those with money – had no problem getting medical care. Those without mony – didn’t matter.
Mary’s comments about pre-war health care make it sound rosy. My own family’s experience of it was far from that. Like a great many people, they could often not afford treatment and thus went without it. My maternal grandmother died because she was refused help by a doctor who demanded money upfront. The NHS changed things so that poor people could get medical treatment when needed. If it is to be replaced by a different system, caution is to be recommended–the generosity of others, personal or corporate cannot be assumed as definite.
I suspect it is too cynical to think that the Treasury is pursuing a deliberate policy of slow motion sabotage of the NHS but, even so, we seem to be drifting inexorably towards a two tier system with half of the population using BUPA et al and a rump NHS providing emergency cover and an under resourced service for the rest of the population. This might reduce costs to the Treasury but would end up costing patients more.
Maybe this is inevitable but I doubt it will lead to better outcomes or lower costs overall. Perhaps we should persevere a little longer with trying to make the existing “free at the point of delivery” model work. In such a huge organisation much of what matters is local or cultural but some obvious macro improvements are:
1/ Fix the IT. Almost any significant improvement in productivity requires effective IT but the NHS has a horrifying record of failure and has had to write off billions of spending on failed and abandoned projects. If one compares what has happened in banks and hospitals over the last thirty years one rapidly gets the point. Meanwhile half of most my medical appointments seem to involve the doctor either typing painfully slowly or desperately trying to find my records.
2/ End the “boom and bust” cycle with a hypothecated tax and a BBC style board. If say NI was repurposed and dedicated to health and social care it would provide a stable and fairly predictable revenue for the NHS of roughly the right size but one which would facilitate long term planning while providing steady and consistent pressure for productivity improvements. The current system has perverse effects and positively encourages crises while disrupting long term reform. Another point is that the Department of Health appears to be conducting a stealthy attempt to suck back power from the NHS Board – which will increase short term politicisation and impede long term reform. Instead the Board should be given statutory independence similar to that enjoyed by the BBC.
3/ Decentralise and allow some competition between models (without embracing full commercialisation). It is near impossible to run an organisation with over a million employees; some form of decentralisation is essential. A degree of competition would encourage innovation and other benefits. I live in the Scottish Highlands where medicine is inevitably a natural monopoly but there is no reason why in the major cities there should not be rival autonomous trusts using different models of integration with families free to switch (just as at the local level GPS have competed). Simon Stevens talked about this.
4/ Make it far harder to sue the NHS. The current blame culture and secrecy in the hospitals is reinforced by the fear of being sued – which sometimes seems to have as much impact on medical decisions as trying to help the patient. The aim should be to move to the approach used in the airline industry: open admission of errors as a first step to eliminating them.
Obviously these are only three of the many ideas needed but they make the point that there are ways to reform the current model. I am very sceptical that drifting to a two tier system – which seems our likely current destination – will improve either overall costs or outcomes.
I suspect it is too cynical to think that the Treasury is pursuing a deliberate policy of slow motion sabotage of the NHS but, even so, we seem to be drifting inexorably towards a two tier system with half of the population using BUPA et al and a rump NHS providing emergency cover and an under resourced service for the rest of the population. This might reduce costs to the Treasury but would end up costing patients more.
Maybe this is inevitable but I doubt it will lead to better outcomes or lower costs overall. Perhaps we should persevere a little longer with trying to make the existing “free at the point of delivery” model work. In such a huge organisation much of what matters is local or cultural but some obvious macro improvements are:
1/ Fix the IT. Almost any significant improvement in productivity requires effective IT but the NHS has a horrifying record of failure and has had to write off billions of spending on failed and abandoned projects. If one compares what has happened in banks and hospitals over the last thirty years one rapidly gets the point. Meanwhile half of most my medical appointments seem to involve the doctor either typing painfully slowly or desperately trying to find my records.
2/ End the “boom and bust” cycle with a hypothecated tax and a BBC style board. If say NI was repurposed and dedicated to health and social care it would provide a stable and fairly predictable revenue for the NHS of roughly the right size but one which would facilitate long term planning while providing steady and consistent pressure for productivity improvements. The current system has perverse effects and positively encourages crises while disrupting long term reform. Another point is that the Department of Health appears to be conducting a stealthy attempt to suck back power from the NHS Board – which will increase short term politicisation and impede long term reform. Instead the Board should be given statutory independence similar to that enjoyed by the BBC.
3/ Decentralise and allow some competition between models (without embracing full commercialisation). It is near impossible to run an organisation with over a million employees; some form of decentralisation is essential. A degree of competition would encourage innovation and other benefits. I live in the Scottish Highlands where medicine is inevitably a natural monopoly but there is no reason why in the major cities there should not be rival autonomous trusts using different models of integration with families free to switch (just as at the local level GPS have competed). Simon Stevens talked about this.
4/ Make it far harder to sue the NHS. The current blame culture and secrecy in the hospitals is reinforced by the fear of being sued – which sometimes seems to have as much impact on medical decisions as trying to help the patient. The aim should be to move to the approach used in the airline industry: open admission of errors as a first step to eliminating them.
Obviously these are only three of the many ideas needed but they make the point that there are ways to reform the current model. I am very sceptical that drifting to a two tier system – which seems our likely current destination – will improve either overall costs or outcomes.
By the so-called Rail Delivery Group’s own figures, one in eight tickets is still bought at a ticket office. Yet almost all of the ticket offices in England are to be closed, just because. But Britain alone has to have this model of railway provision, a model that after a generation, next to nobody still wants, yet which no party will consider reversing. It is bad everywhere, but it is worst in England.
For the same reason, England, alone in the United Kingdom and almost alone in the world, has to have privatised water. People from most other countries, including the United States, routinely refuse to believe that that exists, so absurd and so horrific is the entire concept. The reality fully confirms that assessment, and accordingly the huge majority of the supporters of all parties and none wants rid of it. Yet we have to carry on having it, just because.
And so to the seventy-fifth birthday of the National Health Service. The Fifth of July ought to be the United Kingdom’s national day, celebrated as fulsomely in this country as the Fourth of July was celebrated across the Atlantic. But instead, with horrible predictability, Tony Blair has been wheeled out out from wherever it is that he is kept, to demand more of the privatisation that he, Alan Milburn and Paul Corrigan brought from the outer fringes of the thinktank circuit to the heart of government in 1997. For the third time, though, only in England.
Keir Starmer and Wes Streeting are funded by the American healthcare companies, and no one doubts that Blair has an interest in them, or he would have made no intervention today. So much for his retirement. We should be so lucky.
Following the formal exposure of his daughter’s grift that had always been visible from outer space, no one mentioned that it should never have been Colonel Sir Tom Moore’s job to fund the NHS, that centenarians doing sponsored laps of their gardens was no way to do so, and that we were back to the Bullseye of my childhood, with people playing for the money to buy equipment for their local hospitals. All three parties have been in government, so they are all to blame.
That is why general media overage has been of the question of “whether we can still afford” the NHS. There has been much use of the obligatory, bone idle line about “the national religion”, the purpose of which is to suggest that the people’s overwhelmingly strong support for the NHS could not have the rational and empirical basis that the media, like the political parties, would lazily regard as the opposite of religious belief. As is their wont, the cancelled have been everywhere, with the deplatformed taking their usual place on every platform to canter around it their hobbyhorse of “social insurance”. But that more bureaucratic version of National Insurance is not the insurance peddled by their paymasters. Do not believe a word of it.
And Streeting is their man. Backed to the hilt by Starmer, he is the greatest threat to the NHS since its foundation. Aneurin Bevan would have called them “lower than vermin”. Bevan would never have made it onto the longlist for a Labour parliamentary candidacy under Starmer. Anyone who now expressed his opposition to prescription charges would be expelled from the Labour Party. Yet again, though, the only part of the United Kingdom to have prescription charges is England.
Good to see Paul Corrigan get a mention. The terrific pressure on NHS commissioners between 2001 and 2010 to find ways of ‘sharpening up’ traditional NHS providers (hospitals and community services) through competitive tendering and organisational restructuring seems to have been entirely forgotten. This was the real drive to privatisation, and it was almost monopolised by the New Labour gang.
Good to see Paul Corrigan get a mention. The terrific pressure on NHS commissioners between 2001 and 2010 to find ways of ‘sharpening up’ traditional NHS providers (hospitals and community services) through competitive tendering and organisational restructuring seems to have been entirely forgotten. This was the real drive to privatisation, and it was almost monopolised by the New Labour gang.
By the so-called Rail Delivery Group’s own figures, one in eight tickets is still bought at a ticket office. Yet almost all of the ticket offices in England are to be closed, just because. But Britain alone has to have this model of railway provision, a model that after a generation, next to nobody still wants, yet which no party will consider reversing. It is bad everywhere, but it is worst in England.
For the same reason, England, alone in the United Kingdom and almost alone in the world, has to have privatised water. People from most other countries, including the United States, routinely refuse to believe that that exists, so absurd and so horrific is the entire concept. The reality fully confirms that assessment, and accordingly the huge majority of the supporters of all parties and none wants rid of it. Yet we have to carry on having it, just because.
And so to the seventy-fifth birthday of the National Health Service. The Fifth of July ought to be the United Kingdom’s national day, celebrated as fulsomely in this country as the Fourth of July was celebrated across the Atlantic. But instead, with horrible predictability, Tony Blair has been wheeled out out from wherever it is that he is kept, to demand more of the privatisation that he, Alan Milburn and Paul Corrigan brought from the outer fringes of the thinktank circuit to the heart of government in 1997. For the third time, though, only in England.
Keir Starmer and Wes Streeting are funded by the American healthcare companies, and no one doubts that Blair has an interest in them, or he would have made no intervention today. So much for his retirement. We should be so lucky.
Following the formal exposure of his daughter’s grift that had always been visible from outer space, no one mentioned that it should never have been Colonel Sir Tom Moore’s job to fund the NHS, that centenarians doing sponsored laps of their gardens was no way to do so, and that we were back to the Bullseye of my childhood, with people playing for the money to buy equipment for their local hospitals. All three parties have been in government, so they are all to blame.
