In recent days the failing NHS has been in the news again. Senior figures in the medical firmament have given evidence to a parliamentary select committee about the workforce crisis. A hard-hitting documentary on ITV exposes the ‘reality’ in A and E departments. David Oliver (President Elect of the Royal College of Physicians) writes in the Financial Times about the existential crisis facing our beloved NHS.
Readers will be wearily familiar with the choreography. The curious timing and alignment of views for example. The consistent line that everything would be marvellous, and nothing would hurt, if the evil Tories would just hand over even more taxpayers cash to the wonderful NHS.
I should say at the outset I entirely endorse the view that the NHS is failing. It’s been failing for years – the current inflection point is an acceleration in the pace and breadth of failure – not a change in the direction of travel.
The Daily Sceptic team have asked me to contribute some thoughts on the factors behind the mantra that it’s all about a funding deficit. Before getting into this subject, I should issue a trigger warning – some readers may disagree with me. Some may be very upset by my opinion. Some may want to ‘call me out’ as a regressive dinosaur unsuitable to be a practising doctor. Some may want to professionally cancel me or revoke my licence to practice. Some may think I am an evil person and should be burned at the stake in the town square.
I write partly in jest. The readership of the DS is (or should be) committed to freedom of expression. Sadly, the medical profession is not so keen. I cite the example of Merion Thomas, an eminent and highly respected cancer surgeon – hounded by an outrage mob and censured by his own Hospital management for highlighting in the press the shortcomings of primary care in the U.K. That was over a decade ago, when society still pretended to tolerate dissent. Being consistently ‘orthogonal to the orthodoxy’ (hat tip Sunetra Gupta), I can’t afford professional cancellation, hence retention of the invisibility cloak.
In a way, the use of the word ‘workforce’ sums up the problem. It’s a lazy managerial term for the disparate professional groups working in the medical or paramedical fields. It is redolent of the paradigm shift from professional control of the NHS to managerial hegemony which has been an inexorable trend over my 33 years in clinical medicine – and there lies much of the problem.
Let’s start with workforce demographics. A recent article published in the Daily Telegraph made the plausible claim that three out of four GPs now work part time.
Might there be an association between childbirth and female professionals working part time?
As 55% of the registered GP workforce are female, could this have something to do with the problem?
Is it possible that most female doctors are second wage earners, so have the choice to work part time? Could it be the case that fewer female doctors go into arduous and stressful specialties such as surgery, because intense work at nights and weekends is deleterious to family commitments? Might this have been predictable when over 60% of the current medical school intake are female? (When I entered medical school in 1983, 30% of students were female.) Weren’t these possibilities written about in the medical press?
Lest anyone misinterpret my view, I am not suggesting in any way that female doctors are inferior in quality or professional esteem to their male counterparts, just that they make different choices about working patterns for entirely rational reasons, and that this demographic shift was predictable and indeed predicted. Increasingly, their male colleagues are making the same choices, for reasons I will expand on.
The recently elected President of the Royal College of Physicians writing in the British Medical Journal has described those of us raising such questions as “ill informed, ill conceived, ill willed, outrageous, and discriminatory”.
It is simply impossible to have a rational discussion in public on this point, so I’m not going to bother trying. I simply observe that in 1987 there were 68,777 doctors on the medical register in England for a population of 47.3 million One doctor for 688 people.
In the whole of the UK in 2022 the figures are 350,000 doctors for 67.44 million – one doctor for 192 people.
The medical workforce demographic no longer meets the demand. This is not due to having an inadequate number of doctors – it is a consequence of how those doctors choose to work and how they have been trained. My cohort of doctors in our mid to late 50s are predominantly male and coming up to retirement – so this problem will get a lot worse, before it gets better. Which leads me to my next point.
