March 30, 2022 - 4:42pm
The latest poll on public views of the NHS, undertaken by the King’s Fund and the Nuffield Trust, makes for grim reading. Not only has satisfaction in the NHS dropped to its lowest level in 25 years, the speed at which it has fallen has also been dramatic: between 2020-2021, satisfaction plummeted by a record 17 points to 36%.
This is a far cry from the early days of the pandemic when satisfaction with the NHS soared. As newspapers filled with images of valiant healthcare workers and rainbows were repurposed to show support for our beleaguered healthcare system, the NHS enjoyed a huge bump in support.
But this honeymoon was not to last. The reality is that Covid exacerbated a number of pre-existing problems facing the NHS, and this is now finally filtering through to the public. According to the poll, 65% attributed their dissatisfaction to difficulties or delays in getting appointments. Certainly, this is borne out by the figures — despite fewer people receiving a referral for treatment during the pandemic, the NHS faces record waiting lists, with over 6 million people waiting for treatment.
Unfortunately, this is just one problem out of many. Between 2020-2021, an estimated 1.5 million fewer operations were carried out, and outpatient appointments plummeted as hospitals cancelled clinics. Even more worryingly, A&E departments saw drastic falls in attendances, prompting concerns that many unwell patients had stayed at home and not sought treatment, perhaps as a result of government messaging. This, combined with the negative effects of lockdown, which saw an increase in mental health problems and obesity as well as a worsening in chronic disease diagnosis, has been hugely disruptive for Brits. For these reasons, much of the population has not only been waiting longer for treatment, but it has also been receiving less healthcare and becoming less healthy.
But perhaps the biggest issue of all is staffing. England has one of the lowest numbers of doctors per capita in Europe, and the situation is getting worse: NHS vacancies now sit at nearly 100,000, with an estimated shortfall of 50,000 doctors, and 38,000 nurses. Meanwhile record numbers of staff are considering leaving, due to burnout and poor working culture. As I have written before, none of Sajid Javid’s plans to overcome the current backlog address this fundamental issue.
So the effects of Covid and our policy response to it will not just be limited to 2020 and 2021. While a dip in public opinion two years after the pandemic was probably inevitable, it is unclear how it can recover from this point. Waiting lists are continuing to grow, and despite Javid’s target of a 30% increase in elective capacity, some forecasts expect waiting lists to breach 10 million before 2024. Without a commensurate increase in staffing, the NHS will always be struggling to catch up.
Perhaps it is finally time to have a discussion about the current state of the NHS, the demands placed upon it, and how it can be funded and run sustainably in the future. In Britain, we — perhaps rightfully — treasure the idea of a nationalised healthcare service, but it’s worth considering: if the NHS was a private company, and nearly half its customers were dissatisfied, we would be asking questions of the board.
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SubscribeThe NHS is the British Leyland of healthcare – a nasty, fly-blown, wasteful, inefficient, unresponsive, heavily unionised dump. And it’s worse than Leyland, because instead of offering us rust-bucket cars, it offers bog-standard medical treatment. Mean-spiritedly, it obstructs access to private healthcare and by that process, among many others, forces people to “queue” for treatments until it is too late. Many patients ahead of you in any NHS queue will be dead. In my own experience, the NHS has misread X-rays and risked the death of the patient in each instance. I have been told of a person treated too late for thrombosis, which meant an amputation, which was in turn botched leading to death through blood loss.
State monopoly sucks. It sucks in health as in cars as in anything. And under that flabby, spineless windbag, Johnson, more money than ever is being squandered on state monopoly health, not to mention the savage proliferation of regulation in every sphere, meaning that the whole economy is under de facto state control.
We need a genuinely Conservative government as a matter of urgency.
I’d say a bigger problem is the lack of funding and capacity. The UK has the second lowest spending on healthcare per capita in the G7 at £2.9k per person, compared to £3.7k in France, £4.4K in Germany and a whopping £7.7k in the States.