That is why general media overage has been of the question of “whether we can still afford” the NHS. There has been much use of the obligatory, bone idle line about “the national religion”, the purpose of which is to suggest that the people’s overwhelmingly strong support for the NHS could not have the rational and empirical basis that the media, like the political parties, would lazily regard as the opposite of religious belief. As is their wont, the cancelled have been everywhere, with the deplatformed taking their usual place on every platform to canter around it their hobbyhorse of “social insurance”. But that more bureaucratic version of National Insurance is not the insurance peddled by their paymasters. Do not believe a word of it.
And Streeting is their man. Backed to the hilt by Starmer, he is the greatest threat to the NHS since its foundation. Aneurin Bevan would have called them “lower than vermin”. Bevan would never have made it onto the longlist for a Labour parliamentary candidacy under Starmer. Anyone who now expressed his opposition to prescription charges would be expelled from the Labour Party. Yet again, though, the only part of the United Kingdom to have prescription charges is England.
OK, so the other day, Amanda Pritchard the so-called “CEO” of the NHS popped up to tell us that sorting out pay deals and compensation was something for the government and unions.
Really ?
Just what sort of a CEO is this woman ? I can’t think of any other CEO who has no ulitmate responsibility for such things. The fact that she can get away with passing the buck to the government here is absurd. What actual responsibilities and accountability does this woman have ?
Presumably, she is in charge of the entire NHS budget and bears the ultimate responsibility for how this is split between equipment, salaries, facilities, woke initiatives and other things. She should be making the tradeoff decisions here. Government provides the budget. She decides how to spend it.
Or is her job merely a sinecure ?
And what does – to take another example – The “Head of the NHS Confederation” (Matthew Taylor) have actual responsibility for ?
There are countless such people on large salaries.
So why does anyone believe the government should be responsible for their decisions ?
OK, so the other day, Amanda Pritchard the so-called “CEO” of the NHS popped up to tell us that sorting out pay deals and compensation was something for the government and unions.
Really ?
Just what sort of a CEO is this woman ? I can’t think of any other CEO who has no ulitmate responsibility for such things. The fact that she can get away with passing the buck to the government here is absurd. What actual responsibilities and accountability does this woman have ?
Presumably, she is in charge of the entire NHS budget and bears the ultimate responsibility for how this is split between equipment, salaries, facilities, woke initiatives and other things. She should be making the tradeoff decisions here. Government provides the budget. She decides how to spend it.
Or is her job merely a sinecure ?
And what does – to take another example – The “Head of the NHS Confederation” (Matthew Taylor) have actual responsibility for ?
There are countless such people on large salaries.
So why does anyone believe the government should be responsible for their decisions ?
It surely cannot be doubted that our NHS is chronically overstaffed and thus more expensive than necessary? My recent personal experience of this behemoth essentially started with a confident, and it transpired correct, diagnosis by my GP who, it seemed, was not trusted to make such decisions. So a consultant appointment was requested online. In a sane world I expected the request to be transmitted directly to the relevant hospital surgical team but it actually found it’s way to an anonymous Clinical Commissioning Group. Who sat on the request for over 18 months. And contacted me, by both (duplicated) SMS & Snail-Mail, several times to ascertain if the appointment was still required (It was). On turning up for the appointment I had to run the gauntlet of a largely disinterested receptionist, a nurse who took some information & measurements none of which was relevant to my case and then another nurse who escorted me to the consultants private room. They remained for the ‘consultation’ which lasted less than 2 minutes. It could and should have started and stopped with my GP. I doubt this is an isolated case.
Overstaffed? Too many (bad and overpaid) managers, too many inefficient and lazy administrators, not enough clinical staff.
The only surprise in your comment is that the GP got the diagnosis right first time.
Yep much wrong in that and fairly classic. albeit losing the referral for 18mths isn’t typical (or nobody ever get to see a Consultant) but it does happen. Always worth following up to check, esp given how the pandemic disrupted so much.
The referral vetting a symptom of cash limitations and the Lansley (Tory) reforms. I concur CCGs a disaster and add little value. But a Tory reform as I say.
Your GP may have felt they needed the confirmation of a Consultant diagnosis, and furthermore sometimes they sense the patient expects the referral regardless and thus acquiesce to satisfy the patient. May not have been a correct deduction in your case, but ‘normalised’ GP behaviour in many instances for understandable reasons.
Overstaffed? Too many (bad and overpaid) managers, too many inefficient and lazy administrators, not enough clinical staff.
The only surprise in your comment is that the GP got the diagnosis right first time.
Yep much wrong in that and fairly classic. albeit losing the referral for 18mths isn’t typical (or nobody ever get to see a Consultant) but it does happen. Always worth following up to check, esp given how the pandemic disrupted so much.
The referral vetting a symptom of cash limitations and the Lansley (Tory) reforms. I concur CCGs a disaster and add little value. But a Tory reform as I say.
Your GP may have felt they needed the confirmation of a Consultant diagnosis, and furthermore sometimes they sense the patient expects the referral regardless and thus acquiesce to satisfy the patient. May not have been a correct deduction in your case, but ‘normalised’ GP behaviour in many instances for understandable reasons.
It surely cannot be doubted that our NHS is chronically overstaffed and thus more expensive than necessary? My recent personal experience of this behemoth essentially started with a confident, and it transpired correct, diagnosis by my GP who, it seemed, was not trusted to make such decisions. So a consultant appointment was requested online. In a sane world I expected the request to be transmitted directly to the relevant hospital surgical team but it actually found it’s way to an anonymous Clinical Commissioning Group. Who sat on the request for over 18 months. And contacted me, by both (duplicated) SMS & Snail-Mail, several times to ascertain if the appointment was still required (It was). On turning up for the appointment I had to run the gauntlet of a largely disinterested receptionist, a nurse who took some information & measurements none of which was relevant to my case and then another nurse who escorted me to the consultants private room. They remained for the ‘consultation’ which lasted less than 2 minutes. It could and should have started and stopped with my GP. I doubt this is an isolated case.
The NHS makes perfect sense. It is the main vehicle used by socialists to gradually create a socialist dictatorship by stealth. They are now using compassion and morality to extend their grip. It is only a matter of time before the cloak of democracy falls to reveal their real intentions and by then it will be too late.
The NHS makes perfect sense. It is the main vehicle used by socialists to gradually create a socialist dictatorship by stealth. They are now using compassion and morality to extend their grip. It is only a matter of time before the cloak of democracy falls to reveal their real intentions and by then it will be too late.
Ireland’s health system might be worth looking at not least because we have better medical outcomes though our waiting lists are far too long, worse than the UK’S (until recently at least). We have a dual system similar to the UK but with much greater Private Health insurance take-up (46½% vs 22%). In this way the better off pay far more for health services (taxes plus insurance) and that includes me. It also means that the l9nger the waiting list the more private health insurance is purchased!
We have top-heavy management like the NHS so much so we’re now reverting to a regionalised system like we had in the past or at least partly so. We are also promoting local doctor-run clinics to deal with very minor cases.
In short, we are “Localising” services AMAP to simplify minor service delivery so they are not encumbered with OTT supports that high-tech services (possibly?) need. It is clear that while both types of service maybe be termed medical they are as different as chalk is from cheese in almost every sense.
To deal with Geriatric care we have a clever system whereby residents are required to contribute, not fixed amounts but a proportion of either their pensions or equity in their homes. It’s called the “Fair Deal” scheme and has the advantage of increasing with inflation. We also support stay-at-home elderly people with home services. The whole mishmash is what we call Irish solutions for Irish problems.
You are deluded. Ireland’s health device is completely dysfunctional. The fact it has better outcomes than the NHS isn’t much to write home about. The HSE is a disaster. Like the UK there are not enough doctors per head of population(below European average). Difficult to get a timely GP appointment (like UK). Ironically with Slaintecare trying to copy NHS. Probably best healthcare service to take a look at is Danish system.
You are deluded. Ireland’s health device is completely dysfunctional. The fact it has better outcomes than the NHS isn’t much to write home about. The HSE is a disaster. Like the UK there are not enough doctors per head of population(below European average). Difficult to get a timely GP appointment (like UK). Ironically with Slaintecare trying to copy NHS. Probably best healthcare service to take a look at is Danish system.
Ireland’s health system might be worth looking at not least because we have better medical outcomes though our waiting lists are far too long, worse than the UK’S (until recently at least). We have a dual system similar to the UK but with much greater Private Health insurance take-up (46½% vs 22%). In this way the better off pay far more for health services (taxes plus insurance) and that includes me. It also means that the l9nger the waiting list the more private health insurance is purchased!
We have top-heavy management like the NHS so much so we’re now reverting to a regionalised system like we had in the past or at least partly so. We are also promoting local doctor-run clinics to deal with very minor cases.
In short, we are “Localising” services AMAP to simplify minor service delivery so they are not encumbered with OTT supports that high-tech services (possibly?) need. It is clear that while both types of service maybe be termed medical they are as different as chalk is from cheese in almost every sense.
To deal with Geriatric care we have a clever system whereby residents are required to contribute, not fixed amounts but a proportion of either their pensions or equity in their homes. It’s called the “Fair Deal” scheme and has the advantage of increasing with inflation. We also support stay-at-home elderly people with home services. The whole mishmash is what we call Irish solutions for Irish problems.
In Australia we also have a State-funded health system where anyone can go to a GP or a hospital for free. Most Australians support it, and it’s a pretty good service. What’s mysterious to us is the way Brits worship the NHS in the way they do.
Australia does NOT have a system where anyone can go to a GP for free. GPs can charge patients any amount they want. The Australian government gives patients a fixed sum for each GP visit, but many (if not most) GPs charge an amount well in excess of that rebate.
Australia does NOT have a system where anyone can go to a GP for free. GPs can charge patients any amount they want. The Australian government gives patients a fixed sum for each GP visit, but many (if not most) GPs charge an amount well in excess of that rebate.
