‘Doing the rounds sometimes even means treating patients in storerooms.’ APU GOMES/AFP via Getty Images)
This week, while carrying out a SITREP or situation report in hospital, I came across a 93-year-old woman lying on a trolley in a corridor. Tailgating her was a 94-year-old man, also on a trolley, also suffering from a terminal illness, also largely unaware of where he was or what was going on. Further along the line of desperate patients was a heavily sedated and recently sectioned 58-year-old woman. She too was waiting for a bed. She may as well wait for Godot.
Most consultants will have similar stories. The practice is now so normalised that it has led to its own subbranch of clinical practice: “corridor care”. The Whittington Hospital in London, for instance, has caused a stink by openly advertising for a dedicated “corridor nurse” who can offer care to patients who haven’t got the luxury of a ward bed, let alone a private room.
The situation is so bad that treatment in temporary escalation spaces (TES) sadly goes beyond corridors, extending to storerooms, carparks and even, in one case, a converted toilet. If there’s a space, there’ll be a patient in it. Wes Streeting may lament that he’s “genuinely distressed” by the conditions facing patients, but the fact is that without corridoring, the NHS would collapse. Last month, some 54,000 people waited over 12 hours for treatment, stranded by toilets and drinks machines until ward space finally freed up. And if that’s not shocking enough, an even bigger scandal is that Streeting seems unable to respond.
Wherever you look in the NHS, it’s on the brink of disaster. In Liverpool, to give one example, the local NHS trust lately took the extraordinary step of declaring a critical incident as a flu outbreak put untenable strain on the system, with some patients waiting 50 hours to be seen. The move quickly prompted other trusts to follow suit. That’s despite historic pressure from NHS England to avoid such declarations because of worries around “reputational damage”.
There are many causes for this fiasco, and not all of them are medical. To be sure, hospitals were lately forced to grapple with a “quademic” of respiratory illnesses, quickly overwhelming A&E departments. I’m seeing this myself: patients are increasingly arriving with severe respiratory infections, often exacerbated by the simple inability to heat their own homes. Amid the chaos, the health secretary was notably vocal, though unfortunately not about hospitals. Rather, Streeting has spent much of his time attacking Elon Musk’s controversial comments on grooming gangs.
This lack of focus, coming just as Labour announced its intention to delay social care reform until 2028, has not gone unnoticed by medical professionals. Six months into his role, Streeting’s record on delivering concrete healthcare reforms remains notably thin. I’m not alone in noticing his careful cultivation of a public profile that appears designed to position him as a potential future Labour leader rather than a minister on a mission.
But Streeting’s aspirations for greater power shouldn’t come at the expense of addressing immediate healthcare crises. And he seems unwilling to confront the changing nature of British society, let alone the impact this has on healthcare. We have an ageing population, more single-parent families, more singletons and child-free families. At the same time, fewer and fewer people have the networks and resources to help them, not just in times of crisis but also to support them before their health spirals.
Demographics are squeezing the NHS in other ways too. There are children caring for alcoholic or drug-dependent parents, families supporting disabled relatives, and countless others managing painful chronic conditions without sufficient help. The social pressures here are bewilderingly multifaceted. And when the worst does happen, this assorted jetsam usually ends up in A&E, often because they can’t see their GP.
These issues are unlikely to be resolved soon. And what the Department of Health has announced doesn’t seem much better. Consider a new IT upgrade, trumpeted by politicians and hospital managers alike. In theory, it’ll make booking appointments easier, cutting waiting lists and bolstering treatment. But over my three decades working for the NHS, I’ve seen technological “solutions” come and go, even as the reality on the ground tells a story of exclusion and waste. The NHS’s track record here is grim in the extreme. The failed £11 billion National Programme for IT; the troubled NHS 111 app rollout; the recent Covid-19 contact tracing app debacle — all these represent just a fraction of the billions squandered on digital initiatives, often causing more problems than they solve.
One reason for this is the fundamental disconnect between policy and practice. Apps are all well and good for tech-savvy users comfortable with electronic devices. But they’re not the majority of people I see in A&E. Nor are the usual suspects — older patients or those who struggle with English — the only ones to suffer here. Think about the visually impaired, or else those in rural areas without decent internet. These aren’t edge cases either: 11 million Britons lack basic digital skills, while 1.5 million households don’t have any internet access at all. The irony is that these digital barriers often affect those most in need of healthcare services, creating a two-tier system. The saving grace, if you can call it that, is that some of those in my corridors are so far gone in terms of mental faculty that they have no clue what’s happening around them.