If the UK spends the same as other nations and still has worse outcomes then I’ll agree it may be the model, but at the moment you’re comparing apples to oranges
Fatuous socialist rubbish. Spending on health has doubled and tripled with the same appalling outcomes. It never improves because it has no competition and treats its patients like suppliants to whom it ladles out inefficient “charity”. A regulated insurance market would drive up standards in the twinkling of an eye, just as deregulation has given us efficient car factories, telephones, water companies and rail – a massive improvement by every measure on the accident prone BR. QED.
Why would it? If the underlying funds, doctors and bed capacity isn’t there then patients can’t be treated, no matter which system is in place. Are you just going to ignore the fact the UKs health system only receives 2/3 of the German one because it’s inconvenient to your ideology? If it’s such a great system why is the privatised American model an absolute basket case, despite having 2.5x the funding the British model receives?
I also don’t think you’re correct about privatisation being good for public utilities and transport either. Compare the shambolic UK public transport network with the publicly run European models, they’re chalk and cheese
More money goes in to German healthcare because there is more room for private provision and initiative combined with cooperative public treatment – unlike our own bigoted “health service” which refuses such cooperation and hampers the private sector. And you ignore the point about tripled funding leading to the same or declining outcomes. You are blinkered – or worse.
More money goes into the German healthcare system because their government puts more money into the German healthcare system, that’s it. We can argue about whether it is spent more wisely once it’s there, and I don’t have the info handy to determine if their system leads to better outcomes, but the system is irrelevant when talking about the level of funding it receives.
I happen to have family in Sweden, USA and Germany.
And friends in France.
So yes USA system is wasteful but excellent if you have insurance.
European systems are funded from taxation and topped up by health insurance. That is why funding per head is higher.
Problem with UK is that any mention of insurance and/or GP charges (like in France) immediately leads to accusations about “privatizing” of NHS.
There are serious problems with work culture in NHS and no amount of money is going to change it.
With the European system, can the insurance companies refuse to cover or pay to treat you? And does the cost to the individual increase if they’re likely to need expensive ongoing treatment?
It’s not the government’s money. It’s the citizens’ money, which is taken from them to pay for it.
I have worked in the NHS and I can testify that it is corrupt, grossly inefficient and staffed very largely by people who are not competent and who do not actually care. I can remember feeling ashamed that I worked for the NHS.
Do you think South Staff NHS Trust was an exception
Money is not the problem. The problem is that politically it is beyond reproach which means it is never subject to ant real scrutiny.
Can you imagine if we ran our food industry the same way as the NHS
SHOCKING! A government run bureaucracy that is corrupt and inefficient?? Say it’s not so!
The American model is most certainly not a basket case. When one can see a doctor within a day or two, get a needed operation within a couple of days, how is that a basket case? If all you believe is what you see on CNN, BBC or any of the left wing propaganda outlets, then I can understand. But I am actually living it in real time in the U.S.
The American model that costs 2.5x the UK one and leaves 1 in 10 Americans with no healthcare? Sounds like a basket case to me. There’s a reason no other developed country has copied their model
Improvement on the railways… are you serious? Possibly by some measures in the south east and pre booked services to London, but nil else
Look at the stats. For once.
And improvements in water companies, who dump sewage into our rivers and seas hundreds of thousands of times a year? Effective regulation is a foundation stone of civilised society, not something to be derided and blamed, Mr Denis. Ask the Grenfell families.
Pompous bilge. We are strangled in regulation, the logical outcome of which is “social credit” and a modern gulag. Your “civilised” society is nothing but a prison house, presided over by prigs who eagerly conform until they inadvertently break their own, multitudinous rules.
Arent your figures out of date? OECD and EU surveys put the UK in about the middle of 28 countries (EU) and slightly less than Japan and Australia for spending per capita. . Gernany spends about 10% more for four times the number of doctors and nurses, and miles fewer managers. Actually, in Britain private hospitals are 90% medical and 10% managers, with the NHS 50 % non medical staff.