In Australia we also have a State-funded health system where anyone can go to a GP or a hospital for free. Most Australians support it, and it’s a pretty good service. What’s mysterious to us is the way Brits worship the NHS in the way they do.
Designed at a time when three score years and ten was life expectancy, Doctors and nurses weren’t in it for the money and b**b, nose and other adjustable surgery was undreamed of, at least by Joe Public. Now everybody’s got bad backs, knees, hips and diabetes, There’s cancer for hitherto unknown parts of the body and don’t start on the hypochondriacs, malingerers and facilities management bandits. No, tax relieved health insurance and let the market attend to the better off currently on the NHS books.
Designed at a time when three score years and ten was life expectancy, Doctors and nurses weren’t in it for the money and b**b, nose and other adjustable surgery was undreamed of, at least by Joe Public. Now everybody’s got bad backs, knees, hips and diabetes, There’s cancer for hitherto unknown parts of the body and don’t start on the hypochondriacs, malingerers and facilities management bandits. No, tax relieved health insurance and let the market attend to the better off currently on the NHS books.
The NHS needs a degree of decentralisation, an end to restrictive practices, realistic thinking as to what patients can reasonably expect, and more managed change. I’m retired now and only know about the clinical side but I remember the feeling of ‘here we go again’ when every new health secretary played with the service like it was a new toy. The reality is we have crumbling hospitals, inadequate kit, scarce staff leaving in droves, and an aging population so whatever the model, new money will have to be found. Health spending isn’t necessarily a bottomless pit but it is expensive and if we don’t pay for it we won’t get it. Beware of slipping into a two tier system, we have enough inequalities in this country, we don’t need any more. Beware of thinking that modern healthcare is simply a transaction between the individual and the organisation, there is a public health sphere as well. Beware people who slice and dice stats to suite their views, look at the decayed infrastructure, look at the shortages, we have the evidence of our own eyes. Take a long hard look at people advocating privatisation, to see if they have conflicts of interest.
What’s wrong with hand-written and entirely illegible scraps of paper as a record system? Those ‘computer thingies’ are overrated, I reckon.
Hand written by doctors? A profession which not only imagines that bad handwriting is a sign of brilliance, but thinks it is an acceptable substitute!
Hand written by doctors? A profession which not only imagines that bad handwriting is a sign of brilliance, but thinks it is an acceptable substitute!
What’s wrong with hand-written and entirely illegible scraps of paper as a record system? Those ‘computer thingies’ are overrated, I reckon.
The NHS needs a degree of decentralisation, an end to restrictive practices, realistic thinking as to what patients can reasonably expect, and more managed change. I’m retired now and only know about the clinical side but I remember the feeling of ‘here we go again’ when every new health secretary played with the service like it was a new toy. The reality is we have crumbling hospitals, inadequate kit, scarce staff leaving in droves, and an aging population so whatever the model, new money will have to be found. Health spending isn’t necessarily a bottomless pit but it is expensive and if we don’t pay for it we won’t get it. Beware of slipping into a two tier system, we have enough inequalities in this country, we don’t need any more. Beware of thinking that modern healthcare is simply a transaction between the individual and the organisation, there is a public health sphere as well. Beware people who slice and dice stats to suite their views, look at the decayed infrastructure, look at the shortages, we have the evidence of our own eyes. Take a long hard look at people advocating privatisation, to see if they have conflicts of interest.
We need to unravel the myths woven by the guardians. I simply don’t believe that the NHS is a cherished national institution. I believe the guardians say that, while daring anyone to contradict them. The popular appeal is towards health care, rather than to the particular, nationalised, form of delivering it. If I said I was only alive thanks to supermarkets, people would think it bonkers. Supermarkets are one way to distribute food, not the source of food itself. The dilemma now is that, for Labour, the NHS is a big political advantage while, for the Conservatives, it is simply too difficult to touch. So we are left with a guardian myth, a Labour advantage and no incentive whatever to improve.
You may be right, but in the absence of an alternative suggestion and explanation how it’d work people may cling to what they know.
I think all politicians have an incentive to improve it given how much it does resonate with voters.
The Author and Javid both did the usual – no specific alternative suggestions, just hand wringing.
It feels like the time to pull out the quote from Patton: “when everyone’s thinking the same, there isn’t any thinking going on”.
If there’s an apparent universal concensus that the NHS in “wonderful” and a “national treasure” and the sainted staff are beyond criticism, I think you can be fairly sure that none of these are actually true.
If the NHS were a world class organisation, criticism would be enouraged and used as an opportunity to learn and improve.
You may be right, but in the absence of an alternative suggestion and explanation how it’d work people may cling to what they know.
I think all politicians have an incentive to improve it given how much it does resonate with voters.
The Author and Javid both did the usual – no specific alternative suggestions, just hand wringing.
It feels like the time to pull out the quote from Patton: “when everyone’s thinking the same, there isn’t any thinking going on”.
If there’s an apparent universal concensus that the NHS in “wonderful” and a “national treasure” and the sainted staff are beyond criticism, I think you can be fairly sure that none of these are actually true.
If the NHS were a world class organisation, criticism would be enouraged and used as an opportunity to learn and improve.
We need to unravel the myths woven by the guardians. I simply don’t believe that the NHS is a cherished national institution. I believe the guardians say that, while daring anyone to contradict them. The popular appeal is towards health care, rather than to the particular, nationalised, form of delivering it. If I said I was only alive thanks to supermarkets, people would think it bonkers. Supermarkets are one way to distribute food, not the source of food itself. The dilemma now is that, for Labour, the NHS is a big political advantage while, for the Conservatives, it is simply too difficult to touch. So we are left with a guardian myth, a Labour advantage and no incentive whatever to improve.
A very interesting article by Mary, containing much information that was new to me. There were a couple of details missing. First, the NHS took over a large number of military hospitals in exchange for an undertaking to give service veterans priority. This undertaking is still in force but, by making it subject to “clinical need”, has been rendered meaningless.
Also, the Attlee government believed, with charming naivety, that once the NHS had been running for a few years the population would be so much more healthy that costs would fall. Bless.
A very interesting article by Mary, containing much information that was new to me. There were a couple of details missing. First, the NHS took over a large number of military hospitals in exchange for an undertaking to give service veterans priority. This undertaking is still in force but, by making it subject to “clinical need”, has been rendered meaningless.
Also, the Attlee government believed, with charming naivety, that once the NHS had been running for a few years the population would be so much more healthy that costs would fall. Bless.
Another lucid thoughtful essay from Mary H, much as I distrust politicians use and abuse of the great NHS edifice, I find some empathy with the recent call from Savid Javid for a Royal Commission on its institution and future. My own experiences as a relatively healthy 78 year old are mixed, and I’ve observed that at all the first level care services, great care and commitment is evident but cynicism is so evident the further up the chain one engages .,The present widespread changes in GP services whereby contact face to face with a doctor is a rarity is utterly deplorable and yet becoming accepted as the new norm by many of my articulate peers, and” let the bodies pile up” seems to be the the option for the older others who cannot use modern technology and who do not have active family support.
Suggestion on GPs? Given the huge shortfall and demographic timebomb on the current workforce?
There is alot that suggests many patients prefer on line consultations – less travelling and less inconvenience if working. But to be fair that’s less pronounced with more elderly. GPs need to offer a mix.
Suggestion on GPs? Given the huge shortfall and demographic timebomb on the current workforce?
There is alot that suggests many patients prefer on line consultations – less travelling and less inconvenience if working. But to be fair that’s less pronounced with more elderly. GPs need to offer a mix.
Another lucid thoughtful essay from Mary H, much as I distrust politicians use and abuse of the great NHS edifice, I find some empathy with the recent call from Savid Javid for a Royal Commission on its institution and future. My own experiences as a relatively healthy 78 year old are mixed, and I’ve observed that at all the first level care services, great care and commitment is evident but cynicism is so evident the further up the chain one engages .,The present widespread changes in GP services whereby contact face to face with a doctor is a rarity is utterly deplorable and yet becoming accepted as the new norm by many of my articulate peers, and” let the bodies pile up” seems to be the the option for the older others who cannot use modern technology and who do not have active family support.
I listened to a striking medical consultant interviewed on BBC Radio 4 last week. Like so many of his striking junior doctor colleagues, similarly demanding a 35% pay increase, and nurses, he said he was on strike because he was concerned for falling standards of patient care and the need to better resource the NHS. Two questions:
If this man and his colleagues were tomorrow awarded a 35% pay increase, how would this improve patient care and NHS resourcing>In spite of being awarded a 35% pay increase in the above scenario, would this man and his colleagues continue to strike out of concern for the quality of their patients’ care and the resourcing of the NHS?
Frankly, I would have more respect for these striking people if they just stated bluntly that they wanted more money – period – rather than feeding us crap about their noble motives.
I listened to a striking medical consultant interviewed on BBC Radio 4 last week. Like so many of his striking junior doctor colleagues, similarly demanding a 35% pay increase, and nurses, he said he was on strike because he was concerned for falling standards of patient care and the need to better resource the NHS. Two questions:
If this man and his colleagues were tomorrow awarded a 35% pay increase, how would this improve patient care and NHS resourcing>In spite of being awarded a 35% pay increase in the above scenario, would this man and his colleagues continue to strike out of concern for the quality of their patients’ care and the resourcing of the NHS?
Frankly, I would have more respect for these striking people if they just stated bluntly that they wanted more money – period – rather than feeding us crap about their noble motives.
“It’s over-managed but under-managed; too expensive but not expensive enough; too safety-obsessed and not concerned enough with safety.”
You’ve just described every national bureaucracy of any sort ever, and exactly why the LAST thing any government should be trusted with is health care.