Consider professional training. Two decades ago, a trend towards ‘problem based learning’ in medical education arose in direct challenge to the traditional medical school curriculum. A central tenet of PBL was that doctors ‘didn’t need to know’ the really hard science stuff in order to be efficient clinicians. If a doctor was a sufficiently empathetic and compassionate communicator the medicine would just magically sort itself out. Unfortunately, this is not true. Learning medicine is hard work. It is absolutely necessary that a doctor comprehends the basic sciences of anatomy, physiology, biochemistry and pathology. Such familiarity requires long hours spent sitting on a hard chair in a quiet room preparing for intellectually rigorous examinations with no adjustments made for those who fail to reach the required standard. Problem based learning is not a shortcut to excellence – it’s a direct line to clinical failure.
Higher training in the medical specialties has also changed. My cohort of trainees spent approximately 30,000 clinical contact hours in formal training posts over 10 to 12 years. We did an apprentice style training, comprising a huge amount of ‘service work’ – clinics, operating lists, resident on call, work at nights/weekends and so on, where we had to be physically present on the wards for days at a time.
Current higher professional training takes approximately 8,000 to 10,000 clinical hours, typically spread over eight years. We are told this is more educationally productive. It is certainly easier and less arduous for the trainee, but it’s less obvious that new style training produces specialists on a par with prior periods.
Measurable professional productivity in the NHS was on a downward trend before Covid, and has continued to deteriorate sharply since. Spectator data analysts have noted that European Health systems have recovered faster from Covid than the U.K. Why might that be? The authors of the Bennett Institute report ascribe the decline in productivity to lack of ‘investment’ by the Government. Oddly, they avoid discussion in relation to quality of workforce training and restrictive practices. I wonder why?
Next, I turn to the real elephant in the room – that which no one can speak of. The patients.
It is absolutely correct that the patient cohort are older and sicker than in prior decades. Why does this matter? More complex patients require more medical time. It makes each clinic harder work and more stressful for the doctor. Added to this stress is the increased tendency for patients to complain. Complaints take up huge amounts of administrative time to respond to and form part of the yearly appraisal and five yearly revalidation process for doctors. Simply put, if too many patients complain, a doctor can have their licence to practice revoked.
Readers may take the view that such a system is prudent and reasonable. After all, poorly performing doctors should be weeded out of the profession. There is much to commend that argument.
Regrettably, in practice, the complaints system creates a situation whereby clinical doctors are responsible for things over which they have no control. This is extremely stressful. As a direct consequence, some doctors avoid patient contact. They retire early. They shift their job descriptions to include more non-clinical activities – for example going into clinical management roles, medical education or research. They drop NHS sessions and work privately, where there is a higher degree of control over clinical decision making and where patient interaction is directly incentivised.
The simple truth is that the majority of clinical medicine is unrelentingly hard work and quite often boringly repetitive. Doctors are often faced with clinical problems they cannot solve and subject to complaint or abuse from dissatisfied patients and relatives. Further, there is no prospect of advancing one’s professional status by grunting through endless clinics on the front line. What honours and awards there are in medicine invariably go to those sitting on committees – not to the clinical workers.
But there’s more!
An NHS doctor gets paid the same for doing a timetable filled with non-clinical work as for doing a full clinical schedule. Faced with the opportunity of doing a less stressful job for the same money, doctors make a rational choice. To quote Charlie Munger (Warren Buffet’s business partner) “show me the incentive, I’ll show you the outcome”. If NHS management wanted to incentivise doctors to spend more time treating patients, they could start by addressing relative remuneration rates for clinical vs non-clinical activity and scrap increasingly onerous and intimidating regulatory requirements.
Readers may well ask, if what I have written is true, or even partly true, why are none of these matters being addressed? Again, this is a complex question. At the heart of it is the impossibility of open disclosure and discussion. When senior medical figures denounce discordant opinion as morally unacceptable or motivated by malice, there is no possibility of resolution. Politicisation of medicine inhibits open analysis of operational problems. In addition, there is the embarrassing possibility that many of the current incumbents in medical leadership positions have been complicit in generating the problems we now face. It’s a lot easier to blame the evil Tories than address intractable self- generated structural inadequacy.