Meanwhile, Streeting likes to claim his personal experience as a cancer patient gives him skin in the game, and he’s fond of saying he’ll “save the NHS because it saved me” — but there’s growing concern among rank-and-file staff that this emotive narrative is being wielded as a political weapon than a catalyst for meaningful change. Where the Tories once gaslit the British public, Labour now makes promises it knows it can’t keep.
To be fair to Streeting, he’s only following the example of his predecessors. From John Hutton’s Labour government rating system in the early 2000s, to Andrew Lansley’s ill-fated Conservative changes a decade later, politicians have long heralded their reforms as the solution to the UK’s healthcare woes — without ever reflecting on the underlying social forces that actually shape the service. As for the NHS itself, managers have a stark record of rebranding failure without addressing fundamental issues. It’s like a bargain basement supermarket, constantly changing its brands to avoid acknowledging what we all know to be true: they’re cheap, unpalatable and not very satisfying.
The truth is that for too many, the NHS has become a kind of crutch, indulging unhealthy lifestyles without thinking dwelling on wellbeing. We’re facing an obesity epidemic, rising rates of type 2 diabetes, and increasing mental health issues, all of which begin at home. And, yet, we’re politically paralysed when it comes to discussing personal responsibility. You could say the same about end-of-life care. The current model of warehousing the elderly in care homes, while their children wring their hands about inheritance, isn’t just financially unsustainable. It’s morally bankrupt too.
Perhaps multigenerational households in some communities offer a potential model for reducing pressure on the social care system. Instead of seeing care as a burden, we should perhaps look at other ways of supporting families, who can then take some of the load off the system. Nor do we need to look exclusively to ethnic minority communities in the UK. Japan, for instance, has developed comprehensive approaches to ageing populations and social care, while Denmark has pioneered integrated community care models.
If nothing else, these alternatives make the leadership vacuum in Britain even more glaring. When I have talented, yet stressed out registrars coming to me in pieces, or as was this case this week, in tears and on the brink of quitting, the last thing I want to do is tell them to “pull yourself together”. What I really want to do is give NHS England’s National Medical Director, Sir Stephen Powis and its Chief Exec Amanda Pritchard a piece of my bloody mind. Not that they’d listen.
And all the while, healthcare professionals see the results of Labour inaction each and every day. Patients stacked up in corridors are only the start: in my emergency department, staff are struggling to maintain basic standards of care. We just can’t wait three or four more years to clear the blockages. The NHS won’t survive, and not just over the medium term either. If the current cold snap continues, Streeting may be forced to declare a state of emergency, a measure that would surely test his ability to lead under pressure, and all without a carefully crafted script to help him along.
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SubscribeWhat a great article. Most of us knew the situation already but the article summarised it beautifully.
As a fully-qualified old person I agree that the problem with the NHS is that we have too many old people and we have no idea what to do with them. The difficulty in dealing with the issue is that nobody, ever, ever can see themselves in the future as an old person. Streeting thinks about the NHS without thinking about himself suffering the same problems as an old person. Neither Streeting nor the civil servants around him will ever be poor – they will always be able to pay for themselves – so it is someone else’s problem.
A couple of days ago one of the contributors to UnHerd commented that old people were selfish, which meant that they only thought about themselves. This could be true perhaps but they can suffer considerable pain and the indignity which comes with it. Last year I suffered from sciatica and the pain was so bad that I just couldn’t function. The doctor couldn’t do anything so I writhed about for six weeks and now it is gone. During that time I admit that I only thought about myself so I was being selfish.
There used to be a good solution for solving the problem – let people die younger. Unfortunately, the NHS has stopped this by training doctors and nurses and providing drugs. Families hardly exist today and most younger people (not selfish) can hardly wait to get hold of the selfish old person’s house. Until people in government are brave enough to say things like, “We have problems with old people”, the problem will never be solved. I would prefer an old person to say it, not a young ambitious go-getter. Meanwhile, Labour are trying to kill us all off.
Old people like us aren’t a “problem”. We are precisely the sort of people for whom the NHS was designed – those who cannot solve their own illnesses or lack family to nurse them. This applies to all ages, though the elderly increase the need. The problems are twofold: attempting to do too much and institutional stagnation. The former includes issues such as most weight surgery (stop overeating!), most fertility treatments (start younger), etc. The latter is largely caused by politicians treating the NHS as some sort of panacea with the status of a deity.
