The Daily Sceptic’s in-house doctor – formerly employed by the NHS, now in private practice – has written a guest post about a recent Policy Exchange report on how the NHS should manage its huge waiting list. He isn’t impressed.
Last week, the think tank Policy Exchange published a report entitled: “A wait on your mind – a realistic proposal for tackling the elective backlog.”
I’m very grateful to the authors, because I love a good chuckle, and this banal document had me laughing out loud at several points. There is so much in it, I barely know where to start – this article can only scratch the surface. It commits the cardinal sin of most NHS ‘strategy documents’ effectively being a wish list for a healthcare utopia – oblivious to the obvious fact that in a world of limited resources, one cannot be strong everywhere.
Readers may not be aware of how or why such reports are constructed. As with all medical/scientific publishing, it’s important to understand the process of production to uncover the real purpose and message. I have contributed to several similar documents over the years. The starting point is normally a specific agenda that the report’s funders wish to push – this isn’t always obvious, although an informed audience can read between the lines. I note that this report was “supported by research grants provided by Ramsay Health Care UK, Smith + Nephew and the Independent Healthcare Provider Network (IHPN)”. Readers can probably figure out the agenda for themselves.
The ‘evidence’ for the report is generally acquired by selecting a compliant group of ‘experts’ that can be relied on to provide the correct opinions. The experts are gathered together with plenty of tea and biscuits – or a couple of cases of wine for a more revealing discussion.
Once the experts have sounded off from their particular perspectives, the writers craft the comments into a narrative. The language is usually verbose in style containing pages of pointless verbiage calculated to dress up the work as deeply researched and referenced. On closer inspection many of the ‘references’ are linked to other opinion pieces that conveniently chime with the predetermined purpose. Reliable ‘elder statesmen’ write a preface and a forward to create an illusion of gravitas and authority. Various other lesser figures in prominent medico-political positions are co-opted for endorsements.
The report is then touted around decision makers and passed off as a representation of current thinking. Successful documents provide decision makers with intellectual cover for controversial changes they want to make anyway. In some ways it’s a bit like employing management consultants – they are paid to tell policy makers what they want to hear, and to take the blame if the decision goes sour.
So, what’s the meat sandwiched between the glossy covers? The key message is contained in the very first paragraph of the blurb on the website:
The waiting list for elective treatment in the NHS in England has reached an unprecedented level. It is likely to become the defining NHS issue as we approach the next general election.
Effectively, this is a threat to politicians – Give us what we want or suffer the consequences at the ballot box. It will come as no surprise to readers that they want a lot more taxpayer’s money.
How big is the threat?
the total number of people waiting will grow substantially over the next 12 months, as a proportion of the 7.5 million people who did not seek treatment during the pandemic are referred by general practice.
Readers will note the language: “people who did not seek treatmen” – the fault lies with the public who did not come forward, not with the NHS.
Exaggerating the size of the problem has two advantages. Firstly, it threatens politicians even more – the implication being that failure to hand over more cash will make the problem worse. The elected representatives will get the blame, because the voters can judge them – whereas the NHS managers (who are really responsible for the problem) are not accountable to the electorate. Secondly, by inflating the numbers, the amount of money extorted can also be inflated.
And how is the extra money to be spent? Here is the first of several belly laughs:
New Care Coordinators should support patients facing long waits in pain for elective treatment.
Outstanding suggestion – we definitely need more managers to apologise to patients for the poor performance of the NHS – an excellent use of taxpayer’s money. To be fair, it is consistent with recent management of the system.
Here is another gem:
a massive expansion of the imaging workforce to staff the new diagnostic capacity – with an additional 2,000 radiologists and 4,000 radiographers required.
A 2018 report by GE Healthcare estimated there were 3,360 consultant radiologists working in the NHS. Policy Exchange is suggesting that we immediately find another 2,000 fully trained X-ray doctors, but are silent on where they are to be found. Down the back of the sofa? Hiding in garden sheds maybe?
Ironically, the report also says that “The NHS must adopt an innovation-mindset across the elective pathway”, yet makes no mention of existing technology relevant to radiology, such as companies using telemedicine to have scans reported by radiologists in other countries with high quality specialists (such as Australia), or use of AI to report routine images such as screening mammograms, where machine learning has already been shown to be more reliable than a human eye in picking up minor abnormalities on vast numbers of scans.