I’m not arguing that the NHS has become top heavy, however I’m also wary of privatisation of core public services due to it never having worked out as promised in the past. The state of the railways is appalling especially compared to the European systems, with many franchises often having the services taken back from them only for the taxpayer to end up footing the bill for vast backlogs of maintenance. Likewise the utilities were supposed to offer cheaper rates but again it never happened, the wealthy instead choosing to line their own pockets knowing the taxpayer would pick up the tab for any liabilities.
Too often privatisation has simply meant privatise the profits and socialise the risk.
Billy the worst privatisation was Blair’s Private Finance Initiative in which Hospital trusts pay huge amounts every year for the privilege of having a new Hospital built. Some of these PFI’s will continue until 2050 and cost the NHS £billions. For instance the NHS trusts pay just over £2 Billion annually.
Blair put everything on tick, the bloke was a shyster. Between his PFIs, the MRSA debacle when hospital cleaning was contracted out to private firms and the general state of the public transport and utilities you can’t blame Brits from being wary of handing over too much of the healthcare system to private interests
May I remind readers of this thread that the majority of the GP network is privatised. These are small businesses contracted to the NHS and paid on a per customer basis with substantial add-ons. There is a strong incentive for entrepreneurial owners to maximise profit by minimising cost and maximising customer numbers as well as focusing on additional income streams such as COVID vaccination revenue without additional resources.
It is difficult to identify to whom the GP network is responsible. It is not the CCG’S. Who pays them? Who measures them?
Pretty weird business model, isn’t it? You can give your patients first-rate care or lousy care, just as you please. Doesn’t really matter because the money’s the same either way.
If your GP is lousy, then just leave and go to a better practice. Might work for hospital services too: what do you think?
Precisely. Which blows our friend Carr’s debating point out of the water. Private is best and insurance gives everyone access. End of. Top down state supply is feudal rubbish handed out to suppliant serfs, in health as in everything else. Also, end of. Nothing the squirming reds on this thread can say gainsays those basic points, which are amply borne out by the facts, the stats and our experience.
Private healthcare & treatment is so expensive in this country (my father paid £15,000 for a half knee replacement; he was turned down by the NHS for being too old and wealthy enough to pay), costly a small fortune for the most basic procedure. That isn’t a market anyone wants to get into.
The vast majority of us can’t choose what healthcare provider we use, unless of course we have had good results from alternative practitioners who are usually affordable.
Prices would fall were everyone allowed into the market place. It’s the state monopoly which turns basic access to direct supply into a species of luxury.
Lots of different issues here. Obviously it suffers from being an organisation that is simply too big to be managed effectively. It is under the nominal but not actual control of politicians who have no real experience of heading up large organisations and anyway change before they can gain useful experience.
As Billy Bob has pointed out it is not particularly well funded on a comparative basis but simply pumping more money in is unlikely result in much more than increasing wages all round particularly in the bureaucracy that is part of the problem. Our GPs are I believe better paid than Germany’s – a richer economy. What is needed is to start training many more doctors and nurses and paramedical staff instead of simply relying, as we have for years, on attracting overseas staff – then we can increase the funding to employ them.
A unit should be established to investigate best practices in other health systems and ensure the lessons learnt are implemented. No doubt those working in the health service can make many more suggestions to improve the lumbering elephant. Not paying for diversity officers in an organisation that is disproportionately diverse already is but a minor suggestion. Not pretending men who claim to be women are women would engender a bit more respect. I could go on.
I agree the problems are multiple. Unfortunately too many view the problems through an ideological lens rather than actively looking for solutions, with the left thinking if you keep chucking money at it the problem will fix itself, and the neoliberal right just wanting to sell it off in a mistaken belief that every social problem has a market driven solution.
There’s no doubt in my mind that the NHS is severely underfunded for the amount we expect of it, but it’s also a top heavy and badly managed organisation.
There needs to be a comparison between the NHS and other health systems around the world, from management structures, doctors to management ratios, doctors to patient ratios, capacity, and if other nations additional funding leads to significantly better outcomes in terms of treatment and life expectancy.