The solutions are clear: do less and do it efficiently; focus on that which individuals cannot sort themselves and use the most efficient providers whatever their ownership.
I agree with you 100% that a lot of the symptoms of ‘diseases’ of old age can be at least alleviated by focussing on keeping fit for life (not fit as in going to the gym every day). This means controlling eating and drinking and getting some walking into your life. However, knowing this is one thing and getting millions of people to do it is another. People by nature will always find the easy way forward – like being too busy, which means having too many social occasions.
So, the excuse trotted out every month is that the government doesn’t do enough to control the food that we eat. As you will know, the name UnHerd comes from Nietzsche who said (excuse me, from an old person’s memory) that 99.9% of people were happy to be followers – The Herd. So only those on UnHerd can be expected to take responsibility for themselves. And that is one of the areas where old people can be called selfish. It also applies to young people who are merely old people in preparation.
“… most younger people (not selfish) can hardly wait to get hold of the selfish old person’s house.”
Was this said in irony?
The underlying problem is that the young of today are not encouraged by opportunities created by Education, Industry and Family Life. It’s exacerbated by the negative opinion by the Education Industry Establishment of the few opportunities that exist and their misunderstanding of customers and markets: and the promotion of wokeness.
The problem is that the Young don’t have the opportunities that the Old had, when they were young.
Here’s an example of the hopelessness:
https://notalotofpeopleknowthat.wordpress.com/2025/01/15/ineos-closes-last-remaining-synthetic-ethanol-plant-in-the-uk
The Business Pages are littered with similar reports.
Agree with you that young people don’t have the same opportunities today but I don’t believe that the situation has been caused by old people. Yes, there have been decades of bad politicians, as there have been in most of Western Europe.
If you look at, for example, house purchasing you will see that Britain led the way, spurred on by Margaret Thatcher, who wanted everybody to be middle class. But if everybody is buying a house it would take a great genius not to join in because of possible issues in the future. So today, you have the problem that old people are occupying the majority of private houses. What to do?
A socialist would tax wealth as well as income. Thomas Piketty has made a living from Socialist Economics. He suggests that all property taxes should be doubled, inheritance taxes would be a fixed 50%, and the money thus generated would be returned back as a lump sum (£20,000 say) to every person passing the age of 25 years. This is an idea but would UnHerders agree?
There’s a bit of new management syndrome going on here. Most of us have seen it. A bunch of new managers come in, convinced they will do a better job, not because they have new ideas unavailable to the previous lot, but just because they have a high opinion of themselves.
Labour needs to start finding some new ideas pretty quickly and start communicating them, because patience is currently in short supply. And “sorry you’re all dying in corridors, but there’s no growth, and that’s thanks to the last lot, we didn’t realise how bad it was” will cut no ice.
Doubtless all this is true. But we need a faster fix than turning Brits into better people. And who really anticipates a u turn on individualism any time soon?
And with people struggling to buy houses, both adults working and kids failing to leave home, how many people have space to spare to fit the grand parents in too, or time to spare to look after them.
My husband and I care for his 94 year old father in our home. Because Dad had the temerity to save for his old age instead of peeing it up against a wall we get almost no help. He can’t make the stairs anymore so our tv room is now an old folks home. He’s incontinent so despite wearing nappies and pads he still goes through 3 or 4 pairs of trousers a day. That means his washing gets priority so I just go out and buy new stuff to wear. Being a carer means no meals out no days out no holidays. And when your elderly relative has a fall, 999 says “it’s not an emergency”.
Totally recognise that PWB. You can ask for a Carers assessment and I guess your father would qualify for a Care Home albeit charged against his assets until only £24k left.
Are you keeping him with you to inherit the assets before they disappear in care costs, plus what he prefers and you would like for him? It is a challenge and dilemma more and more of us face.
So are you recommending this as the future of care in Britain?
Remember Tebbitts ‘ on your bike’. He never said ‘on your bike’ and bring the parents or grandparents with you in case later you have to look after them.
It’s really only in the last 70years families have spread driven by economics. For centuries most of us did not stray far. We just haven’t caught up with the implications for social care in old age.
I was going to make exactly this point.
It’s also remarkable how much of the system is set up on the assumption that we all still live in close proximity to our parents.
Or for increased longevity.