Why might that be? Is it possible that U.K. radiology doesn’t want competition from doctors in other countries? Or maybe they take a Luddite approach to new technology that might displace them from lucrative employment? The reader may very well think that – I could not possibly comment.
The next one is an absolute belter:
The NHS must become relentless in increasing productivity and patient throughput in treatment.
And how is this to be achieved?
the Referral to treatment (RTT) target should remain, given its importance for maintaining public confidence in the NHS.However, this should become a ‘split’ 18-week standard to encourage swifter diagnosis within eight weeks. The current operational policy standard should be replaced over time with a series of fines for ICSs who are unable to give patients a diagnosis/treatment decision within eight weeks of initial referral.
Fantastic – we don’t need another target, but a ‘target within a target’. Leaving aside the fact that we can’t even hit the first target in normal times, we will now put even greater pressure on the people actually doing the work and punish them when they fail to meet it. Genius. Why didn’t I think of that?
As far as actually getting more elective operations done, there is a sensible suggestion in this report – the establishment of ‘surgical hubs’ which are specific treatment centres that only do routine operations. Surgical factories, for want of a better term.
The report glosses over the inconvenient fact that this is not a new idea. Surgeons have been keen on it for decades and there are highly successful existing facilities doing exactly this – one example being SWLEOC orthopaedic clinic at Epsom (referenced in the report – it opened in 2004). The balkanised NHS management has opposed replication of these highly efficient models for years – too many vested interests in keeping remunerative elective surgery under the control of individual hospital trusts and keeping control of the surgeons. Getting this model up at pace and scale might reduce the size of the problem by increasing efficiency, but my experience of NHS management suggests it is unlikely to be delivered no matter how many reports are written or how much cash thrown at it. Curiously, the report recommends a similar system run by Ramsay Healthcare. I’m sure the fact that Ramsay funded the writing of the report had nothing to do with the recommendation, nor with the recommended 20% uplift of remuneration for areas with the longest waits.
My main criticism of this report relates to the ‘elephant in the room’ addressed obliquely and indirectly – the workforce problem. This is a complex issue comprising legacy issues predating COVID. Simply put for the benefit of readers, we don’t have enough properly qualified and experienced staff to manage the workload. Further, the best performing and most experienced people are leaving the NHS far faster than they can be replaced – and the replacements are not like for like.
Lest readers write me off as an archetypal old man disparaging the younger generation, let me elaborate. The EU working time directive was implemented from 2009 in respect of higher medical and surgical training, capping the average working week at 48 hrs from the previous 80 hrs for junior and many senior doctors. Combined with a reduction in the length of training, this has reduced the experience of new consultant appointees to about a third of that experienced by the cohort trained in the 1990s and substantially reduced the number of hours newly appointed consultants are expected to work compared with their immediate predecessors. This matters because in clinical medicine, experience is incredibly important and directly affects productivity. Simply put, a fully experienced doctor will process more cases per unit of time than an inexperienced one.
Further, the Royal College of Physicians recently published a survey suggesting that over half of current trainee doctors intend to work part time. So, although we have increased the number of doctors, the number of whole-time equivalents is falling.
As to why doctors are retiring early from the NHS, Policy Exchange think tank suggests it is to do with the lifetime allowance on pension pots. This may be a factor, but I doubt it is the principal reason. I can only speak from my own experience. I left the NHS in my early 50s for two main reasons. The first, overwhelmingly important reason was that I was totally pissed off with being pushed around by managerial mediocrities who had zero understanding or interest in the realities of clinical practice. The second reason was that I had a better option – the market for my skill set outside the NHS was and remains buoyant. That’s not the case for all specialties, but as the NHS continues to fail, the demand for treatment outside the system is likely to rise. Therefore senior doctors will have an incentive to withdraw from the service at an early stage, intensifying the productivity gap.
Of course, it is easy to mock reports for their facile solutions to complex problems, so, having said all that, what is my solution? Well, I’m afraid I don’t have one. My opinion is that the NHS is a failing system that is incapable of matching the outcomes and efficiencies of mixed healthcare economies in other developed countries. It’s been so for years and the inherent systemic flaws have just been exposed and exacerbated by Covid. If the aftermath of this debacle and the chaos yet to come convince the public that serious structural change is required, eventually we may end up with something better, but this report won’t provide it.