I think the NHS emergency care is fine personally, it’s the routine stuff that it struggles with
I agree that ideology does stand in the way of finding optimal solutions for the NHS. I believe capitalism has been the engine of vast improvements in life throughout the world where it has been adopted. But it relies for it’s beneficial effects on the availability of competing choices between the producers of goods and services that the customer has some chance of evaluating. In the case of most routine medical issues proximity is an important factor so a natural monopoly arises. Again unless there is a surplus of services to chose from this inhibits competition. I well remember crossing from Communist Czechoslovakia to West Germany being struck by the paucity of petrol stations in the east compared to the plethora in the west. Creative destruction is not an ideal system for medical services starting from a poorly resourced base.
A lot of the problems of the NHS are cultural problems derived from the wider society so that systems that operate well abroad may not translate well here.
There can never be a perfect system as all systems are compromises that tend to benefit one group or type of service at the expense of another. As you say emergency care is not too bad whereas a lot of relatively routine stuff is poorly executed but the absence of any pricing mechanism means large sums are wasted on what are essentially social problems.
I think everyone who has spent time in hospital will have their own bad experiences to relate but correcting the problems is hard detailed work that politicians of either stripe have little to contribute to.
Capitalism is by far the best solution for the bulk of the economy, but for me it only works where people have the option of not buying the product at all which doesn’t really apply for emergency healthcare. If it’s something people have to have such as the utilities, education or healthcare, or where de facto monopolies are the norm such as public transport routes it simply doesn’t work as intended in my opinion
It will be good if as a nation we can at least talk about the issues. The politicisation of NHS management seems to be half the problem. I agree looking at other healthcare systems is a good idea. I have Dutch and German relatives, they seem relatively happy with their insurance based system. I don’t understand the detail, but it seems everyone has access, so not really capitalist, but seems to take management and blame a step away from government interference.
There’s definitely a lack of accountability for the higher ups, though as I say that seems fairly common throughout the private sector as well, it’s not a problem exclusively for the NHS. Those at the top are always shielded from their incompetence, it’s those at the bottom that pay the price through job losses or in the case of the health service being massively overworked.
However while there are definitely aspects from the European models that could be incorporated, it’ll always be a hard sell to the British public because their experiences of privatisation has been almost completely negative. The transport system is a shambles, the utilities poorly maintained and expensive and the taxpayer always seems to end up footing the bill while shareholders are handsomely rewarded for driving services into the ground. You can see why people are wary about letting money men become involved in areas as vital as public health
I live in the area served by the Shrewsbury and Telford NHS trust which is in the news because of the Maternity scandal. The trust is in Special Measures because of all sorts of failings not just the maternity thing. The Chief executive who ran the hospital was forced to resign in disgrace but is now working for another NHS trust, unbelievably as an “Advisor” and probably on a suitably high salary. In recent years we’ve had similar scandals in Stafford and Barrow in Furness and more scandals are waiting to be exposed. Successive chief executives took our local trust from “Good” to “needs improvement” to “failing” in three easy stages.
Funding and manpower shortages are certainly major factors in the problems of the NHS but I think there is more to it than that. I don’t work in the NHS but I have 3 close relatives who are NHS nurses and they all say the same thing – bad management.
All due credit to the doctors and nurses who worked hard during the pandemic but I can’t help feeling a bit sick when I see all those “Thank you NHS” rainbow posters everywhere.
The gravy train for NHS managers,even when poor at the job,never seems to stop as they just move on to another trust.
That’s not a problem confined to the NHS, many in the private sector always manage to fall upwards despite being hopeless at their job.
Personally I think this is because most of those at the top are there through their background, contacts and family connections rather than being particularly skilled or having a good work ethic but that’s a different argument
Of course people are disillusioned with the NHS. The upshot is that despite people having lost their livelihoods and sacrificed their children’s education and mental wellbeing to “Save our NHS”, we now have to pay yet more money to “Save our NHS”.
The increase in funding announced last year was immediately followed by various NHS Trusts advertising generous salaries for yet more “Diversity, Equity, and Inclusion” admin and manager.
Any further monies, if not strictly conditional, will add further to the administration, not to medical care. It’s the public sector – every branch of which needs massive pruning and reorganisation to reorient them towards public service.