When I came to the USA to clean up messes – yes there were some (notably DMV – driver’s licensing) that were huge bureaucratic messes – but I quickly found that every company was the same Pacific Bell, At&T, you name them… i.e. the public/private thing was irrelevant – it’s the size and the middle management stasis PLUS the CEO shuffle (wealthy families)
This is true, although companies lack the government’s official monopoly on violence with which to enforce their edicts, its immunity to the crucial need to be effectively profitable, and by way of the civil service, its insulation from the people who pay its salaries. In addition, people can choose not to buy or use services or products they don’t want. Health care is something that everyone sooner or later MUST have access to. Giving government a monopoly on it is almost as bad as giving the government a monopoly on the dissemination of news and information.
This is true, although companies lack the government’s official monopoly on violence with which to enforce their edicts, its immunity to the crucial need to be effectively profitable, and by way of the civil service, its insulation from the people who pay its salaries. In addition, people can choose not to buy or use services or products they don’t want. Health care is something that everyone sooner or later MUST have access to. Giving government a monopoly on it is almost as bad as giving the government a monopoly on the dissemination of news and information.
When I came to the USA to clean up messes – yes there were some (notably DMV – driver’s licensing) that were huge bureaucratic messes – but I quickly found that every company was the same Pacific Bell, At&T, you name them… i.e. the public/private thing was irrelevant – it’s the size and the middle management stasis PLUS the CEO shuffle (wealthy families)
“It’s over-managed but under-managed; too expensive but not expensive enough; too safety-obsessed and not concerned enough with safety.”
You’ve just described every national bureaucracy of any sort ever, and exactly why the LAST thing any government should be trusted with is health care.
That is a very strange analysis of the pre-war health system, as if it was 100% funded by ‘local authority taxation … churches, charities, private subscription and mutual societies’; that is obvious baloney! That may indeed have covered much, maybe most, but what about the private sector, and the fact that most (?) people wanting health care had to pay a doctor or hospital for it, so funded health with their own money payments!
Hospitals had almoners ( yes, just one each, hard to believe now) who were there to help the poorer patients. Ever hear of anyone going bankrupt from being in hospital pre 1948? No.
No, but one hears a lot about poor people avoiding health care because they couldn’t afford it! They didn’t have lines of credit so couldn’t go bankrupt – that is not a get out clause for the working class so irrelevant to mention. Not my point though, which is that the author entirely disregards the very large private health sector and the charging for basic health care.
Now heath care is unavailable to many. No appointments to see GPs so illnesses are not being picked up, long waits to see consultants and have operations. Not much point in it being free if it isn’t working
Now heath care is unavailable to many. No appointments to see GPs so illnesses are not being picked up, long waits to see consultants and have operations. Not much point in it being free if it isn’t working
No, but one hears a lot about poor people avoiding health care because they couldn’t afford it! They didn’t have lines of credit so couldn’t go bankrupt – that is not a get out clause for the working class so irrelevant to mention. Not my point though, which is that the author entirely disregards the very large private health sector and the charging for basic health care.
Most people in the UK currently “fund health care with their own money payments”. The difference between that and the pre-NHS system is that, pre-NHS, your health payments went directly to the healthcare provider, rather than through the tax system and the bloated civil service.
Hospitals had almoners ( yes, just one each, hard to believe now) who were there to help the poorer patients. Ever hear of anyone going bankrupt from being in hospital pre 1948? No.
Most people in the UK currently “fund health care with their own money payments”. The difference between that and the pre-NHS system is that, pre-NHS, your health payments went directly to the healthcare provider, rather than through the tax system and the bloated civil service.
That is a very strange analysis of the pre-war health system, as if it was 100% funded by ‘local authority taxation … churches, charities, private subscription and mutual societies’; that is obvious baloney! That may indeed have covered much, maybe most, but what about the private sector, and the fact that most (?) people wanting health care had to pay a doctor or hospital for it, so funded health with their own money payments!
“Provision was split between three main groups: voluntary hospitals, “Poor Law” institutions and local authorities.”
This is a grotesque over-simplification. Many working class people could not afford the fees for their local doctor. There was an elderly trade unionist who wrote for the Guardian a few years ago, and he chronicled, from bitter experience, the terrors of having no medical help available in times of need.
“Provision was split between three main groups: voluntary hospitals, “Poor Law” institutions and local authorities.”
This is a grotesque over-simplification. Many working class people could not afford the fees for their local doctor. There was an elderly trade unionist who wrote for the Guardian a few years ago, and he chronicled, from bitter experience, the terrors of having no medical help available in times of need.
47% of hospitals, says Mary Harrington, were run by local authorities. Were we to return to this presumed idyllic state, where’s the money going to come from? Is she arguing for devolution on a massive scale? And does each local authority devise its own specialities? Or do they cooperate on some kind of aaagh! National Health Service? Old L. P. Hartley in his first sentence to The Go Between was being so much more prescient than he ever, ever knew!
It was one of those pseudo-clever points made by the Author after some basic GCSE type research into the formulation of the NHS.
A fundamental problem with LAs was their size and whether co-terminous boundaries acted against sensible healthcare economies of scale and concentration. LAs also couldn’t run national standard regulation or workforce planning – at least for doctors/nurses etc. Author would be guilty of v ‘rose tinted’ view of pre-WW2 healthcare were she that old. She’s just guilty of insufficient inquisitiveness as to why we ended up where we did.
But you know when the Author implied the NHS at fault for our withdrawal from Aden and Diego Garcia you know we’re into reverse nostalgia.
It was one of those pseudo-clever points made by the Author after some basic GCSE type research into the formulation of the NHS.
A fundamental problem with LAs was their size and whether co-terminous boundaries acted against sensible healthcare economies of scale and concentration. LAs also couldn’t run national standard regulation or workforce planning – at least for doctors/nurses etc. Author would be guilty of v ‘rose tinted’ view of pre-WW2 healthcare were she that old. She’s just guilty of insufficient inquisitiveness as to why we ended up where we did.
But you know when the Author implied the NHS at fault for our withdrawal from Aden and Diego Garcia you know we’re into reverse nostalgia.
47% of hospitals, says Mary Harrington, were run by local authorities. Were we to return to this presumed idyllic state, where’s the money going to come from? Is she arguing for devolution on a massive scale? And does each local authority devise its own specialities? Or do they cooperate on some kind of aaagh! National Health Service? Old L. P. Hartley in his first sentence to The Go Between was being so much more prescient than he ever, ever knew!
The author clearly has no understanding whatsoever of the times immediately post-1945. The electorate had been provoked beyond endurance by thirty years of war and depression. As my late mother used to put it, “we were told we had won, and wanted a prize”. There was a general determination for “no return to the 1930s”, “no resetting the clock to 1938”.
The British, and particularly the English have a strongly developed sense of “fairness” which has little or nothing to do with the leftist use of the term. They believe in equslity of opportunity, and dont much worry about the outcome. They wanted decent homes for returning soldiers and as an urban, industrial people they greatly valued health care.
They were at odds with the ruling politica class, but for once the rulers were afraid of them.
The author clearly has no understanding whatsoever of the times immediately post-1945. The electorate had been provoked beyond endurance by thirty years of war and depression. As my late mother used to put it, “we were told we had won, and wanted a prize”. There was a general determination for “no return to the 1930s”, “no resetting the clock to 1938”.
The British, and particularly the English have a strongly developed sense of “fairness” which has little or nothing to do with the leftist use of the term. They believe in equslity of opportunity, and dont much worry about the outcome. They wanted decent homes for returning soldiers and as an urban, industrial people they greatly valued health care.
They were at odds with the ruling politica class, but for once the rulers were afraid of them.
The big problem with reforming the NHS — and the rest of the welfare state — is that it will require people to pay for stuff that is presently “free.”
In general, humans will burn the place down rather than pay for stuff they used to get for “free.”
Yup, well spotted. It’s that undermining and disastrous aversion-to-loss drive etched so deeply into our hunter gather brains. It can be circumvented sometimes at an individual level, but is very difficult to pull off on the mass scale.
Yup, well spotted. It’s that undermining and disastrous aversion-to-loss drive etched so deeply into our hunter gather brains. It can be circumvented sometimes at an individual level, but is very difficult to pull off on the mass scale.
The big problem with reforming the NHS — and the rest of the welfare state — is that it will require people to pay for stuff that is presently “free.”
In general, humans will burn the place down rather than pay for stuff they used to get for “free.”
Having lived briefly in the US, all I know is that I’d sure hate to be old, ill and poor in the US.
Old you get covered by Medicare, poor or you get covered by Medicaid. Not that I would have the American system over any other in the Western World. It’s the people in the middle that get shafted – hugely expensive insurance (especially as % of income) – frequent arguments and surprises over who pays what (merely being picked up by an ER ambulance that is not covered by your insurance can cost thousands) – 500,000 people a year declare bankruptcy due to unpayable medical bills!
I live in the USA – it varies by state but it’s clear – suicide and ‘gun death’ are a normal choice for the average bloke who has saved maybe 50 grand or owns a house worth anything – then it’s healthcare where a week in hospital is 30 grand. People choose death to leave it to their children. I know several cases personally.
On a smaller scale – putting your parent in ‘elder-care’ can cost $100K a year – who the hell can afford that? So families get torn apart – endless compromises and arguments – again 1/2 the people I know here
Contrast my Mother in the UK – early Dementia late 70s – home visits twice a week then as she declined twice a week (from NHS) then moved to a lovely home with 24×7 care – ALL FREE – no suicides – no shame – she worked hard in the land army and deserved every penny. You choose where to live?
Is it a class thing?
Above should say “twice a day” – why can’t we edit our comments?
Above should say “twice a day” – why can’t we edit our comments?
I live in the USA – it varies by state but it’s clear – suicide and ‘gun death’ are a normal choice for the average bloke who has saved maybe 50 grand or owns a house worth anything – then it’s healthcare where a week in hospital is 30 grand. People choose death to leave it to their children. I know several cases personally.
On a smaller scale – putting your parent in ‘elder-care’ can cost $100K a year – who the hell can afford that? So families get torn apart – endless compromises and arguments – again 1/2 the people I know here
Contrast my Mother in the UK – early Dementia late 70s – home visits twice a week then as she declined twice a week (from NHS) then moved to a lovely home with 24×7 care – ALL FREE – no suicides – no shame – she worked hard in the land army and deserved every penny. You choose where to live?