The publication is really aimed at extracting lucrative government funded contracts for existing private companies to exploit the opportunities presented by a political crisis. It is not about turning a monolithic monopolistic state provider into a mature mixed economy with multiple providers competing on price and quality – quite the reverse in fact. It effectively says that existing private providers are welcome but more regulations should be introduced to discourage new entrants into the market. The authors are quite happy for the NHS to continue to fail as long as the overflow contracts keep coming.
Plus ça change, plus c’est la même chose
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I want the NHS dead, it’s failed me too many times.
I’ve been abroad and paid not too much for excellent CARE, and been to the UK and queued for a pretty shite ration of treatment by largely disinterested staff.
Completely agree. I’ve had much better and faster treatment in China, Singapore, Poland, and Spain. And for much less than the £3000 the NHS costs every man, woman, and child in the UK. At least have an opt-out to encourage competitiveness.
fuck me your a traveling health disaster
You could buy very good private healthcare for £3,000
No – it needs reform – but, sorry to piss on the politically prejudiced pansies – but only three days ago, as a frequent flyer, I had yet another example (one of many) of dedicated staff putting themselves about to give me outstanding treatment. I’ve also had very mediocre private treatment, as have others of my acquaintance.
I’ve got my grouses – particularly in terms of the politically influenced crap management who are dictating shite policies at the moment, and, above all, years of mickey-mouse ideas about ‘the market’ tearing chunks out of the organisation at the behest of tenth rate politicians obsessed by neoliberal obsessions.
The vultures are circling – the same ghouls who also brought you Covid as a lever. Lets start with them – represented by Blair and Johnson.
cheers Rick for an honest report from the other end of the coal face – its a complicated one, I put my thoughts in a later post, but I have no problem with being wrong
but do you admit that the ‘NHS’ has become (in a way) a religion, and if you can’t criticise it then the problems become worse rather than being solved
We need to look on our healthcare provider as we do our car mechanics, not as we do our church leaders
Well put!
I know far more people who had crap treatment – self included, also many relatives, friends and colleagues, and a far smaller number who had excellent treatment. In exactly the same way I’ve had a couple of excellent garages and a whole bunch of crap ones. The worst were Ford but Vauxhall weren’t much better when dealing with company car fleets, they would get away with charging for work they never did simply because they had a captive market. In the same way the NHS has a captive market. And yes I know someone who nearly died as a result of a crap garage. Plenty died as a result of a crap NHS.
Fixed that for you.
‘ … but do you admit that the ‘NHS’ has become (in a way) a religion … ‘
I cannot admit that because the NHS was always a religion / religious concept and has not become so. It was never anything other than yet another impractical utopian fantasy.
Incidentally, anyone who has actually read Utopia knows how thoroughly unpleasant the Utopians and their island society were.
What’s your proposed remedy or replacement? Selling it off to US, or any other, corporate vultures is not an option.
Why isn’t it an option?
Especially given that the entire country has been destroyed to protect the NHS.
I’ll assume that you’re in favour then.
He forgot to add that production of the report lined someone’s pockets in the beatified National Covid Service.
How so? The report is from Policy Exchange which is a privately funded think tank.
The NHS’s time has come and gone. Other countries do public healthcare far better and the final straw for it is the way the it has been used and abused for the benefit of a pro-lockdown agenda. I was on the fence about its future before Covid. Now I want it to die.
Protesters outside Mark Drakeford’s
https://www.youtube.com/watch?v=ex9yQhj30FA
Stand in South Hill Park Bracknell every Sunday from 10am meet fellow anti lockdown freedom lovers, keep yourself sane, make new friends and have a laugh.
Join our Stand in the Park – Bracknell – Telegram Group
http://t.me/astandintheparkbracknell
HOME EDUCATION – Ex-Primary School Teacher on Resistance GB YouTube Channel:
https://www.youtube.com/watch?v=kZ5oS2ejye0
https://www.hopesussex.co.uk/our-mission
The company I used to work for were leaders in hearing aids, amongst other things. They suggested dedicated hearing clinics to the NHS. Service free at the point of delivery, far, far better hearing aid than NHS one, shorter time frame, lower cost, better product. NHS turned it down due to a desire to not reduce the breadth of offering at local hospital. They knew their offering was pretty hopeless but that didn’t seem to matter.