The bureaucracy is expanding to meet the needs of the expanding bureaucracy.
Point taken on number of doctors per capita, but we will be forever denied a proper national conversation about the ever-increasing “capita” in the UK and how it can ever be supported by current level of public services with even the highest level of taxation most of us have seen in our lifetimes.
I suspect we are approaching a tipping point in public views of the NHS comparable to the shift in attitudes to the Catholic Church in Ireland in the 1990s. Reverence and respect risk being replaced by revulsion – or, at a minimum, by a distrustful cynicism – in a dramatic shift from one extreme to another. What has emerged so far may be only the first signs of a wider unleashing of scandals as NHS staff lose their fear of speaking up.
This could be unnecessarily destructive since I think the NHS does more good than harm. My experience of the NHS is that it is inconsistent and patchy. I have encountered both callous self serving incompetence and selfless compassionate excellence and much in between. Hospitals vary enormously in their level of professionalism and effectiveness. As do GPs.
I have, however, also seen the similar variation in private medicine. I am very sceptical that the solution is to unleash untrammeled market forces. The effect might be like that of Perestroika on the Soviet economy i.e. carnage.
There are many reforms necessary but I would emphasise as starting points
a) An acceptance that there is something seriously wrong in NHS culture and management that no amount of money or staff can fix.
b) An immediate and focused assault on the linked blame and cover up cultures in the hospitals. It is hard to see any other reform succeeding with systematic dishonesty still in place. One factor reinforcing this toxic culture is the fear of being sued which distorts many decisions. My father died in horrific circumstances as a direct result of this perversion of priorities. It is more important to learn lessons from than attribute blame for errors. If we want an airline style safety culture then we need to replace ambulance chasing lawyers with a less contentious compensation system.
c) There also needs to be a more mature wider public debate which accepts that the British public is committed to the “free at the point of delivery” aspect of the NHS and therefore avoids the stale rhetoric of market vs. public provision. The issue should be how is the NHS to be managed to deliver what we want at a reasonable cost. What are the different models? How do we create incentives in the system to promote perpetual improvement?
d) Professional politicians are entirely unsuited by temperament, time horizon and skills to cope with the long term management and reform of the NHS which is a herculean task needing at least a ten year view. It needs to be separated even further from day to day politics with a board, an outstanding chief executive and stable long term finances including a hypothecated tax. The closest governance model is the current arrangements of the BBC (even if they are no longer appropriate for the BBC itself). The obvious solution to the need for a hypothecated tax would be to repurpose NI – which yields about the right amount to cover the NHS and social care – and pay pensions etc out of general taxation.
The culture of the NHS is itself sick. The first step is to accept that diagnosis. Otherwise we risk public anger turning on the NHS.
An excellent post. The present top down structure focussed around ever larger and increasingly expensive hospitals panders to producer demands and centralised management control. It does not focus on patient health and individual outcomes.
The much demonised Lansley reforms were an attempt to create a patient-led service placing more responsibility in the hands of GP’s. These reforms generated massive kickback from the existing health establishment in Whitehall and the NHS who, rightly, saw them as a massive threat to the status quo.
The Lansley proposals attempted to place the control with the individual using GP’S to impose some financial and performance improvement on the suppliers – hospitals and doctors – using CCG’S. Without commitment and motivation from the NHS this was never going to succeed.
I wonder whether the Local Authority Directors of Public Health could be used to monitor and measure the state of health and performance of health outcomes for their population including service delivery of the GP’S in their area.
I agree especially with your last point. Part of the reform of the NHS has to involve causing it to driven overall more by measured outcomes and less by a combination of producer interests, politics and fads.
The use of targets by Blair certainly had an impact on some issues but left others unaffected. There needs to be something more comprehensive and consistent.
LA Directors of Public Health could certainly play a part. My own particular enthusiasm would be to agree a fixed peer group of nations and then use comparisons with that peer group as the default measure of any public service undertaken by the UK government. An annual report with league tables of overall and detailed health outcomes, costs and satisfaction levels might focus debate and lead to effective action on weak spots. The “targets” would be automatically comprehensive, constantly evolving and transparently objective.