So, wonderful system, wonderful consultants but useless politicians, fat selfish public, uncooperative viruses arriving all at once etc etc. everyone is to blame except the NHS itself. Perhaps a little reflection on the systems own failings might help – something beyond consultants blaming managers and managers blaming staff.
One consolation – there isn’t a Developed Economy that isn’t grappling with the same problems.
Of course. But not all of them are failing so spectacularly.
Management is a problem because very few people are good managers of other people. Today’s managers are good at one thing – looking at spreadsheets and graphs. (Or is that two things?). People are earning hundreds of thousands of pounds because they can interpret accounts and make accounting decisions. The problem is people, not accounts.
Led by unions and management, people have become obsessed with job descriptions and their rights – but not what they can offer. A story told to me was of a junior doctor who was so fat that she couldn’t follow the Consultant around the wards without carrying a stool so that she could sit down at every bed. Instead of managing, the union and Manager talked about her rights – her right to carry a stool for her own health. Stories like these occur every day. Managers can’t or won’t manage people because of repercussions down the line – possibly career-ending repercussions. You have meetings about when to hug and when not to hug. Should a Grade 4 hug a Grade 3?
The final killer is that true professionals, those who keep things going every day, can only reach a certain grade if they don’t have a degree. So, 22-year-old graduate managers are recruited to manage senior professionals.
You haven’t met many public sector managers if you think they are good at managing budgets!
That’s all rather grim. I firstly went straight to comments, and then thought I should read it.
The author neglects the biggest cause of the collapse of the NHS.
If you import 20 million, 30 million people, no one knows the true number, without increasing the number of hospitals, of course, the system will collapse when those people start to get old.
Let’s agree (for once) immigration too high.
However remember since it’s inception NHS had to recruit overseas because we don’t train enough of our own. I suspect you’ve relied on care provided by immigrants or their children, and probably never really got worked up about the insufficient number of doctor and nurse training places in the UK.
Economically to pay for an aging population we also need a pool of younger adults paying tax. Demographics have changed on this too compounded by the Baby Boomer cohort now getting into old age. So whether you like it or not until AI driven robots can wipe backsides and dress and feed folks we are going to have to rely on some immigration. The Right decided we’d get this from all round the World rather than closer to home in the EU.
Another Trade Union consequence:
BMA meeting: Doctors vote to limit number of medical students
https://www.bmj.com/content/337/bmj.a748
It’s rent seeking! Doctors are maintaining their salaries at unnaturally high levels by restricting supply.
Is anybody else astonished that this is a decision to be made by the doctors trade union! Way too much power.
Funny other countries dont need to import medical staff. Nor did we, prior to the NHS.
So, would you agree, JW, skilled immigrants who work hard and pay tax – good; unskilled immigrants who don’t work and claim benefits – bad?
“… patients are increasingly arriving with severe respiratory infections, often exacerbated by the simple inability to heat their own homes.”
The policy of terminating the winter fuel allowance, implemented by Sir Keir Stalin and Rachel-from-accounts Reeves is having consequences.
How surprising!
My 94 year-old father-in-law had a fall on Friday night. We had to get a friend to drive over to help get Dad off the floor, because we’ve been told before by 999 operators “that’s not an emergency”.
He seemed okay, nothing obviously broken. By Saturday morning he couldn’t stand up. Rang 111, and many hours later an ambulance did arrive. He was taken to hospital by ambulance. We weren’t allowed to see him. He spent two nights in a corridor, then was moved to a cubicle. Every time we tried to call to find out his diagnosis the phone just rang out.
By Tuesday he was moved to the Medical Assessment Unit, where 6 elderly men were jammed into a room that I reckon was designed for 4. Still no-one had explained what was causing his pain. He’d had no pain relief.
Now they’re trying to get rid of him. If he comes home we’re going to need a team to lift him out of the car. He won’t be able to get to the toilet. My husband is on the verge of a nervous breakdown.
Gee thanks NHS. This is what 50 years as a taxpayer gets you.
The NHS is not cheap. The UK spends around 12% GDP on it. Same as France Germany Sweden etc. More than several other European Countries. More than Switzerland.
All of those European countries provide far better health services than the NHS.
None of them spends £45m on Diversity Officers. Non are state run monopolies.
You got a link for the DEI officers? Can’t find that anywhere. It’s not zero but I have suspicion it’s nothing like that sum. Would stand corrected if you have a reputable link.