Perhaps the hearing aid clinics on offer were interested mainly in the mild- moderate cases with potentially good outcomes, leaving the NHS with the profound/complex/perceptive cases that tend to be revolving-doors and needing frequent review appointments. Patients often value continuity of care and thorough diagnostic testing, at least in the first instance, rather than a quick ‘hearing screen’ that may miss something requiring further investigation.
I daresay the high-street providers will take over much of the field in time to come though.
Around here you can’t get ear wax removed at the gp. Need to pay £45 to get it done at pharmacy. Hearing will go the way of dental and optical care.
But don’t skip on eye and ear checks – they can show up tumours and hydrocephalus (see me earlier comment).
Reduced access to such checks will cause disability and death .
I agree with all you say. The poor old souls with the whistling aids and too deaf to use the phone are the ones who will suffer the most.
This slick techy age doesn’t take account of those struggling alone and aged who simply turn up to clinics without appointments because they can’t manage to make one via a godawful answering machine with half a dozen options.
My surgery won’t remove wax either, nor will the ENT clinic. This is a basic thing that can make a huge difference to those dependent on hearing aids.
We are conditioned to be grateful for every little bit of care we receive, however grim the experience has been. Thank goodness for the NHS they say, as though every other developed country has no efficient affordable healthcare. Not all bad, but much not to be proud of.
The NHS needs reforming as it cannot function in its current state, it’s expensive, inefficient, blotted with bureaucracy and a dinosaur. A product of the 1940’s and should be reviewed for reform.
Tattoo removal and sex changes is not what the NHS was set up to perform.
You’ve omitted hymen repair and cosmetic breast surgery.
Plenty of well meaning people in the NHS, as well as plenty of idle shits, but the organisation is rubbish.
Excellent post – I remember a few years ago watching a sunday morning nicky campbell debate there was a representative of a group of private hospitals who was adamant his group could treat NHS patients at a lower cost and higher quality than the NHS.
The leftie stooge from the BMA claimed that they would only cherry pick the easy operations.
The private group chap simply said, ”you pick the easy ones and we will treat the rest for less cost and with better care – and serve them an ‘a la carte ‘menu on top ”
Unfortunately the debate was moved on – but there lies the solution
healthcare nearly free at the point of use (no one respects things that are free) = lots of high quality care providers competing for patients, having to stay at the top of their game or no one will chose their services – funded by tax payers but without the bureaucracy, incompetence and corruption
“lots of high quality care providers competing for patients”
For market competition to work, there has to be both the possibility of failure and there has to be sufficient excess capacity in the system for their to be a true choice. Standard hiring theory says that is 20%.
The NHS doesn’t run with 20% spare capacity. That’s one of the reasons it struggles.
And do you really want your private provider going bust in the middle of an operation. If not what is the market control mechanism? Isn’t it going to end up just like the train franchises?
The NHS is doubly damned and damnable. It is what remains of an anachronism, that was founded in a flawed model of an era that has passed, based on a moral crime that remains active.
The flawed model was the big government, bureaucratic, state socialist model of the early C20th, that failed everywhere by the late C20th and clung on only where, as with the NHS, it became a shibboleth for the ruling elites, a cynically abused political football, bolstered by childishly naive sentimentality.
The moral crime is the idea that the state is responsible for everyone’s health. The state of course has no resources beyond what it steals from the people in taxes. What it pretends is charity, is actually theft from those who pay for it. And when the state is given responsibility for the people’s health, it inevitably takes control of the behaviour of the people, ostensibly to fulfill that responsibility.
In the end, it is that moral crime that is the problem. It does not really matter if it is achieved by the state socialist NHS route, or by the various more modern mixed/corporate/insurance based methods used in other countries. The expression of that moral crime is the nanny state, and a nanny state can only expand its intrusion into individuals’ lives. Lockdown and coerced prophylaxis, whether by “vaccine” or by drugs, are the logical next steps in a nanny state.
Until we can get back to a culture in which the state has no involvement in healthcare, and individuals, families and charity are the only bases for it, we are doomed to that route. Which means, short of counter-revolution, we are likely stuck with it.