Is it a class thing?
Everyone over 65 gets state provided health care through Medicare. The poor get it free health care through Medicaid. If you’re both old and poor, you get covered by both. There are gaps and flaws in the US system, but the old and poor are well covered. Also, in the US the old get treatment pretty much immediately. There are no year-long wait lists for hip-replacements.
The problems of the US system are concentrated around working age people without employer provided healthcare.
Misleading – see above comment
Yep, and the overall costs – much greater per capita than in the UK. In part why you don’t wait for certain elective care, but it’s more than that. Your system has some significant macro inefficiencies, but marvellous care at a micro level when you get it.
Misleading – see above comment
Yep, and the overall costs – much greater per capita than in the UK. In part why you don’t wait for certain elective care, but it’s more than that. Your system has some significant macro inefficiencies, but marvellous care at a micro level when you get it.
Old you get covered by Medicare, poor or you get covered by Medicaid. Not that I would have the American system over any other in the Western World. It’s the people in the middle that get shafted – hugely expensive insurance (especially as % of income) – frequent arguments and surprises over who pays what (merely being picked up by an ER ambulance that is not covered by your insurance can cost thousands) – 500,000 people a year declare bankruptcy due to unpayable medical bills!
Everyone over 65 gets state provided health care through Medicare. The poor get it free health care through Medicaid. If you’re both old and poor, you get covered by both. There are gaps and flaws in the US system, but the old and poor are well covered. Also, in the US the old get treatment pretty much immediately. There are no year-long wait lists for hip-replacements.
The problems of the US system are concentrated around working age people without employer provided healthcare.
Having lived briefly in the US, all I know is that I’d sure hate to be old, ill and poor in the US.
It’s fun to watch Mary’s evolution toward traditionally Rightwing economic theories. As ugly as Capitalistic systems are with profit taking, decentralization and localization of goods and services far outperforms Nationalized alternatives. (I’ve been a expat in France, Ireland, and the Netherlands with many British friends). Much can be said about the cost of American healthcare, but we fund much of the R&D for new diagnostics and treatments that are later subsidized on a global basis. America’s inefficiencies are rooted in half-a__ed intrusions by the US Government trying to impose National administration rather than setting up guardrails as they should. Nothing is ever perfect, but nationalized healthcare in the US given Federal government corporation and ineptitude would be a disaster. Sounds like the UK isn’t that much better.
Yes US has the best cutting edge health care in the world…if you can access/afford it.
It also spends almost double the UK and on a population basis has no better outcomes.
You are correct nothing is ever perfect. I’d contend we’ve much to learn from the US, both on what works better and what doesn’t. There is plenty of both.
Yes US has the best cutting edge health care in the world…if you can access/afford it.
It also spends almost double the UK and on a population basis has no better outcomes.
You are correct nothing is ever perfect. I’d contend we’ve much to learn from the US, both on what works better and what doesn’t. There is plenty of both.
It’s fun to watch Mary’s evolution toward traditionally Rightwing economic theories. As ugly as Capitalistic systems are with profit taking, decentralization and localization of goods and services far outperforms Nationalized alternatives. (I’ve been a expat in France, Ireland, and the Netherlands with many British friends). Much can be said about the cost of American healthcare, but we fund much of the R&D for new diagnostics and treatments that are later subsidized on a global basis. America’s inefficiencies are rooted in half-a__ed intrusions by the US Government trying to impose National administration rather than setting up guardrails as they should. Nothing is ever perfect, but nationalized healthcare in the US given Federal government corporation and ineptitude would be a disaster. Sounds like the UK isn’t that much better.
Australia and many other countries benefited from health professionals tho fled the NHS looking for a saner existence. But then Medicare arrived in Australia. Not what was wanted or recommended by the expert panel set up to advise the government. But a political solution to a problem that largely didn’t exist.
Australia and many other countries benefited from health professionals tho fled the NHS looking for a saner existence. But then Medicare arrived in Australia. Not what was wanted or recommended by the expert panel set up to advise the government. But a political solution to a problem that largely didn’t exist.
Fascinating story about the trade offs made between welfare and defence – that much possibly was not new – but linking Britain’s focus on the welfare state at the expense of geopolitical power is a new way of thinking of it for me. Very interesting indeed.
Fascinating story about the trade offs made between welfare and defence – that much possibly was not new – but linking Britain’s focus on the welfare state at the expense of geopolitical power is a new way of thinking of it for me. Very interesting indeed.
I am an American fascinated with the lively, thoughtful, and varied positions taken in the Unherd comments. One assertion stated multiple times here and in other commentaries is respecting “unearned” dividends. Can someone explain to me what that means? I apologize for my ignorance. But it comes up frequently.
Any economists (or Marxists) please correct me, but usually when a UK Labour politician or supporter uses the phrase “unearned divdiends” it’s a disguised disparaging of return on capital investment and of capitalist enterprise in general. Where it gets interesting and more debatable, is in the case of the more rapacious end of Private Equity ownership, (asset stripping, a less used phrase now) and squeezing the assets dry. They effectively mean what the Marxists call rentier class behaviour. It’s a complex world out there isn’t it.
Any economists (or Marxists) please correct me, but usually when a UK Labour politician or supporter uses the phrase “unearned divdiends” it’s a disguised disparaging of return on capital investment and of capitalist enterprise in general. Where it gets interesting and more debatable, is in the case of the more rapacious end of Private Equity ownership, (asset stripping, a less used phrase now) and squeezing the assets dry. They effectively mean what the Marxists call rentier class behaviour. It’s a complex world out there isn’t it.
I am an American fascinated with the lively, thoughtful, and varied positions taken in the Unherd comments. One assertion stated multiple times here and in other commentaries is respecting “unearned” dividends. Can someone explain to me what that means? I apologize for my ignorance. But it comes up frequently.
One hears of many organisations that are, “too big to [be allowed to] fail,” but the NHS presents us with the striking case of an organisation that is too big, or at least in the wrong condition, to survive.
I would like to offer some gem of advice, which would be eagerly seized upon as a solution, but I can’t. So, I shall just watch as the problem finds its own solution, irrespective of any formal plan.
One hears of many organisations that are, “too big to [be allowed to] fail,” but the NHS presents us with the striking case of an organisation that is too big, or at least in the wrong condition, to survive.
I would like to offer some gem of advice, which would be eagerly seized upon as a solution, but I can’t. So, I shall just watch as the problem finds its own solution, irrespective of any formal plan.
Isn’t the elephant in the room in this discussion the question of why we are so unhealthy as a population that we need such institutions, however they are organised and funded? We make ourselves sick and susceptible to disease through poor nutrition, lack of exercise, lack of connection with green spaces and fresh air, too much stress, lack of meaning for many people, (and another elephant) iatrogenic disease etc. The pharmaceutical industry has a huge interest in keeping us unhealthy. We have seen how easy it is to scare the living daylights out of most people by telling them that they are weak and vulnerable and need the state to look after their health to the point of micro-controlling their lives. The state wants to keep us sick too. If our governments instead enacted policies that supported better health the need for hospitals and “health centres” could be greatly reduced, no?
Isn’t the elephant in the room in this discussion the question of why we are so unhealthy as a population that we need such institutions, however they are organised and funded? We make ourselves sick and susceptible to disease through poor nutrition, lack of exercise, lack of connection with green spaces and fresh air, too much stress, lack of meaning for many people, (and another elephant) iatrogenic disease etc. The pharmaceutical industry has a huge interest in keeping us unhealthy. We have seen how easy it is to scare the living daylights out of most people by telling them that they are weak and vulnerable and need the state to look after their health to the point of micro-controlling their lives. The state wants to keep us sick too. If our governments instead enacted policies that supported better health the need for hospitals and “health centres” could be greatly reduced, no?
Excellent article. It provokes thoughts of similarities in the devolution of the US healthcare system.
I wonder how much it would help, and not just the NHS, if the Tories had the guts to raise taxes for those earning, say, six figure salaries.
Author shows no real insight into why so many still support the NHS. She’s mystified, or at least likes to project that. One suspects she just doesn’t want to admit the public don’t share her view and for good reason. She then ‘cops out’ and offers no alternatives or policy suggestions claiming agnosticism. And the point to this Article was…
Now of course there is much wrong that needs corrective or new medicine. A week ago the Tory Govt finally announced a national long term workforce plan and stopped this essential being blocked repeatedly by Treasury. We’d need this whether having an NHS or not and it’s absence has been crippling. We’ve too much decrepit infrastructure and that needs a national plan. We need to resolve how we are going to pay for social care, something many more of us are going to need in old age. Currently it is silting up too much NHS capacity. There is then something about how we better manage the avalanche in ‘worried well’ and the single condition Charities and drug companies that seek to grab greater shares of the available resource. Perhaps the French reimbursement model for Primary care appointments worth trying, and banning Drug companies from funding Charities worth considering. Technology and AI diagnosis can help deliver further efficiencies too.
But let’s not lose some key strengths. Significant regulation always essential as information and knowledge asymmetrical. Medical services have tendency to concentration and are natural monopolies, esp for emergency care. Hence Govt has to play a major role. It’s admin costs are amongst the lowest – management can be improved though but we waste no money filtering insurance bureaucracy. We can do more on public health – we all know we exercise less and eat more sugar than people my age did in our youth. We’ve all agency here but also the way we manage society too has a consequence.
Remember US spends twice the per capita GDP and has massive macro-inefficiencies and poorer population outcomes. Every health system grappling with aging population and thus hardly a surprise we are all reflecting on how best to handle this.
Then the intangible the Author secretly detests – that sense of social solidarity and equality. And furthermore the fact as the biggest employer in Europe we all know someone who works in it and so many personal and family experiences are bound up with it.
Hagiography of our NHS unwarranted and unhelpful. Over simplistic criticism and failure to engage with the challenges indolent.