In my Hospital they had a post but it’s not been filled and looks like a cost saving, at least for the moment. Nobody grumbling from what I gather either.
Do you have a degree?
Perhaps the Civil service should have realised that persuading Ministers to increase the population by 10m, might have consequences.
Hmm, remember Businesses have to request the Visa’s. Perhaps chat to Farmers, Social Care providers and other overseas recruiters.
Obviously one-offs like Ukraine and Hong Kong slightly separate.
(Illegals a separate issue too)
Probably more like 20 million, surely.
If something is free, it has no value I know this over simplifies things but therein lies a truth. A small charge for use would work wonders and fools would take a little more care of themselves so as to avoid a cost.
And conversely the NHS doesn’t want to charge lest it suddenly find itself obliged to deliver a commensurate service.
Insurance would be a better model. If you drive carelessly and cause accidents or damage your car, your premiums go up. So you take extra care to avoid needing to make a claim. The same with health insurance or dental insurance.
“The truth is that for too many, the NHS has become a kind of crutch, indulging unhealthy lifestyles without thinking dwelling on wellbeing”
My god, ring the bells, the author has suddenly realised that socialism (giving people stuff for free) means they don’t value whatever that freebie is, and will consume far more of it than if they had to pay for it (or at least contribute) themselves.
If all your healthcare is free then there’s very little incentive to look after your own health. Thats the NHS’s job, innit? Why should I do hard things, like exercise and not eat myself into the size of a small car when I can indulge myself and demand the NHS solve all my resulting healthcare problems? Indeed, couple quite generous disability welfare payments with a free NHS and there is in fact is every incentive for some people to seek out ill health rather than avoid it. There’s a not unreasonable life to be lived like that, on the back of others of course.
As economists keep telling us, incentives matter.
There are so many reasons why the NHS is unsustainable, mainly thanks to incompetent management. It is financially unsustainable and needs to be a hybrid private/state system. An aging population plus surge in immigration have overwhelmed it. People who have not contributed via PAYE should have to pay. Preventive healthcare is essential, and should start in childhood education. Patients should need to comply with targets for weight, exercise, smoking, alcohol, drugs etc.. or pay for private health insurance. People should not expect the taxpayer to fix them if they sabotage their own health. In Australia, “genuine, unavoidable” health issues get free care, unlike self induced, lifestyle and unessential conditions. Apparently people were asked to differentiate which sounds fair. A massive transformation is needed. And that’s just a few ideas…
If Brits want to be fat, drunk and unfit, the NHS they have then chosen to pay for is one that has to cater to their lifestyles. Saying the health service shouldn’t be treating the unhealthy, is the equivalent of telling someone to “stop being ill” and only demanding healthy patients.
Now, if you want an health care system that excludes some treatments (eg cosmetic surgery) that’s one thing, but to exclude people (who pay their taxes for health care) because they don’t fit some technocratic social-credit-score criteria, that’s something else. Do you exclude prisoners for being ‘bad people’, or risk-takers for taking risks, or curb the activities of people with disabilities in case they hurt themselves for instance. Health care shouldn’t be a ‘prize’ you give to people who tick a certain set of boxes.
People who get injured playing sports or climbing mountains should be charged for their treatment. They could take out insurance to help cover those costs, of course.
I once went to A&E on a Saturday afternoon and there were a lot of muddy footballers and rugby players clogging the place up. They would get free treatment, same as anyone else.
In Skye, where I lived for several years, Broadford Hospital pulled out all the stops for foreign tourists injured while climbing the Cuillin Hills, but elderly locals dialling 999 could lie on the floor for 24 hours before an ambulance came.
When I was 29 I suffered a pulmonary embolism stepping off a flight from Hong Kong to Heathrow. I fainted on the airbridge as the blood clots in my lungs caused hypoxia, a lack of oxygen to the brain. The first thing I heard on waking was an aggrieved passenger saying “do you mind?” While trying to step over me.
When I got to hospital they gave me heparin immediately, before confirming a diagnosis, which probably saved my life. They then put me on a trolley in a disused surgical theatre. My neighbour on my left was terminally ill of cancer but his son refused to see him before he died. To my right was an elderly man whose wife had just died. He screamed all night with grief and had to be strapped onto his trolley. As we were in a disused annex the catering staff forgot we were there. We didn’t get fed for 16 hours.