I’ve got a lot of time for the nearly free at the point of use principle, it just needs to be done right – but I guess that’s the challenge
if corruption pays…. where there is demand there is a supply…
I suppose if one were being generous one could look upon the “theft” of people’s resources to pay for the NHS as a collective decision to be charitable, agreed upon by the majority, in order to make the charity more efficient by pooling resources. Most people are sort of prepared to accept giving a portion of their income to pay for healthcare for themselves and others, without being too picky about whether the come out ahead or down in terms of whether they need the care they have paid for, or more, or less.
Obviously in the UK there’s no opt-out and in most other rich countries there’s always a portion of your income being paid for backstop healthcare. You could object to that lack of opt-out and say that it should be a right. I think there’s a lot to be said for that, as a principle.
Did socialised healthcare lead inevitably to the covid debacle? Would it have happened without socialised healthcare? Maybe not. Did some states with socialised healthcare resist the worst of the madness – yes, but very few. But then very few states of any kind resisted. Is there a way to provide near-universal coverage through more voluntary means and properly separate that from the state so the state does not start poking its nose into people’s lives too much? One would like to think so, but perhaps not. Perhaps the near-monolithic nature of an “independent NHS” would lead to the same ills.
Could a smaller-scale, charitable/private business driven approach provide similar or better coverage, on average? Could you stop it from becoming a monster?
I recall from somewhere the the NHS is the 3rd or 4th largest employer IN THE WORLD. It was also reported in the 90s as the largest remaining Stalinist bureaucracy at the time.
The fact that our leaders haven’t done something about it just shows that some of them, or their mates, must be making a few Bob out of it….
NHS Subsidises low immigrant wages.
Helpful list of groups not to trust self-select themselves
https://medicalxpress.com/news/2021-07-major-medical-groups-mandatory-covid.html
“American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Surgeons, American Academy of Nursing, American Pharmacists Association,”
Lying about vaccination and promoting coerced medical procedures is an instant black-mark in my book.
Brilliant!
‘…what is my solution? Well, I’m afraid I don’t have one. My opinion is that the NHS is a failing system that is incapable of matching the outcomes and efficiencies of mixed healthcare economies in other developed countries. It’s been so for years and the inherent systemic flaws have just been exposed and exacerbated by Covid.’
Yes, you do have a solution:
‘In terms of outcomes, quality and efficiency, social health insurance systems are consistently ahead of the NHS on almost every available measure. They combine the universality of a public system with the consumer sovereignty, the pluralism, the competitiveness and the innovativeness of a market system. We do not see any one particular country’s health system as a role model, because they all have flaws and irritating aspects of their own. But there are also plenty of interesting lessons to be learned, which we are missing out on by ignoring alternatives to both the NHS and the American system.
The Dutch system shows that a successful health system needs no state-owned hospitals, no state hospital planning and no hospital subsidies. The Swiss system shows that even substantial levels of out-of-pocket patient charges need not be regressive, and that people can be trusted to choose sensibly from a variety of health insurance plans. The ‘PKV pillar’ of the German system shows that a healthcare system can be fully prefunded, just like a pension system.
The quasi-market reforms of the 2000s can be built upon, to move gradually from the status quo to a pluralistic, consumer-oriented healthcare system. Clinical Commissioning Groups (CCGs) are, in a sense, comparable to insurers, so giving people free choice of CCG would be a necessary (albeit not sufficient) first step towards creating a quasi-SHI system. CCGs’ budgets would then have to correspond closely to the risk profile of the patient population they cover, and this market should also be opened to private non-profit and for-profit insurers. CCGs and non-NHS insurers should be free to offer a variety of health plans, including plans with co-payments and deductibles in exchange for rebates.’
https://iea.org.uk/wp-content/uploads/2016/12/Niemietz-NHS-Interactive.pdf
la même chose not le meme chose
Can anything save the NHS?
In a word No
Its as if all the NHS boosters are unaware there are functioning health systems all over Europe, Japan, Singapore Oz etc, all of which provide better healthcare, with no dead bodies in the street.
The NHS lovers need to admit its a jobs cult, not a 1st world healthcare system.
I always ask people, if the NHS system is so good, how come no one else does it like we do?
I never get an answer
Lots of reasonable points in this article but also some stuff that is categorically untrue.
Yes, junior doctors hours are lower but actually face to face delivery of care / hours spent in hospital by consultants is the highest it’s ever been.