Really.. stop. We all have experience of the NHS and say French systems and so we all know that it is crumbling inefficient and now quite dangerous. The international comparative stats on performance do not lie. GP surgeries threw barbed wire around themselves in covid and we just cannot get in to see the 100k 3 days a week guardians anymore. Talk to Phone. The 7 million people and 1 year waiting lists do not lie. The BBC’s Kim choir propaganda now feels sickly & insulting. The idea that the striking super rich consultahts and glint eyed entitled gold plated young doctors (all in food banks we are told) warrant our respect is a joke. They way that they and the Nurses jeopardise patients lives for more money is sickening. They do great harm. You are also ignoring the fact that this NHS is the reason our economy and State finances are ruined and in an inflationary death spiral triggered by NHS systemic failure. We were imprisoned to save the reputation of an ill prepared no bed panicked institution that shafted are homes and turned into a National Covid Service. There is no way back for this NHS now. As the death toll of excess deaths from them stopping cancer services mounts, the Big Lie of State NHS worship just will not wash. We are all in a Traumazone but – yet again – the vast undemocratic NHS First State Blob & the weak political class they lead by the nose will not move to protect us from harm.
Oh dear. Yet again you forget to mention the Right been in charge for 13yrs and to solve the NHS problem undertook one it’s biggest restructures. You forget to mention we don’t spend what the French, Germans et al do per capita. You forget to mention Tory Treasury blocked a national joined up workforce plan, until err…last wk when at least Sunak/Hunt thought they want to be remembered for something positive. You don’t mention what you expect nurses and doctors to do when their real incomes have reduced much more than private sector equivalents, and even if you disagree with the remuneration contention you offer no solution. You certainly don’t mention what you’d do to address social care and how it backwashes into NHS capacity.
In fact fairly standard WM – high on invective and indignation, low on real understanding and practical way forward. It’s why perhaps Brexit had such appeal. Same psychological trigger. But it doesn’t address anything does it other than a bit of ego.
Of course J Watson! It is all about Tory misrule, insufficient funding and Brexit! Silly me! You pontificate so grandly – then quickly give up and dole out crass personal insult. Very Elect. Not very Unherd. I am not a Tory. I just want a radically new different NHS (and social care..forgive me not writing a 1000 page manifesto) as this one is now sickly and broken. You seem to deny all the NHS management’s own multiple failures (a pandemic prep plan/hospital bed removals?). They share as much culpability for this car crash as the forever doomed/flawed Tory AND Labour reforms (disastrous GP contract?). Wake up. 1948 into 2023 does not go. We can see and have experienced the far superior twin funded French and German systems but the Left’s obsession with a socialist monolith religion stops us embracing a better future. The relationship between people and NHS has been forever broken by the 2 year lockdown to protect IT, not us. If you are truly comfortable with the strike action of gold plated consultants at a time of such suffering, fine. You would do better to track the excess death data your pot pan bashing brought about. Lets resume communication in a few years when poor Wes and we are overwhelmed by these same old systemic problems but still too cowardly to grasp a way out that suits the suffering people, not the NHS itself.
Actually we got something out of you there WM – you’d welcome a move to the social insurance model in Germany/France. There are some differences between the two, but I concur much to be said for both systems. The insurance is compulsory of course so in many regards more a hypothecated tax (I’d welcome that in the UK). Employers contribute and in Germany the regions have greater admin role. The safety net is there for those without cover too.
Both spend more in total as proportion of GDP and have done for years. They both have national workforce plans fully funded to ensure sufficient healthcare professionals available.
Still like it? I do.
And guess what – the EU not stopped either and as sovereign countries they’ve made these decisions entirely themselves.
Actually we got something out of you there WM – you’d welcome a move to the social insurance model in Germany/France. There are some differences between the two, but I concur much to be said for both systems. The insurance is compulsory of course so in many regards more a hypothecated tax (I’d welcome that in the UK). Employers contribute and in Germany the regions have greater admin role. The safety net is there for those without cover too.
Both spend more in total as proportion of GDP and have done for years. They both have national workforce plans fully funded to ensure sufficient healthcare professionals available.
Still like it? I do.
And guess what – the EU not stopped either and as sovereign countries they’ve made these decisions entirely themselves.
Of course J Watson! It is all about Tory misrule, insufficient funding and Brexit! Silly me! You pontificate so grandly – then quickly give up and dole out crass personal insult. Very Elect. Not very Unherd. I am not a Tory. I just want a radically new different NHS (and social care..forgive me not writing a 1000 page manifesto) as this one is now sickly and broken. You seem to deny all the NHS management’s own multiple failures (a pandemic prep plan/hospital bed removals?). They share as much culpability for this car crash as the forever doomed/flawed Tory AND Labour reforms (disastrous GP contract?). Wake up. 1948 into 2023 does not go. We can see and have experienced the far superior twin funded French and German systems but the Left’s obsession with a socialist monolith religion stops us embracing a better future. The relationship between people and NHS has been forever broken by the 2 year lockdown to protect IT, not us. If you are truly comfortable with the strike action of gold plated consultants at a time of such suffering, fine. You would do better to track the excess death data your pot pan bashing brought about. Lets resume communication in a few years when poor Wes and we are overwhelmed by these same old systemic problems but still too cowardly to grasp a way out that suits the suffering people, not the NHS itself.
Oh dear. Yet again you forget to mention the Right been in charge for 13yrs and to solve the NHS problem undertook one it’s biggest restructures. You forget to mention we don’t spend what the French, Germans et al do per capita. You forget to mention Tory Treasury blocked a national joined up workforce plan, until err…last wk when at least Sunak/Hunt thought they want to be remembered for something positive. You don’t mention what you expect nurses and doctors to do when their real incomes have reduced much more than private sector equivalents, and even if you disagree with the remuneration contention you offer no solution. You certainly don’t mention what you’d do to address social care and how it backwashes into NHS capacity.
In fact fairly standard WM – high on invective and indignation, low on real understanding and practical way forward. It’s why perhaps Brexit had such appeal. Same psychological trigger. But it doesn’t address anything does it other than a bit of ego.
Yes, but what I do know is that it is impossible to see a GP (I am in Scotland) and I don’t see that changing for the better. Something *has* to give, but, just like Mary, I don’t know what.
AI GPs? ..will AI be better at diagnosis and also prognosis. It will do the ‘paperwork’ a million times faster. Perhaps we’ll have an AI GP at every pharmacy?
Yes you’d think this is one area where AI can make a real difference. We’re not there yet though. Diagnosis tends to be combination of questioning on medical history, examination and diagnostic tests. Some of these are more easily migrated to an AI solution than others.
Yes you’d think this is one area where AI can make a real difference. We’re not there yet though. Diagnosis tends to be combination of questioning on medical history, examination and diagnostic tests. Some of these are more easily migrated to an AI solution than others.
Yep getting a GP appt can be a nightmare. Many reasons of course. The shortage of GPs being the main one. Solution is obvious – we have to train and retain more but that’s not quick and we needed to grasp this some years back.
There are other factors – how the incentives work for GPs re: capitation – needs overhaul but remember most remain private contractors so at a time of shortage not a simple uncontentious fix. The explosion in worried well seeking GP consultation a factor too – maybe some AI will offer medium term part solutions but we aren’t there yet.
AI GPs? ..will AI be better at diagnosis and also prognosis. It will do the ‘paperwork’ a million times faster. Perhaps we’ll have an AI GP at every pharmacy?
Yep getting a GP appt can be a nightmare. Many reasons of course. The shortage of GPs being the main one. Solution is obvious – we have to train and retain more but that’s not quick and we needed to grasp this some years back.
There are other factors – how the incentives work for GPs re: capitation – needs overhaul but remember most remain private contractors so at a time of shortage not a simple uncontentious fix. The explosion in worried well seeking GP consultation a factor too – maybe some AI will offer medium term part solutions but we aren’t there yet.
I presume you are also an ardent Remainer. I am amazed how many admirers of the EU are so blind to the superiority of mainland European healthcare services, none of which are run like the NHS monolith. I’ve had experience of the French system (quite superb) and the Italian equivalent (nearly as good). Friends who lived in Germany say it’s utilitarian but 50% better than the NHS. Outside of the EU, Israel (running by private companies licenced by the government and in open competition) is possibly the best of all.
Cognitive dissonance. Misty-eyed fondness. Myopia. You display all of these when it comes to the dying, unfair, command-and-control behemoth that is the NHS. A service which more or less led to both of my parents dying early and treated one of them as an administrative inconvenience.
I’d find your nostalgia touching if it wasn’t so damaging.
Remainers worship the NHS for the same reason they worship the EU: a love of centralised authoritarian control and a class-driven belief that most people other than them are incapable of managing their own affairs. It’s basically a form of snobbery.
Just maybe they sense the chumps who’d pull it to pieces would end up making the mess they’ve made of Brexit. All critique, ya-boo and no plan. Folks can sense that more now.
That said some reforms are needed.
Just maybe they sense the chumps who’d pull it to pieces would end up making the mess they’ve made of Brexit. All critique, ya-boo and no plan. Folks can sense that more now.
That said some reforms are needed.
Just a thought as I have no idea how to really make the Health Service run better, but to suggest that what we need is a privatised system regulated by government is rather a triumph of hope over expectation. It is a set-up which has utterly failed in the UK with the privatisation of utilities, so why should it work for a health service?
You make a fair point – the fact is other countries manage it. I suspect their are too many vested interests in the NHS and our ‘Rolls Royce’ civil service is in fact a clapped-out 1980s Lada.
Not many BJ. Even in the US they spend as much on Medicaid and Medicare as we spend on the NHS, and those only cover who can’t afford private insurance.
The social insurance models in western Europe are essentially not that different from funding via tax. But there is a little more choice in provider. That though has it’s limits too as the complexity of health care leads to concentration in providers for obvious reasons and Govt regulation remains firm.