That was 25 years ago. I made the mistake of nearly dropping dead just before Christmas, when “Granny Dumping” clogs up NHS wards with healthy people released from care homes for the holidays, only to be abandoned to the tender mercies of the state by their families. Every hospital system faces overcrowding in winter. But I have not heard of another country with such stark issues around granny dumping. Yes, the NHS saves lives. Yes, the NHS is a crutch. Without political triage to prioritise the most important issues for reform, the system will simply collapse under the weight of unresolved tensions.
Streeting showed his colours when his first NHS reform was to reduce services still further by cutting back on vital follow-up appointments after surgery. He, like previous Health Ministers, has been fully captured by the NHS blob.
Alas, we have the same in the US. It’s called “boarding” – when patients who need to be admitted languish in the hallways of the ER because there are not enough beds in the hospital. It is happening in all the hospitals in my area of New York State.
Boarding also jams up the ER so that patients who need to be seen cannot be seen because by law the doctors can only treat a certain number of people in the ER at one time.
I am approaching 60, and this terrifies me. We have a crisis of geriatric care in the US. People are living longer in nursing home facilities but when they become ill they are taken by ambulance to the hospital.
I was recently in the ER and waited 9 hours to be seen. The ER was full of elderly patients with respiratory viruses who needed admission but there was nowhere to put them.
When I finally got back to the ER, there were elderly people on stretchers in the halls of the ER.
As our population ages, we need to find solutions to caring for them that do not involve leaving them in hallways unattended.
So you’re saying that 54,000 waited over 12 hours in a country of 69 million? And that’s over the whole year? The median waiting time in A&E is currently under three hours, so that suggests that an awful lot of people wait less than three hours. I was recently admitted, I spent three hours in triage, then I went through to a mixture of corridors and cubicles, where I had to wait 36 hours as there wasn’t a space on the ward. I then spent a week in a private toom on the ward, Thankfully it all ended well. Yes, they’re very busy, but they’re not constantly busy all the time in all hospitals at all times of year at al ltimes of day. so as well as a postcode lottery, we have a clock lottery, a date lottery, anything else?
I am fortunate in that I have a first class G P practice and Health Centre just 300 yards from where I live and over the years I have tried to keep fairly healthy by not smoking nor drinking alcohol. I pose these two simple questions:
1.How can you truly have a National Health Service when G P practices and Health Centres like mine, the first point of call if you are feeling unwell, close at 6.30 p.m. on a Friday and don’t re open until 8 a.m. on a Monday thus creating greater pressure on weekend locum G P s and A & E units ? and 2.Surely it is no longer sustainable to fund the N H S out of general taxation which we learn is at its highest level in seventy years and when only 60 to 65% of the working population pay income tax ? :
The main problem is the fact we have a nationalised health care system, a monstrosity created by the post war virtually communist Labour government in the teeth of huge opposition from the doctors, insurance companies and others who knew better. Any politician who can undo that will have my vote. Certainly Streeting does not have the stature or ability to undertake this awesome task which will require the destruction of the myriad self serving interests who have controlled the nhs since its miserable genesis in 1947.
The sooner the collapse the sooner the recovery.
It seems ridiculous, but it seems to be true that only on the verge of catastrophe does real change happen. If then.
True. But what is the recovery? You are old and ill and you will not be looked after.
How does this get better?
Don’t worry, Dr. Jones. It will struggle on in its self-declared perma-crisis just as it has for the past few years you’ve been writing about it here. There’s simply not the combination of will and competence to do anything about it. There’s a Mary Harrington article today about Britain’s post-imperial delusion. I suggest that the far bigger and more dangerous delusion is our attitude to the NHS.
But there’s some good stuff in this article, notably the extract below – a final recognition that people’s expectations of the NHS have inflated way beyond what it can actually provide. I think this is the first time I’ve seen the author say this,
This is the message Dr. Jones should focus on. The NHS was never meant to be a mechanism for abdicating any and all personal responsibility. And the fault is at least as much with the users of the NHS as it is with the politicians or NHS staff.
“The truth is that for too many, the NHS has become a kind of crutch, indulging unhealthy lifestyles without thinking dwelling on wellbeing. We’re facing an obesity epidemic, rising rates of type 2 diabetes, and increasing mental health issues, all of which begin at home. And, yet, we’re politically paralysed when it comes to discussing personal responsibility. You could say the same about end-of-life care. The current model of warehousing the elderly in care homes, while their children wring their hands about inheritance, isn’t just financially unsustainable. It’s morally bankrupt too.”