There is no medical system on the planet that combines perfect clinical outcomes with perfect patient satisfaction. I think we need to stop treating access to medical care as a ‘human right’ provided by the state. Moving towards a system where medicine functions as an appropriately regulated professional service industry, where the onus of maintaining health rests with the individual rather than the Government, would eventually lead to better results. Available data comparing different healthcare systems supports this view. A European/Antipodean style mixed health economy with a variety of social insurance schemes and safety netting for the impoverished would be preferable to the quasi-monopolistic current system – it could hardly be worse. Such suggestions are anathema to the apparatchiks and commissars of our NHS. They react to such suggestions by vilifying and demonising doctors advancing meaningful reform, and by deliberately inculcating terror in the public about alternative models of care. Regular readers of the DS over the last two-an a-half years may spot a pattern of behaviour.
The NHS is socialism in practice. Nice idea. Never works.
That’s why its failing.
The author is a former NHS consultant now in private practice. He contributes regular pieces to the Daily Sceptic and is often referred to as our in-hour doctor.
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Criminal! I hope to god children and parents have the sense to refuse. I fear they won’t.
having lived in British Columbia, Alberta, and Quebec, I know that all Canadians have much sense.You do not last long in Canada without sense. Thye will not be scared by a piddly vaccine shot. I juat wished they’d get a move on and catch up, get back to normal so I can draw my pension that they owe me!
You want to be like the UK?
Step 1 – V day. Massive death spike
Step 2 – blame the V deaths on The Vid
Step 3 – more lockdowns
Step 4 – repeat.
There is nothing “piddly “ about experimenting on immature immune systems by invoking an unknown antibody response for a disease that will not harm them. I do not recognise your generalisation of Canada as having ubiquitous common sense. If you can demonstrate any other medicine or vaccine which has ever been licensed for children in a similar manner you would have some credence. This is a gross moral and ethically incorrect experiment on the young to make their elders feel better .
Some of my Partner’s family live in Canada and married Canadians. One or two have common sense but by no means all of them. Certainly not the druggies and alcohol abusers.
All true, except it’s driver is pharma profitability. Nowt else.
A very dark day indeed
Heaven help them
My eldest is 7, but as and when they get down to that age they can stab me where the sun don’t shine before putting it in her. And yes, she’s had every other regular vaccine going.
Germany has just provided funding of 3.8 billion € for the purchase of booster and variant Covid gene therapies for 2022 and 2023.
There is no plan or chance that the plandemic ends, without us forcing them out.
Extrapolation of jab deaths sofar x doses purchased now suggests 11.000 ‘vaccine’ deaths in Germany alone.
Before the medium and long term side effects related ones, or the vascular ones due to the spike protein factories in the jabbed.
DEUTSCHES ÄRZTEBLATT: Gesundheitsministerium bekommt weitere 3,8 Milliarden für Beschaffung von Coronaimpfstoff – Auszug: „Es geht dabei um Impfstoff für die Jahre 2022 und 2023, also vor allem für Auffrischungsimpfungen und Impfungen gegen mutierte Coronaviren. Das geht aus einem Schreiben des Finanzministeriums an den Haushaltsausschuss des Bundestags hervor. (…) Demnach zeichnen sich Vertragsabschlüsse der Europäischen Kommission ab, ‘um eine ausreichende Versorgung mit adäquaten Impfstoffen gegen COVID-19 auch für die kommenden Jahre sicherzustellen‘. (…) Außerdem stehe ein Vertrag kurz vor dem Abschluss, bei dem es auch um angepasste Impfstoffe für Kinder gehe. Deutschland müsse jetzt Zahlungsverpflichtungen eingehen, damit entsprechend viel Impfstoff bestellt werde.“ (Anmerkung Paul Schreyer: Damit ist die Katze ist aus dem Sack: Die Impfungen sollen fortan regelmäßig erfolgen. „Neue Normalität“ für immer – sämtliche bekannten und unbekannten Risiken und Nebenwirkungen inbegriffen. Kinder zu impfen ist dabei die letzte denkbare Eskalationsstufe und angesichts der vollkommen unerforschten Langzeitwirkungen eine Verantwortungslosigkeit unfassbarer Tragweite. Eines Tages werden sich viele von denen, die diese Beschlüsse und deren Umsetzung jetzt „durchwinken“, vor Gericht verantworten müssen.)