Newly appointed consultants often work even more hours than experienced consultants due to the addition of two tier rotas, having them work shifts instead of the old on call from home system.
Whilst the pension pot debarcle and lowered pay (relatively) have contributed to people leaving – there is also the fact that the old 1995 pension paid thousands out from a retirement age of 55… compare that to my pension that will pay out when I’m 68.
The main issue is that it is a bloody miserable place to work. This was true pre covid but it’s insufferable now.
Lots of the aspects about the treatment hubs are also untrue. Ours will only take asa 1 (the most simple cases) and still get paid the same as the nhs who do the most complex and need 3x longer in a bed.
Specsavers are getting £40 per cataract follow up done and are now doing almost all of them locally. Our hospital gets nothing…
NHS England has managed everything in the poorest possible way and the only answer is apparently for us to work for free to deliver 10 hours a week – the backlog locally will take over 5 years to clear if we managed that much.
Meanwhile we are getting fined for breaches left right and centre – meaning we have no money to deliver anything more – even if staff were prepared to work for free (which they are not).
Do I think the NHS is fucked – yes absolutely.
There’s no political party that will dismantle it effectively though – they will piss billions up the wall to their mates.
I fear that any political party who even suggests looking to alternative systems, will feel the full force of collective outrage.
We are stuck with it.
I think with the right public consultations it could be done
I agree with you.
What is needed is for a collective of stakeholders – from politicians to patients and, yes, pharma and medtech companies, to sit down with a blank sheet of paper and work out what healthcare delivery in the 21st century looks like.
Unfortunately, groups like the unions and and some politicians have made this such a toxic issue that it’s never going to happen. It would be political suicide for whoever suggested it and our politicians are nothing if not self-serving.
I left at age 58 after 30 plus years in various roles, not a doctor. Towards the end I felt I wasn’t able to continue protecting the service users from the nhs without it costing too much personally. I worked in mental health and it is often a Cinderella area, so even harder to protect people.
“ they (the political interests) will piss billions up the wall to their mates.”
The dominant theme of the post-Thatcher age. Run things into the ground, then sell off the bits to the mates to peck at.
This is the key issue which will not be undone by more of the same old same old, unimaginative ‘market driven’ crap that is the fare of the interest group that is the Policy Exchange.
Rick, list 2 good things that Thatcher achieved…
Smashed the unions. That’s worth two.
Oh my, you know what’s happening! Good post. I made similar points (see above) but yours has “bite”. Thanks for posting.
So true; CCG’s are a disaster area in many respects according to a close relative. Pension Pot – aka excess annual allowance charge – is not a debacle if you are the geniuses in the Treasury who dreamt it up, just diabolically clever and fiendishly difficult to work what is best – and it is by no means a bad thing to “stay in”…..although a lot have swallowed that hook line and sinker.
The non-clinical side of the NHS is totally overrun with ineffective and unnecessary levels of middle management. A family member worked in triage centre for a while. She got the job by attending a recruitment day event. Apparently it consisted of managers picking and choosing who they wanted based on appearance. Luckily for my relative, she is very young, pretty and innocent in appearance so had numerous managers chopping at the bit. According to her the interview consisted of not much more than ‘what is your name and when can you start?’. At no point was she offered training, despite the role including arranging blood tests and hospital transport for premature babies. Her manager could barely understand English other than when she wanted a new office chair or footrest. The manager was very often on annual leave or some sort of sick leave.
sounds incredibly efficient – for a public
shitserviceThe NHS can’t be reformed. Instead, make it compulsory for private companies with more than 100 (say) employees to provide private healthcare. To get it through politically promise (and keep your promise) not to spend less on the NHS (the UK spends less on healthcare than other countries, pre Covid anyway). In time you will build a constituency for private healthcare and the NHS can be reformed without too much expenditure of political capital being required. No doubt the government would have to hold fast against complaints of resources being stolen from the NHS, as nurses and doctors jump ship to the better paying private sector. This plan needn’t take a decade, especially if services could be provided from abroad (or insurance companies could fly you abroad for treatment).
The NHS, like schools, and most other government provided services that are shielded from competition, are run first and foremost for the benefit of the people who work there rather than the people they are supposed to serve.