Other countries give far better service for similar cost. It’s just a crap system. Since when were state run monopolies good at service ?
I’m not disagreeing … though occasionally they can be if you can get them to engage with you as an individual and they see their role as problem solving. I’ve had some better experiences with HMRC at time than some private companies (when they answered their phones).
Day 2 of the NHS in July 48 had the Daily Mail headline ‘NHS in crisis’.
One of the reason why it persists, and perhaps not the best one but nonetheless, is all the other options are worse.
Agree we need to do fund Social care much better. That’s not down to the NHS but rather us and how susceptible we all are to rolling the dice and hoping it doesn’t catch us.
But we do know that not all the other options are worse. Many decades of experience show that most European systems are better. And no one else has copied the NHS model. The “there is no alternative” mindset needs to go.
But my main realisation from this article is just how much the users are at fault here rather than the “victims” they wish to be. As with politicians and the media – people ultimately get the service they deserve. If we really want mediocrity and no need for personal responsibility, then perhaps the current NHS is all people really deserve. But we don’t all agree with those assumptions.
Depends on your education. If you have always pushed for yourself and not relied on others, maybe you are in a minority (like me).
Correct in recognising the change of tack by Dr Jones. Prior to the summer election, it was invariably a diatribe against a government she didn’t agree with. Now, at last, a recognition by her (including a reference to a previous Labour health secretary) that the problem extends beyond finance and political priorities to one of the culture in which the NHS remains sacrosanct – the sacred cow of the UK.
And finally, reference to alternative ideas.
It’s got to the point where I don’t think the NHS problems are solvable (for all the good it does under difficult conditions). There are too many political and vested interests to allow any real change to happen.
Perhaps new ‘continental’ hospitals should be provided (either new build or converting old NHS hospitals)? These would charge a small fee for consultations and treatments, possibly backed by health insurance. Many already exist as ‘private’ hospitals doing minor operations or cataract surgery but they could probably expand given the political blessing to do so.
A&E and advanced care would probably remain with the NHS – but perhaps they should not tackle some of the elective surgeries?
The separation debate is complex, but something in it. NHS tries to separate elective and emergency sites where possible. But many specialties have to cover both so scale can reduce costs. Two On call rotas rather than one etc.
Private sector has tended to cherry pick too. Doesn’t often want to do the complex elective.
The sooner we accept that “free at the point of use” must be abandoned as a principle, the better.
For all those keen to emulate the European model, paying £15-£50 for an appointment is perfectly normal. It is abnormal to provide many procedures, such as breast enlargements, on the grounds of mental well-being.
It is ludicrous that GPs are signing off thousands of people as being incapable of working on the strength of someone claiming to have Long Covid.
Everyone in work should have a basic health insurance policy and additionally pay (say) £10 for a GP visit – per illness and £25 to go to A&E. If you play soccer at weekends and twist an ankle, why should I pay for your fun? Get sports injury insurance. Want to go indoor rock climbing and done your back in? Bad Luck and I hope your insurance covers your physio.
Emma is right in the general concept of people looking after themselves – but her direction of travel is to withhold treatment for the obese and mentally ill – both conditions more associated with poverty and age and thus people in the main already on benefits. Free at the point of use for those who can’t afford it – benefits – and Contributory charges to those who can.
French have a public reimbursement model in line with a bit of what you say. Something in it. Would make on think wouldn’t it. But it creates an additional admin cost of course, so the charges need to cover that off to. Collecting money and processing isn’t cost free and people get worked up enough about NHS admin costs (albeit internationally they are v low if not always deployed optimally). And some things you want to intercept early and not have the person delay in an attempt to save a bit of money.
The difficulty with what might be an insurance exclusion or not is that where does it start/stop? At a genetic screening level with some then uncovered? What about the benefits to playing sports in reducing other ill health through fitness and well being? It’s more complicated when you get into it, but maybe a national discussion needed. Certainly the private insurance model in the US is failing – huge growing costs, anger at exclusions and if Obamacare is rolled back, millions without affordable cover.
An excellent point. In the Republic of Ireland most people pay for GP visits and A&E, but their costs are rapidly capped if something serious happens, unlike the US insurance model where you pay 10X in annual insurance premiums to hedge against bankruptcy. At the same time the poorest 30% of people, including elderly pensioners, have medical cards that effectively make the system like the NHS. There are still issues in Ireland with overcrowding but the system is not used as a crutch anything like as much as the NHS.