CORONA TRANSITION: Wie gefährlich sind die neuen Covid-19-Impfungen wirklich? – Auszug: „Hat sich Deutschland mit 410 Mio. Impfdosen auch 11’000 Todesfälle ‚eingekauft‘? (…) Im Vergleich zu allen anderen Impfungen zeigen sich bei den neuen Covid-19-Impfstoffen stark erhöhte Werte (jeweils pro 100’000 Impfungen): Nebenwirkungen steigen von 7 auf 217 (Faktor 31); Schwerwiegende Nebenwirkungen steigen von 3,2 auf 23,9 (Faktor 7,5); Todesfälle steigen von 0,06 auf 2,83 (Faktor 47) (…) Deutschland hat sich 410 Millionen Impfdosen ‚gesichert‘ (Stand Anfang Januar 2021). Aufgrund der aktuellen Zahlen des Paul-Ehrlich-Instituts (und nach Adam Riese: 2,83/100’000 x 410 Mio.) müssen wir also in Deutschland mit über 11’000 Todesmeldungen im Zusammenhang mit den Impfungen rechnen! Wohlgemerkt: Es handelt sich um gemeldete Verdachtsfälle! Die Zahl der ursächlich an den Impfungen Verstorbenen liegt natürlich darunter. Andererseits gibt es eine Dunkelziffer – nicht alle Todesfälle werden gemeldet.“
Andy chance of a translation?
“The BBC News report is worth reading in full.”
NO
IT’S
NOT.
None of the stories you quote from the BBC, Guardian or Telegraph are worth reading in full.
We need to shun these organisations and anyone who works for them.
LDS became a media noise repeater several months ago.
Agreed. We do not need to be linked to the propaganda, thank you
Great, I’ve got a little pension, locked up in canada worth £7 a day, which covers my bar tab, but I can’t get at it since Canada is closed. I can’t open a bank account, nobody answers the phones, I can’t get transfer funds. so my money stays locked up, I’m pissed off at Canada. They need to get a grip on this thing there, like we have, I want my 2 pints a day!!!
I could fly to Canada to sort it out in a year or two, meanwhile, I’m pissed off at Canada.
Canada has turned into Gilead.
The whole of North America, Europe and Australasia has turned into Gilead.
Yes, barmy in Gilead.
This is the Devil’s work – and yes, they are closing the churches and jailing the pastors.
The forces of the Antichrist are sadly ascendant.
Keep praying. Keep resisting. Do not throw your children into the tophet.
What, in hell’s name, is wrong with Canada? From the current state of. Vancouver, I wonder if it’s Chinese influence flooding over it from west to east.
Healthy children in Canada probably have a 1-in-2-million probability of dying from COVID … and still parents will line up to make sure their kids are “protected” from this terrifying health risk.
Sod the kids, it’s to protect old people.
That’s a shame, because vaccinating children will contribute NOTHING to safety of seniors.
Kids don’t infect adults with this virus, more the others way around.
Vaccines for kids, booster jabs without any evidence that they achieve anything, cheap treatments such as Ivermectin and Hydroxychloroquine blocked. Yes Covid is a serious disease for certain groups, but it’s looking more and more like big pharma carries a lot of the blame for blowing the whole thing out of proportion, maybe more blame than authoritarian/incompetent governments or people pushing the great reset.