I think a peer group of countries with political systems, cultures and levels of prosperity etc roughly similar to our own would carry most credibility with the public. (Sweden, Norway, Denmark, Germany, Netherlands, Ireland, Canada, Australia, New Zealand?).
At present, the majority of British public services score on this basis “mildly below average outcomes delivered at significantly below average costs”. For the NHS an aspiration of delivering “significantly above average outcomes at roughly average cost” would probably command widespread support. Its achievement in each speciality and region – whose scores would vary considerably – would provide a continuous spur for improvement.
Of course, one needs to be careful of perverse incentives. e.g. many surgeons appear to have reacted to league tables by refusing to admit to any errors – with unfortunate consequences on occasion: I nearly lost a sibling. On the other hand, hospital administered satisfaction surveys are largely worthless. Get the ONS to sort out robust and objective measures and seek to get common data standards agreed across the peer group.
This obviously is only one of many strands of reform necessary and no magic wand but, I think, it would provide a useful pressure on the NHS nonetheless.
I do so agree with your conclusions.
And I agree with your experience; when we called for help, we had paramedics arrive, followed by an ambulance, all within minutes, despite being in the country. After caring and skilful attention, the ambulance carted the person off to hospital 20 miles away, followed by a wait for four hours before being seen, checked as OK and discharged, and collected at 3 a.m..
And
Regarding the manpower problem. I’m not sure what the current situations is but didn’t the government stop paying for the training of nurses so they have to fund their own training. Do you think this was a mistake?
Personally I think the continued poaching of doctors and nurses from developing countries is highly immoral, and the scrapping of funding for training was incredibly short sighted
I agree completely with that. It always amazes me how little attention this behaviour is given.
A very valid point. Another policy decision made by the out of touch political/management ‘elite’, who have never remotely experienced financial hardship in their lives.
Why provide funding for training when any level of service is accepted, because there are no alternatives. Besides, just think of all the malpractice lawsuits that will follow, which is a bonanza for the lawyers, who fund political campaigns! The cash settlements, with 30% for the lawyers, are paid by the taxpayers, once again. Get the connection?
Too many chiefs, not enough Indians.
Last time I was in the hospital there were quite a few Indians to be honest. And Chinese
It has come to my attention that final year medical students have been unable to find training places for their two years of work experience.
One would have thought that five years is enough time to adjust supply to expected demand in a business crying out for extra resource.
We have a vicious circle. The dominant opinion of the public is that healthcare should be free, so the question is how it should be delivered.
Labour seems to believe that any questioning of the existing monolith controlled by the elected government is heresy, whereas Conservatives might be open to a different system, such those commonly adopted by the majority of European states and others. However, they don’t dare make changes for fear of the regular GE tactic of being accused of ‘privatisation’. Instead, because they are also blamed for any shortcomings, they, or rather their civil servants, find themselves unable to resist meddling and micromanagement.
I despair.
The NHS is a government body, and governments suck at everything. QED.
Same with the Navy- there aren’t enough engineers or dock-workers/fitters.
It is a question of manpower. More beds, more frontline staff. Such things take a very long time to sort.
And money
Ever since I can remember there has been a continuous cry about lack of doctors. I would have expected the Government and NHS leadership to have invested in education and training to dramatically increase the supply of doctors.
For whatever reason this does not appear to have happened.
Comment self-edited as inappropriate. My apologies.
Unfortunately the BMA is very powerful. They have spoken out against training more docters, claiming that there aren’t enough senior staff to train the interns. Pity Thatcher was ousted before she could tackle them.
Can it really be true that 1 in 6 of all Britons need major medical intervention? This is not a trip to the GP for some pills but hospital based, mainly surgical, intervention. Or is major parts of this backlog minor procedures that whilst inconvenient to the patient are hardly life threatening?