And you can tell by how the people that work there tend go on about how selfless and dedicated they are and how little they are appreciated.
if everything is a priority, nothing is a priority.
Too many people trying to reinvent the wheel.
Look round the world.
Decide which version of Social Health Insurance we prefer?
Japan, Singapore, Switzerland Germany?
Copy it.
No pratting about with bells and whistles, just copy what they do.
UK spends above European average on healthcare for below average results.
Mostly down to sheer bureaucratic inefficiency.
Before its alleged we don’t spend enough:
a) Move to a system in which people choose to spend more on their health or look after their health better i.e Holland.
b) Read the below
https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20201202-1
Yes above average “healthcare” expenditure. But, because we contrive to waist money on high salaries and generous contracts with the private sector we end up with some of the lowest capital healthcare expenditure
Hence few hospital beds, scanners, radiotherapy machines etc etc and some of the worst outcomes for serious illness like cancer.
Not the case, read the chart again.
Salaries again ,- in the top 3rd so generous and certainly not performance related
The countries with more private sector involvement like Germany or Holland have better healthcare.
It is the very structure of the NHS that dooms the British to a 2nd world system inn perpetuity.
Its the contracts for cromies of the permanent bureaucracy & politicians that are the problem.
So in this chart, 14 countries have greater expenditure and 17 less expenditure. We appear to be above EC average. The chart excludes capital expenditure,
‘Current healthcare expenditure quantifies the economic resources dedicated to health functions, excluding capital investment.
Thats right, given the legacy the mature countries have of hospitals, capital expenditure is not included for any country, not just the UK.
But if you look up the numbers you will find our capital expenditure (compared to most developed countries) has been remarkably low for many many years. That’s the nub of the NHS underfunding problem. Rarely explained, well hidden and crucial (in my view).
And one of the first things the government decides to do is ban students from university unless they first take their jab. Mustn’t make university unsafe – we want to keep the unselfish, obligingly jabbed youngsters free to contract Fresher’s Flu, glandular fever etc as per usual.
Great way to train up all these radiologists and medics we are going to need.
So much best practice overseas that we ignore.
And so strange that we train so few doctors relative to need. Relying on foreign-trained doctors and nurses to the extent that we do is morally wrong (there are NO countries with a surplus of doctors, nor really of nurses either) and also smacks of ludicrous protectionism.
For starters, our medical schools clearly need a good kicking to admit more applicants. And the idea that nurses need a ‘degree’ is moronic. We’re talking PPE-BBC-Guardian-level stupidity.
“For starters, our medical schools clearly need a good kicking to admit more applicants. “
That’s not the problem. The problem is that the NHS doesn’t have sufficient training staff to do the field training.
Hence why Exeter is having to kick forward students this year due to over-offering.
To train people requires that the current system runs below capacity to allow that training to occur. After years of eating the seed corn, the NHS is incapable of training more people than it currently does.
It’s never a matter of money. It’s always a matter of manpower. To recover a rundown service requires belt-tightening to free up enough capacity to expand.
The nhs is doomed. Try getting an appt to see a GP.
Lack of attention to mistakes is a big problem …. My dad had hydrocephalus in the 90s due to a fuck up on medication, no one investigated why. My stepmum didn’t want to cause trouble.
Similar happened to someone close to me just six years ago, I complained left right and centre but whole organisation passed the buck. Solicitor now engaged and lawyers will make a fortune, but incompetent doctors and the GMC won’t be held to account.
Part of problem is that public need to see themselves as a customer receiving bad service, not as someone being given free advice by a friend.
The NHS was set up in good faith after the war when there were probably less people who all paid National Insurance. There are to many people not contributing to this pot so we cannot save it. Privatise it and maybe some people would take better care of their health.
Fair critique. However given this doctor left in their early 50’S as his lifetime allowance was close kind of actually sums up the problem with the NHS. The pensions are unaffordable. Until every doctor is put into defined contribution the ever growing pig in the snake will drain resources now and in the future.
Perhaps the NHS actually not perhaps, but in reality the NHS does not recognise the link between taxations and funding.In the past getting on for 2 years now, the NHS has worked tirelessly with the Government to close down businesses, remove people’s livelihoods, pay out billions in furlough, to spaff 32 billion on a useless track and trace system which again has crippled industry. I could go on. This money has to be paid back. So there is going to be less money for the NHS, the Government is going to have to raise taxes for its folly. Which as anyone knows is an anathema to most but is especially an anethma to Conservative voters. So Johnson has not only proven himself to be a weak inept leader, he will also lose the next election through fiscal mis management on a grand scale.