I think the credulous people who accepted all the extraordinary, unsupported claims with nary a question in response also bear some of the blame.
Jesus, I lived in Calgary for 18 years and hearing this makes me ill … Evil fuckers behind this abhorrent decision.
In the UK in 2020, a little more than 1 in 700,000 children in this age group died of covid-19. These had pre-existing conditions. For those without pre-existing conditions, it was less than 1 in 3,000,000.
The current UK death rate for the jab is about 1 in 42,000. This jab is therefore between 17 and 70 times as risky as that which it protects from! Furthermore, their immune system will be compromised and less able to deal with new pathogens in the future.
Jabbing these kids is criminally insane!
“Criminally insane”
No, not insane, as that implIes they are not aware of their actions.
Leave it at criminal
Died with covid-19!
Yes, to the 1 in 700,000. But the 1 in 3,000,000 had covid-19 as the sole reason on the death certificate, unless it was a misdiagnosis.
Died within 28 days of taking a test that may or may not have produced a false positive result.
Did you know almost 4,000 children have been vaccinated for COVID-19 in the States?
And that:
9 died within 28 days (0.2%)?
7 almost died?
3 were permanently disabled?
71 had to see a doctor or were admitted to hospital or had their stay prolonged?
https://mobile.twitter.com/RealJoelSmalley/status/1390011607175081985
9 out of 4000? Seriously? So more than 2 per 1000 died? So in a big school, expect 2 kids to die and one be permanently disabled, and in a smaller school of a few hundred expect one to die?
Add in the 3 disabled and 7 nearly died, that’s 5 per big school. Do you feel lucky, punk?
Appalling.
Twitter deleted that Tweet. Can you remember the source?
“Bring out your dead….”
6,662 DEAD 299,065 Injuries: European Database of Adverse Drug Reactions for COVID-19 “Vaccines
https://healthimpactnews.com/2021/6662-dead-299065-injuries-european-database-of-adverse-drug-reactions-for-covid-19-vaccines/
Not to be biased, other jabs are available…
Total reactions for the experimental vaccine AZD1222(CHADOX1NCOV19) from OxA…Z: 1,086 deaths and 150,863 injuries to 10/04/2021
4,092 Blood and lymphatic system disorders incl. 44 deaths
5,911 Cardiac disorders incl. 140 deaths
52 Congenital, familial and genetic disorders incl. 1 death
3,886 Ear and labyrinth disorders
112 Endocrine disorders incl. 2 deaths
5,994 Eye disorders incl. 4 deaths
47,881 Gastrointestinal disorders incl. 40 deaths
117,802General disorders and administration site conditions incl. 363 deaths
162 Hepatobiliary disorders incl. 6 deaths
1,499 Immune system disorders incl. 5 deaths
8,809 Infections and infestations incl. 84 deaths
3,095 Injury, poisoning and procedural complications incl. 11 deaths
7,336 Investigations incl. 14 deaths
6,078 Metabolism and nutrition disorders incl. 10 deaths
68,519 Musculoskeletal and connective tissue disorders incl. 7 deaths
97 Neoplasms benign, malignant and unspecified (incl cysts and polyps) incl. 3 deaths
92,586 Nervous system disorders incl. 154 deaths
71 Pregnancy, puerperium and perinatal conditions
39 Product issues
7,934 Psychiatric disorders incl. 9 deaths
1,446 Renal and urinary disorders incl. 8 deaths
1,328 Reproductive system and breast disorders
12,49 Respiratory, thoracic and mediastinal disorders incl. 109 deaths
19,069 Skin and subcutaneous tissue disorders incl. 6 deaths
256 Social circumstances incl. 3 deaths
322 Surgical and medical procedures incl. 7 deaths
6,136 Vascular disorders incl. 56 deaths
All coincidence. It has a long harm, remember.
Nice to see the comments are considerably more “sceptical” than the considerably “unsceptical” author on the “so-called sceptical” website.