The reason we haven’t moved easily to another form of provision is actually all face similar problems and nobody cracked it. Comparatively, and ironically, the NHS controls costs better than most (salaried, no fee for service generating unnecessary care, no insurance bureaucracy), but mess up workforce planning and you’ll get waiting lists and probs getting hold of a GP.
Not many BJ. Even in the US they spend as much on Medicaid and Medicare as we spend on the NHS, and those only cover who can’t afford private insurance.
The social insurance models in western Europe are essentially not that different from funding via tax. But there is a little more choice in provider. That though has it’s limits too as the complexity of health care leads to concentration in providers for obvious reasons and Govt regulation remains firm.
The reason we haven’t moved easily to another form of provision is actually all face similar problems and nobody cracked it. Comparatively, and ironically, the NHS controls costs better than most (salaried, no fee for service generating unnecessary care, no insurance bureaucracy), but mess up workforce planning and you’ll get waiting lists and probs getting hold of a GP.
You make a fair point – the fact is other countries manage it. I suspect their are too many vested interests in the NHS and our ‘Rolls Royce’ civil service is in fact a clapped-out 1980s Lada.
Wow.. that bad, eh?
As you read, but glossed over, some reforms are needed. But the French spend more, significantly. They’ve had long term national workforce plans for years. Same in Germany. And social care, whilst it has it’s problems, not in the state it is in the UK. Nonetheless their reimbursement model I like.
Israel quite a small country so comparison more difficult, but it has universal cover and 4 non profit schemes that compete with each other. Patients pay some top ups. It certainly has significant Govt oversight but much we can also learn from I agree. They have a much younger population though and that makes quite a difference to the pressure on a system.
Remainers worship the NHS for the same reason they worship the EU: a love of centralised authoritarian control and a class-driven belief that most people other than them are incapable of managing their own affairs. It’s basically a form of snobbery.
Just a thought as I have no idea how to really make the Health Service run better, but to suggest that what we need is a privatised system regulated by government is rather a triumph of hope over expectation. It is a set-up which has utterly failed in the UK with the privatisation of utilities, so why should it work for a health service?
Wow.. that bad, eh?
As you read, but glossed over, some reforms are needed. But the French spend more, significantly. They’ve had long term national workforce plans for years. Same in Germany. And social care, whilst it has it’s problems, not in the state it is in the UK. Nonetheless their reimbursement model I like.
Israel quite a small country so comparison more difficult, but it has universal cover and 4 non profit schemes that compete with each other. Patients pay some top ups. It certainly has significant Govt oversight but much we can also learn from I agree. They have a much younger population though and that makes quite a difference to the pressure on a system.
You have completely missed the point of this article, I’d say mainly because you have a partisan and pretty slanted position (championing the current NHS system, which let’s remind ourselves is an outlier) and Mary Harrington does not. Her article was not trying to analyse and evaluate the ideal health service structure, but providing what seemed to most of us, an excellent analysis of how we got to where we are, and, perhaps to your delight, possibly staying there. Although performing the sin in passing of mentioning that no other European country has adopted the same system!
The link to defence spending was particularly interesting; recall that we do not in fact today have an entirely ‘free at the point of delivery’ system. Dental and optical charges were introduced when the country was rearming at the time of the Korean War, and have stayed ever since. Also mentioned was the often forgotten fact that GPs are private businesses, one consequence of which is that the government has next to no power to direct where they are located. That means in turn that provision is very patchy and often too little in ‘challenging’ areas.
It is quite incredible how many Remainer types – (maybe a bit of a simplistic label but it certainly means something) – consider almost every aspect of European institutions and culture superior to Britain’s, with the exception of healthcare, where there isn’t even a debate or even interest, just ignorance or silent denial.
Since you’ve entered this territory, to mention advantages that you might be theoretically correct about, such as administrative efficiency, but not to mention the mediocre patient outcomes achieved with current funding levels, is like saying that your election leaflets were judged the best after you’d suffered a landslide defeat! Or your team’s racing car, which came in last in the Grand Prix having the nicest livery – etc.
The NHS now has among the highest state funding of all European health systems so that excuse is no longer credible.
https://www.spectator.co.uk/article/the-nhs-isnt-underfunded/
A couple of your points are pretty desperate:
“Then the intangible the Author secretly detests – that sense of social solidarity and equality”
(British people of course, are intrinsically more socialist (despite decades of Thatcherism and Blairism!) than the French or Germans, and don’t care about piddling matters such as patient care or outcomes. Instead, they are apparently big on “equality” – which by the way, is actually far from being achieved in the actual existing NHS!).
How do you know Mary Harrington secretly “detests” this social solidarity? It’s a strong word to use, and nothing I’ve ever heard her write or say makes this view remotely likely. She often speaks from personal experience and has balanced and fair views. When you start imputing opinions someone has never said, it’s a sure sign of a poor argument.
And then of course we have the obligatory paragraph about the United States’ equally idiosyncratic healthcare system (compared with other developed nations), but in the other direction. No politician or think tank in the UK has ever advocated a move to anything remotely resembling the American system, so this sort of argument often just acts as an attempt at an emotive brake on any debate about significant reform of any kind. I’d certainly agree that although certain types of care in the US are among the best in the world, overall the system is very costly and with poor outcomes. So, yes, the current NHS system is preferable to that particular alternative!
I have had really poor experiences of NHS hospital care over three generations of my family, of which chaos, lack of information, and poor pastoral care loom the most. (My, as it turned out, dying partner, dropping his pills from his trembling hands and not one of the nurses having the basic human decency to do anything about it, being a particular nadir).
So my views might be less positive than most. However, the British public’s views are also starting to become much less positive. (It’s all the Tories’ fault, comes the inevitable cry!).
I’d say sympathy, ‘fairness’, history and emotion, and perhaps to some extent even your ‘social solidarity’ are on the side of the long term continuation of the NHS model. But other factors are working strongly against it: patient outcomes (objective), qualitative experience, and the fact that despite a lot of cant on the issue, most people really aren’t all that keen on paying (even) higher taxes to the general government coffers. There is a different feeling and a greater degree of control about the same amount of money being taken through other means, as occurs in Europe.
Why else do you think he mentions American but not European healthcare?
Err you extolling the virtues of the western European way of doing things? Blimey there is hope yet.
Err you extolling the virtues of the western European way of doing things? Blimey there is hope yet.
That article in the Spectator is disingenuous and frankly a distortion of the statistics. Look at the health spending per capita, on which measure we are much further down the table, and way lower than Switzerland.
Everything’s more expensive in Switzerland. Higher per capita GDP – of course health spending per capita is higher.
Everything’s more expensive in Switzerland. Higher per capita GDP – of course health spending per capita is higher.
I did actually mention the French reimbursement model something I think could be tried in the UK, esp with primary care visits. Would need a safety net for those who couldn’t pay, but always thought this worth a go.
That aside the Euro countries we should compare ourselves to – France and Germany, just spend more, significantly so on all measures and for many years thus a compound benefit effect. They don’t have the workforce probs we do in the UK in part because they’ve national plans. Now how UK would compare on performance were to equalise on both these advantages would be intriguing.
That doesn’t mean some things shouldn’t be reformed.
But you do what the Author did – all critique and indignation no practical ideas. I didn’t actually make a link to Brexit but as you did one could contend it’s the same desire to critique but not really have an alternative practical plan again that characterised the Brexit failure.
Why else do you think he mentions American but not European healthcare?
That article in the Spectator is disingenuous and frankly a distortion of the statistics. Look at the health spending per capita, on which measure we are much further down the table, and way lower than Switzerland.
I did actually mention the French reimbursement model something I think could be tried in the UK, esp with primary care visits. Would need a safety net for those who couldn’t pay, but always thought this worth a go.
That aside the Euro countries we should compare ourselves to – France and Germany, just spend more, significantly so on all measures and for many years thus a compound benefit effect. They don’t have the workforce probs we do in the UK in part because they’ve national plans. Now how UK would compare on performance were to equalise on both these advantages would be intriguing.
That doesn’t mean some things shouldn’t be reformed.
But you do what the Author did – all critique and indignation no practical ideas. I didn’t actually make a link to Brexit but as you did one could contend it’s the same desire to critique but not really have an alternative practical plan again that characterised the Brexit failure.
Well said
Sorry jw, no amount of recycling old tropes about the US can disguise the very simple fact that anyone who has experienced healthcare services in France – and even Italy – is well aware of: by comparison the NHS is a shambles..
I use the NHS in Italy. A call to my GP produces an appointment a few days hence ( non urgent). Looking for a flat in a small town bear Lucca, c 3500 inhabitants, I was intrigued to see how many doctors were listed. Maybe you can hang out your shingle without interning in a hospital for several years. I dont know. But they seem to be dong something right.
Covered the significant funding difference earlier above, but I concur that with that funding and national plans there are things we can learn and adapt from Europe, esp western Europe. Great to see you pushing the wonderfulness of how they do things just over the Channel.
Some things. Far from everything. You’re again making sweeping assumptions and stretching what people write – as in your assumption that Mary Harrington “detests” social solidarity. Only she can know that. But most of us would be surprised.
Most UnHerd Articles are based on sweeping generalisations aren’t they PB? We’re not reading scientific papers are we.
But point taken – I don’t know exactly what MH thinks about social solidarity, but I get the impression from reading her articles she sees alot of it as Lefty, woke-ist rubbish. Didn’t she speak at the Nat C conference? Not exactly a bastion of collective approaches to social policy.
I think you might be doing it again – denouncing someone by association. The fact that she spoke at a certain conference certainly does not mean that she agrees with all the views of the organisation.
Indeed, I doubt whether Mary Harrington would even consider herself to be a conservative of any description. That’s clearly not the direction she’s coming from (at least my inference from reading many of her articles). However, it may be where she’s – perhaps not wholly consciously – headed. But I suspect that’s easier for us to see from outside than for her. She’s exhibiting all the classic signs of my own decline from moral righteousness – getting older, moving to a rural/semi-rural/small town environment from an urban one, settling down with children.