The problem is not necessarily the NHS or the money passed on to it (note: nobody can afford ‘modern medicine’ in any way: it is an industry of illness)
The problem is the type of medicine that is provided: it is spreadsheet medicine which means that only 33% of people will be really helped whatever you do. (statistics, gauss curve etc)
When medicine (health policy) will start looking at how to make people healthy (improving the resilience of people, improving their participating in their health, better feeding, better living conditions, treatments that improve health balance etc) medicine will become affordable again…. but this is not as sexy and talking about the latest technical breakthrough in medicine… I don’t hold my breath…
Could you expand on the comment on how with “spreadsheet medicine” only 33% of the patients will benefit whatever you do? Thanks.
Was it an old Chinese tradition that one paid their doctor when healthy and stopped when ill?
NHS funding is a symptom not the disease. The NHS has lost its way and the populist politicians are too afraid to be honest and make the appropriate choices and policies because they are so wrapped up in the arms of sycophantic demagogy.
Having worked in the pharmacy industry for many years, I am dumbstruck, how is it right that prescriptions are written for basics such as paracetomol, aspirin and antihistamines, which cost the NHS £12 plus the cost of drugs per prescription, when people can buy them in any supermarket for less than 50p? There are many many other examples of stupid waste and poor leadership made because politicians won’t be honest with the electorate.
We need a government that will decide if the purpose of the NHS is to deliver its founding ambition or if it is to be all things to all people, in which case we need to accept we must pay for the service and cut our cloth accordingly.
A friend recently fell and broke his hip and his arm and the ambulance took 6.5 hours to arrive while he was in constant agony unable to move. These stories have become far too common again, reminiscent of those dying on trolleys in corridors during Thatchers reign.
As for GPS, there appears to be more chance of finding Lord Lucan riding on Shergar, than to find a GP appointment slot.
Let me pose two ideas:
(1) It’s hard to simultaneously control the demand-side and supply-side of any market. The government may virtually monopolize the supply of healthcare services, and it could even try to prop up the demand-side by, say, giving people subsidies. but then there’s always going to be perceptions that the supply-side (the NHS in this case) can’t keep up.
This is a generic problem. Even in Canada one hears exhortations about making the health system more “efficient” — meaning expand supply while at the same time inflating the demand-side.
Basically, there are two ways to ration demand: by price or by imposing waiting lines. So, we get waiting lines, and everyone complains that the system is inefficient. But, is it?
(2) Not everyone likes the idea of “markets”, but you can’t ban markets. That is, you can control supply, but folks on who use services will still have their demands.
Another way to put it is that you can’t ban exchange. Sometimes folks deploy the metaphor “The enemy gets a vote.” Same idea. Exchange may be friendly or hostile, but exchange involves strategic interaction, and — guess what? — folks respond to incentives; they behave strategically, and we can’t control their “votes”. It’s like containing jelly with rubber bands.
So, complaining about the NHS is just part of the nature of subsidized services.
I had an MRI last week. My GP called a couple of hours later to tell me that I have a brain tumour. She said someone from neurology would call to make an appointment to tell me more. 9 days later and someone called this morning to make an appointment for next Wednesday. Over two weeks to wait to find out what is growing inside me is just inhumane.
RaggedClown Says…
The NHS is a national treasure and the doctors and nurses who work there are angels who walk this earth but there is an attitude in the bureaucracy of the #NHS – and the politicians that set their direction – that is focused on reducing costs by cutting services that don’t show up in key performance indicators. This attitude makes everything a little shabbier.
I lived in the USA for 25 years. The USA spends approx 3x what the UK spends per capita and the NHS is still better than what they provide over there (long wait times notwithstanding). But it needs some serious investment to eliminate its penny-pinching attitude to service.
It keeps receiving serious investment, but I think investment is the wrong term.
The Commonwealth Fund report comparing health care services across 11 countries puts the UK at overall position 4 (1 is best 11 is worst) so that doesn’t seem to be so bad. Except that under the category “Healthcare outcomes” the UK is 9th with only Canada and the US worse. In fact the US is worst in most categories.
The OECD also compares health services across countries and it has an interesting summary of the UK health service –
Not sure what to make of that.