Just curious. Why would you mention the US model instead of. any of the 27 EU countries with better outcomes than Brjtain, and 24 with lower costs?
A few days ago, I read of a walker in the Peak District, in his sixties, slipping on ice and his rescue involving police, doctors, paramedics and a helicopter, apart from volunteers. I assume he was not billed for any of this. So you and I paid for it, in that case.
Why isn’t it required that people engaging in hazardous pastimes (including walking on the hills in snow and ice) be billed for the cost of their rescue and subsequent medical care ? If they don’t want to risk bankruptcy, they should take out appropriate insurance.
I used to live in Skye and it was a frequent occurrence that major operations were required to rescue those climbing the Cuillins, including those experienced and well equipped as well as ill-equipped novices.
What was galling was that many of the victims were foreign tourists, who had contributed nothing to the NHS (and were probably not billed for their rescue or their treatment).
Meanwhile, locals could be left lying on the floor for 24 hours after dialling 999 for an ambulance and were neglected in favour of tourists taking reckless and uninsured risks.
In Canada, the province of Ontario is facing similar challenges. It could well be that the days of taxpayer-funded, 100% government-directed health care are over. With big-pharma and big-agriculture creating a culture of chronic disease and chronic dependence on medications, perhaps “universal” taxpayer-funded health care systems are no longer financially viable. Sure, provide some help for seniors, the extremely impoverished and those with severe disabilities, but not everybody needs or wants what public-sector health care systems are offering. Maybe try freeing things up a bit for private sector providers, so there is greater choice and greater innovation in health care.
As someone who works clinically, albeit part time, not in A&E but pretty close, I have to say this was a disappointing rant from the Author. If she exhibits that degree of stress to her Junior Doctors then she’ll certainly compound the problem.
Firstly she’s under the illusion there is a quick fix. There isn’t. Quite apart from the Country struggling for money right now, (and folks not voting for more of the basic taxes without recognising a consequence), what you need to spend it on – infrastructure and more trained staff – is not instantaneously deliverable. It took 14 years to get here and it can’t be reversed in one. It’s probably 5yrs+. Training more takes some time as does, obviously improving physical infrastructure.
Secondly her blaming personal behaviour is a bit overdone. There is a societal issue about responsibility for one’s health, but much more a factor is the aging population, the decay on Primary care’s capacity to keep up with this demographic challenge coupled with crippled Social Care. We have to be careful about blaming people for getting old and frail – we all will if lucky. We can though say that collectively we’d had our head in the sand on the repercussions and many of us will only grasp this fully when accompanying a loved one to A&E or there ourselves.
Seemed fairly obvious that Labour concluded the changes needed in Social Care will significantly cost and the only way to get these agreed, as we’ll all have to pay, and not undermined is to have cross-party support. The last two decades both Parties have sought short term political advantage rather than collective agreement on a national problem. Let’s hope they do find a way to stop undermining each other on this. Suspect a majority of us would accept we have to pay for this differently if a combined political recommendation.
I hope you’re not pretending here that the NHS has been “underfunded” over the last 14 years. Real terms funding has been continuously rising. Results and productivity have not.
What happened to the Nightingale hospitals, erected very quickly.i suppose they were pulled diwn.
I don’t think most of them saw a single patient.
There was no general shortage of beds during Covid, as most non-Covid treatment was cancelled or postponed.
If the Nightingale hospitals were still standing, there would be no staff to run them.
Glad to see the author inching towards the realisation that decades of policies deprecating the traditional family have led us to this point.
“The truth is that for too many, the NHS has become a kind of crutch, indulging unhealthy lifestyles without thinking dwelling on wellbeing.”
YES that is the truth Emma, thank you.
Having read many of the other comments, might I, with apologies for having a second bite, raise another possible scheme for the future?
With the many discussions the subject of Voluntary Euthanasia still causing much angst, supposing the state offered a tax-free bounty for passing on/over. I do no know the current cost per annum of NHS care for the demographic spread of age, sex, and location, but let us imagine that the national average is £9000 pa for a 75-year-old man and £11500 for a 95-year-old woman. Imagine being offered a tax-free sum at 85 of, say, £85000 for choosing to visit the Slough or Newport Pagnell version of Dignitas.
Deal or No Deal? Just asking…
Reck0ner