If there’s one crime out of all of this nonsense that’s worth getting angry about, it’s medical experimentation on children who bear no risk and do not have the capacity to consent for themselves.
True, but the list of anger-raising crimes is so long it is hard to pick a worst one!
Vaccines for everything and all ages if this is the baseline.
Parents get ready for the fight of your life.
Keep your murderous hands off our children! Off our grandchildren! You evil genocidal scumbags.
Sadly scientists have failed to recognise that in their rush to publish regardless of the quality of their data they are harming society. When innocent children are having their future lives potentially harmed by a vaccine for a disease which will not harm them ethics and morality has been dismissed. Shame on all those who feel that children should be used as a comfort blanket for their elders.
Scientists might have rushed to publish but the blame lies squarely with governments the world over who are coercing their populations to have the current jabs on offer and future “top-ups” to deal with scariants or whatever public health emergency is drummed up. The blame lies with the governments. They are the pushers.
Disgusting unethical child abusers
Sorry, Curzon is incorrigible. My only explanation is that TY wants a contrarian voice on the page to show that there is “balance” in the reporting. Note: contrarian here is used to mean contrary to the principles of the site. The byline of Lockdown Sceptics is: Stay Sceptical. Control the Hysteria. Save Lives. Curzon is not sceptical (of vaccines). The articles he promotes elevate hysteria and could cost lives–it is unconscionable to inject children with an experimental substance for a disease that does not affect them. This is so outrageous that even MSM should be asking this question of why children?. So I guess Curzon is just going to keep doing Curzon when it comes to vaccines…..
If there is one that is likely to cause the sheeple to finally wake up is when these bastards start taking their children.
“In March, Pfizer said initial results from trials of its vaccine in this age group showed 100% efficacy and a strong immune response.”
Strong immune response – meaning the poor children experienced adverse effects from a totally unnecessary assault on their medical freedom by use of questionable injections?
What is the world coming to, abusing children like this? To abuse those children in order to ‘protect the old and / or vulnerable’ and in doing so, may irreparably affect their own health and life. Unforgivable.
This must be about the vaccine passport. There’s no other reason for it. They need everyone to be vaccinated so that everyone has a ‘passport’. Children and young people are key to this ambition since they will be the ones who will be mostly affected by future passport control.
Did I really write that? How things have changed in the last 12 months.
There’s a lot of money in the child vaccine market.
I think it’s high time we stopped calling this injection a vaccine. If you’ve not watched the video of five doctors discussing this thing, you can see it here:
https://www.bitchute.com/video/i2fMnrMH3Zm3/
Set aside an hour and twenty minutes (though jump past the first 5 minutes of the annoying woman at the start who keeps letting her phone ring while talking).
And the UK column transcript of the interview with the NHS whistle blower who was working on the jab rollout – that person kept calling it a jab for the very precise reason that the injection did not meet the criteria to be called a vaccine. That same person said it was genocide.
Essential watch on the ‘vaccines’ – Interview with Sucharit Bhakdi :
https://off-guardian.org/2021/04/30/watch-perspectives-on-the-pandemic-15/
… and the answers to all the Mayo crap about absolute v. relative RR (above) is also answered – with the important point that the risk increase from the vaccine can also be calculated – with a very sobering set of figures for vaccine worshippers – whichever way you look at it. The relative risk of blood clotting symptoms of no-vaccine versus vaccine are pretty shocking in relative terms – if that’s your chosen measure.
Sauce for the goose …..
“Canada has recorded more than 1.2 million coronavirus cases and roughly 20% of those have been in people under the age of 19”
The underlying message is that kids are at threat – get them vaccinated! But they could have tested in any winter season and got the same (or better or worse) results.
The only reason for vaccinating kids (or anyone) is if there’s a threat of serious illness or death. There is not.The policy continues to be abhorrent and parents should be defending their kids by NOT getting the vaccine.