But I don’t think she’s close to reaching dismissing stuff as “lefty woke-ist rubbish” yet. Also too good a writer to need to.
I think she’s clever enough to know what audience to cultivate and what they like to hear. She has to make a living of course and becoming a darling of the Nat C’s or whatever but one way of doing that.
That said I read her stuff. Makes you think for sure. But where I think she’s talking cobblers or misleading with a bit of GCSE history I’ll chip in.
I think she’s clever enough to know what audience to cultivate and what they like to hear. She has to make a living of course and becoming a darling of the Nat C’s or whatever but one way of doing that.
That said I read her stuff. Makes you think for sure. But where I think she’s talking cobblers or misleading with a bit of GCSE history I’ll chip in.
I think you might be doing it again – denouncing someone by association. The fact that she spoke at a certain conference certainly does not mean that she agrees with all the views of the organisation.
Indeed, I doubt whether Mary Harrington would even consider herself to be a conservative of any description. That’s clearly not the direction she’s coming from (at least my inference from reading many of her articles). However, it may be where she’s – perhaps not wholly consciously – headed. But I suspect that’s easier for us to see from outside than for her. She’s exhibiting all the classic signs of my own decline from moral righteousness – getting older, moving to a rural/semi-rural/small town environment from an urban one, settling down with children.
But I don’t think she’s close to reaching dismissing stuff as “lefty woke-ist rubbish” yet. Also too good a writer to need to.
Most UnHerd Articles are based on sweeping generalisations aren’t they PB? We’re not reading scientific papers are we.
But point taken – I don’t know exactly what MH thinks about social solidarity, but I get the impression from reading her articles she sees alot of it as Lefty, woke-ist rubbish. Didn’t she speak at the Nat C conference? Not exactly a bastion of collective approaches to social policy.
Some things. Far from everything. You’re again making sweeping assumptions and stretching what people write – as in your assumption that Mary Harrington “detests” social solidarity. Only she can know that. But most of us would be surprised.
I use the NHS in Italy. A call to my GP produces an appointment a few days hence ( non urgent). Looking for a flat in a small town bear Lucca, c 3500 inhabitants, I was intrigued to see how many doctors were listed. Maybe you can hang out your shingle without interning in a hospital for several years. I dont know. But they seem to be dong something right.
Covered the significant funding difference earlier above, but I concur that with that funding and national plans there are things we can learn and adapt from Europe, esp western Europe. Great to see you pushing the wonderfulness of how they do things just over the Channel.
Really.. stop. We all have experience of the NHS and say French systems and so we all know that it is crumbling inefficient and now quite dangerous. The international comparative stats on performance do not lie. GP surgeries threw barbed wire around themselves in covid and we just cannot get in to see the 100k 3 days a week guardians anymore. Talk to Phone. The 7 million people and 1 year waiting lists do not lie. The BBC’s Kim choir propaganda now feels sickly & insulting. The idea that the striking super rich consultahts and glint eyed entitled gold plated young doctors (all in food banks we are told) warrant our respect is a joke. They way that they and the Nurses jeopardise patients lives for more money is sickening. They do great harm. You are also ignoring the fact that this NHS is the reason our economy and State finances are ruined and in an inflationary death spiral triggered by NHS systemic failure. We were imprisoned to save the reputation of an ill prepared no bed panicked institution that shafted are homes and turned into a National Covid Service. There is no way back for this NHS now. As the death toll of excess deaths from them stopping cancer services mounts, the Big Lie of State NHS worship just will not wash. We are all in a Traumazone but – yet again – the vast undemocratic NHS First State Blob & the weak political class they lead by the nose will not move to protect us from harm.
Yes, but what I do know is that it is impossible to see a GP (I am in Scotland) and I don’t see that changing for the better. Something *has* to give, but, just like Mary, I don’t know what.
I presume you are also an ardent Remainer. I am amazed how many admirers of the EU are so blind to the superiority of mainland European healthcare services, none of which are run like the NHS monolith. I’ve had experience of the French system (quite superb) and the Italian equivalent (nearly as good). Friends who lived in Germany say it’s utilitarian but 50% better than the NHS. Outside of the EU, Israel (running by private companies licenced by the government and in open competition) is possibly the best of all.
Cognitive dissonance. Misty-eyed fondness. Myopia. You display all of these when it comes to the dying, unfair, command-and-control behemoth that is the NHS. A service which more or less led to both of my parents dying early and treated one of them as an administrative inconvenience.
I’d find your nostalgia touching if it wasn’t so damaging.
You have completely missed the point of this article, I’d say mainly because you have a partisan and pretty slanted position (championing the current NHS system, which let’s remind ourselves is an outlier) and Mary Harrington does not. Her article was not trying to analyse and evaluate the ideal health service structure, but providing what seemed to most of us, an excellent analysis of how we got to where we are, and, perhaps to your delight, possibly staying there. Although performing the sin in passing of mentioning that no other European country has adopted the same system!
The link to defence spending was particularly interesting; recall that we do not in fact today have an entirely ‘free at the point of delivery’ system. Dental and optical charges were introduced when the country was rearming at the time of the Korean War, and have stayed ever since. Also mentioned was the often forgotten fact that GPs are private businesses, one consequence of which is that the government has next to no power to direct where they are located. That means in turn that provision is very patchy and often too little in ‘challenging’ areas.
It is quite incredible how many Remainer types – (maybe a bit of a simplistic label but it certainly means something) – consider almost every aspect of European institutions and culture superior to Britain’s, with the exception of healthcare, where there isn’t even a debate or even interest, just ignorance or silent denial.
Since you’ve entered this territory, to mention advantages that you might be theoretically correct about, such as administrative efficiency, but not to mention the mediocre patient outcomes achieved with current funding levels, is like saying that your election leaflets were judged the best after you’d suffered a landslide defeat! Or your team’s racing car, which came in last in the Grand Prix having the nicest livery – etc.
The NHS now has among the highest state funding of all European health systems so that excuse is no longer credible.
https://www.spectator.co.uk/article/the-nhs-isnt-underfunded/
A couple of your points are pretty desperate:
“Then the intangible the Author secretly detests – that sense of social solidarity and equality”
(British people of course, are intrinsically more socialist (despite decades of Thatcherism and Blairism!) than the French or Germans, and don’t care about piddling matters such as patient care or outcomes. Instead, they are apparently big on “equality” – which by the way, is actually far from being achieved in the actual existing NHS!).
How do you know Mary Harrington secretly “detests” this social solidarity? It’s a strong word to use, and nothing I’ve ever heard her write or say makes this view remotely likely. She often speaks from personal experience and has balanced and fair views. When you start imputing opinions someone has never said, it’s a sure sign of a poor argument.
And then of course we have the obligatory paragraph about the United States’ equally idiosyncratic healthcare system (compared with other developed nations), but in the other direction. No politician or think tank in the UK has ever advocated a move to anything remotely resembling the American system, so this sort of argument often just acts as an attempt at an emotive brake on any debate about significant reform of any kind. I’d certainly agree that although certain types of care in the US are among the best in the world, overall the system is very costly and with poor outcomes. So, yes, the current NHS system is preferable to that particular alternative!
I have had really poor experiences of NHS hospital care over three generations of my family, of which chaos, lack of information, and poor pastoral care loom the most. (My, as it turned out, dying partner, dropping his pills from his trembling hands and not one of the nurses having the basic human decency to do anything about it, being a particular nadir).
So my views might be less positive than most. However, the British public’s views are also starting to become much less positive. (It’s all the Tories’ fault, comes the inevitable cry!).
I’d say sympathy, ‘fairness’, history and emotion, and perhaps to some extent even your ‘social solidarity’ are on the side of the long term continuation of the NHS model. But other factors are working strongly against it: patient outcomes (objective), qualitative experience, and the fact that despite a lot of cant on the issue, most people really aren’t all that keen on paying (even) higher taxes to the general government coffers. There is a different feeling and a greater degree of control about the same amount of money being taken through other means, as occurs in Europe.
Well said
Sorry jw, no amount of recycling old tropes about the US can disguise the very simple fact that anyone who has experienced healthcare services in France – and even Italy – is well aware of: by comparison the NHS is a shambles..
Author shows no real insight into why so many still support the NHS. She’s mystified, or at least likes to project that. One suspects she just doesn’t want to admit the public don’t share her view and for good reason. She then ‘cops out’ and offers no alternatives or policy suggestions claiming agnosticism. And the point to this Article was…
Now of course there is much wrong that needs corrective or new medicine. A week ago the Tory Govt finally announced a national long term workforce plan and stopped this essential being blocked repeatedly by Treasury. We’d need this whether having an NHS or not and it’s absence has been crippling. We’ve too much decrepit infrastructure and that needs a national plan. We need to resolve how we are going to pay for social care, something many more of us are going to need in old age. Currently it is silting up too much NHS capacity. There is then something about how we better manage the avalanche in ‘worried well’ and the single condition Charities and drug companies that seek to grab greater shares of the available resource. Perhaps the French reimbursement model for Primary care appointments worth trying, and banning Drug companies from funding Charities worth considering. Technology and AI diagnosis can help deliver further efficiencies too.
But let’s not lose some key strengths. Significant regulation always essential as information and knowledge asymmetrical. Medical services have tendency to concentration and are natural monopolies, esp for emergency care. Hence Govt has to play a major role. It’s admin costs are amongst the lowest – management can be improved though but we waste no money filtering insurance bureaucracy. We can do more on public health – we all know we exercise less and eat more sugar than people my age did in our youth. We’ve all agency here but also the way we manage society too has a consequence.
Remember US spends twice the per capita GDP and has massive macro-inefficiencies and poorer population outcomes. Every health system grappling with aging population and thus hardly a surprise we are all reflecting on how best to handle this.
Then the intangible the Author secretly detests – that sense of social solidarity and equality. And furthermore the fact as the biggest employer in Europe we all know someone who works in it and so many personal and family experiences are bound up with it.
Hagiography of our NHS unwarranted and unhelpful. Over simplistic criticism and failure to engage with the challenges indolent.