One observation that I will make, although because the NHS is still the religion of the country I guess it will smacked down. If you really want to get the waiting list down and the pressure taken off the NHS, the Government should give tax breaks to those who use private medical. It takes the the pressure off the NHS as more people would use it. However the taxation on Private medical means many do not take it up as to do so is to be punished.
Either way the Tories by closing down and ruining a country to save the NHS have caused their own demise.
“but in reality the NHS does not recognise the link between taxations and funding.”
That’s because there isn’t one. The NHS is funded like all government services by the people that work in it – who then aren’t available for the private sector to use.
And that’s it. Nothing to do with taxation. If we want a better NHS then we have to stop the private sector using the sort of people the NHS needs and transfer them to the NHS. More like a military deployment than a corporate bean counting operation.
And the way to do that, if we want an NHS, is to stop private healthcare existing. That will free up people to work in the NHS. Private healthcare doesn’t expand provision. It shrinks the NHS – because there is a supply limit on skilled medical people.
Money does not have to be paid back in a sovereign nation with its own currency. It pays itself back automatically when the saving that generates the ‘deficit’ is finally spent.
See https://new-wayland.com/blog/why-tax-matches-spending/
They don’t use Sterling anywhere else. It has to be spent here.
Yes so if we trebled the wages of everyone in the NHS then we’d all be even better off.
Maybe we should quadruple the wages of everyone getting paid out of taxation so we’re all better off.
The NHS should not be saved, certainly not in its present form. Socialised medicine works about as well as anything else coming under the banner of ‘socialist’, having too many chiefs (creaming off vast sums at the top) and not enough indians, far, far too big and therefore largely unaccountable.
The person supposed to be ultimately in charge is so remote from the coal face that he/she cannot possibly know anything about the nitty-gritty of such a large and unwieldy organisation; Hancock has degrees in Philosophy and Politics – how could he possibly be equipped for such a post? None of it makes any sense at all.
We need choice about who we pay our health insurance to, to keep it competitive and therefore working well for those it’s meant to benefit – the patient who pays for it – so often an afterthought in today’s internationally-abused NHS, with everybody too scared of ‘waayssist’ to tackle the problem “go to England – free health-care for everybody!”.
I find that some parts of the NHS still work well, but with so many foreign staff with barely any English, and who don’t appear to subscribe much to the ethos of patient-dignity, the whole experience of hospital for me has been quite scary.
The small procedure I had done in a private hospital was a hugely better experience, but it shouldn’t have been; that kind of quality of care should be what the NHS is striving for but isn’t, and can’t, because it’s socialised, full of pen-pushers and headless chickens and too many staff who just don’t care.
Oh, and it’s damned expensive.
We have loads of examples from Germany Austria, Switzerland Holland Japan Singapore etc etc, all running some form pf Social Insurance healthcare.
Just copy a system proven to work elsewhere.
After all Singapore tried an NHS in the 1960’s, realised it was bleeding stupid and moved to having a 1st world healthcare system instead.
I’d say copy Singapore’s system, as they moved from a 2nd world NHS to a 1st world Social Insurance system.
What an insightful article.
When the “working time directive” kicked in junior doctors working hours halved and as a result hospital consultants began to work more intensivley and for longer hours.
This is why many consultants opted out into private practice or, more usually, retirement. Those left behind were put under serious stress and so opted to work part-time if they could. This put even more pressure on those left working. Inevitably things started to deteriorate.
Many doctors are now disillusioned because when training as medical students they were reassured that doctors’ work stress was a problem that had been solved. This attitude is most common in young consultants who are often the same people who benefited from the changes ushered in 10 or so years ago.
COVID has served to highlight this problem. I have no idea how to solve it.
Perhaps if the NHS stopped treating those who have never paid into it – serial unemployed, illegal migrants etc, it would be in a better state. No-one should get any free treatment until they have paid in 5 years of NI (and I don’t count unemployment stamps).
No, just move to one of the Social Insurance systems proven to work elsewhere.
NI is a dead end.