I was delighted to read Dr. Andrew Bamji’s recent piece in the Daily Sceptic and particularly grateful for his kind recognition of my contributions. The first rule of journalism (even for the amateur) is to acquire a readership – if that readership choose to engage, so much the better. I’m equally delighted to be able to discuss these matters in the Daily Sceptic. The DS and the Free Speech Union provide forums for testing ideas that our public squares seem incapable of accommodating – a vital feature of a free society.
I agree with much of his article, especially in relation to futile care, having had a similar experience with my mother to the one he describes. Dr. Bamji takes issue with some of my observations, but in general his comment are, perhaps inadvertently, highly supportive of my thesis that the current system is incapable of meaningful reform. The importance of historical memory in understanding how we ended up in our current situation is raised. I couldn’t agree more and will elaborate.
I have previously alluded to the central question of where power lies in U.K. healthcare. Most commentators consider the foundation of the NHS in 1948 as the key date in the history of medicine in the U.K. My view is that the passage of the National Insurance act in 1911 is a more significant moment. The centrality of this date is admirably explained in David Green’s important book Working class patients and the Medical establishment. I commend it to interested readers.
To summarise Green’s book, 1911 marked the moment where the state first became involved in healthcare provision via a general taxation levy. Prior to that, medical provision for working people had largely been provided through the ‘friendly societies’ – mutual ‘self-help’ subscription organisations run by the working class to spread the risk and cost of medical treatment. The destitute were provided for by the multiple iterations of the Poor Laws. Friendly societies directly employed doctors on modest rates and were not universally popular with the medical profession – partly due to the low pay, but also due to the perception in some quarters that being beholden to working people reduced doctors’ social status. Doctors generally preferred providing services to the middle and upper classes who could pay more. But economic reality forced most to sign up to friendly societies’ remuneration structures. Economic power was with the societies and their members because they paid doctors’ wages.
1911 marked the point where economic power tilted from the consumer to the provider. The state inserted itself as an intermediary between the citizen and the providers of medical care. Medical remuneration rates increased, eventually very significantly, because of effective professional lobbying of the Government. Friendly societies participating in the National Insurance scheme were sidelined. The mass of the working public were deprived of economic power in the medical arena and excluded from active participation in deciding how their money was spent. 1948 marked further encroachment by the state in the administration and centralisation of healthcare. Attempts during the 1980s and 1990s to rebalance the system in favour of the taxpayer failed, not least because of vocal and sustained opposition from the BMA.
Dr. Bamji’s points about the increase in medical capability, the cost of drugs and diagnostics, the burgeoning care needs of the elderly and the effects of obesity and diabetes are well-made, self-evident and incontestable. These features are not unique to the U.K., but consistent across most Western economies. I part company with his analysis over his assertion that the medical profession has been supportive of reform in the NHS. All the changes in relation to working practices he describes are not reforms, because they don’t shift the fundamental locus of power away from the medical establishment and towards the service user. This is the sine qua non for any meaningful realignment of power in U.K. healthcare.
The editorial in the British Medical Journal last week describes fundamental reform of the NHS system towards a social insurance model as “a monumental waste of time”. Keir Starmer, writing in the Daily Telegraph, can only offer to dispense with the current model of independent GP practices contracting to the NHS and replace it with directly employed NHS GPs. This is not reform – it is an expansion of the current system. His Shadow Health Spokesman, Wes Streeting talks a better fight in an interview with the Independent. Streeting explicitly says, “I think the history of the NHS since its foundation 75 years ago is one where successive Governments do run into resistance to change within the professions… the status quo is driven by provider interest, producer interest and not by patient interest. And change is required.” It is notable in the same piece that Rachel Reeves, the Shadow Chancellor, fails to commit to increasing NHS funding. Finally on this point, lest any reader think that these observations are a new phenomenon, I include a link to an article written by the recently deceased Paul Johnson in 1991. It’s well worth a read – could have been written yesterday.
Successful healthcare systems in Europe and Australasia incorporate elements of co-payment, a variety of insurance top-ups with a guaranteed basic level of acceptable care for the unwaged and impoverished. Bismarck’s original social insurance model was in part designed to integrate the German working class into the social fabric of the newly established unitary state. The French Mutuelles are the legacy of the friendly society model, where subscribers have influence over how contributions are spent. These features establish a clear understanding that healthcare is not ‘free’ and that patients are paying. Consumers in mixed healthcare economies are empowered with genuine choice over which doctors to consult. Critically, social insurance schemes prevent insurance companies from ripping off customers by ‘exclusion of pre-existing conditions’ or by rapidly inflating premiums – because everyone subscribes, the risk is spread wider across the population than in our existing private healthcare insurance market. NHS ‘reforms’ in the first decade of this century purported to empower consumers in a similar way. In reality, they were deliberately confected chimeras intended to project an illusion of choice without any substance. The real purpose was to maintain centralised control. As Professor Alastair Lee pointed out in the Telegraph yesterday, “The public has little or no sense about the money put into this system or how it is used, and this disconnect is one of its fundamental problems.”
No system of healthcare is perfect – they are all subject to a variety of user complaints and workforce stresses. But a key distinguishing feature of continental systems in comparison to the NHS is the higher degree of choice for the consumer and a direct link between delivery of service and professional remuneration.
Dr. Bamji contests the effectiveness of surgical treatment centres. He was an opponent of the Blair administration’s policy around independent sector treatment centres (ISTC) in 2005 and submitted written evidence to the parliamentary select committee enquiry on the issue.
Readers may wish to consult this lengthy document – it runs to 175 pages. Dr. Bamji’s contribution is on page 159. Evidence was submitted by many interested parties with an astonishing concordance of opinion from all medical bodies in opposition to treatment centres. Several leitmotifs run through these submissions – ISTCs would provide unsafe care; they would deprive NHS hospitals of routine cases for surgical training and leach funds away from NHS hospitals; foreign surgeons would do most of the operating and ISTCs would destabilise pay rates for doctors. Yet, years later, more sober analysis showed that ISTCs had provided good quality of care with high rates of patient satisfaction.
The treatment centre model was so successful that it was copied within the NHS, the best example being the excellent SWELEOC orthopaedic centre in Epsom. It is perhaps telling that all objections about elective treatment centres vanished once the NHS retained control. For clarity, I am completely agnostic about which organisations provide elective surgery. The core point about elective centres is that they are geographically separate from acute centres, so routine operations are not cancelled due to emergency pressures. Whether they are run by the NHS or private sector businesses is completely irrelevant. It is also self-evident that risky complex cases require surgery in larger hospitals where critical care is available. Audit records show that surgeons and anaesthetists are highly proficient at risk stratification and minimisation of post-operative risk – they are quite capable of identifying the majority of routine cases suitable for treatment in elective centres and which need surgery in acute hospitals. This criticism is a canard and a classic example of provider interest ‘shroud waving’.
I’m further surprised Dr. Bamji considers paying doctors by levels of clinical activity problematic and unworkable. The French and the Australians operate their primary care system in that way and the private sector in the U.K. has been doing it for decades. Introduction of such a change would take time and would need to be gradual, but it is demonstrably possible, because other healthcare systems already run such models. Parity of pay between different medical specialties has long been a core tenet of the British medical establishment – but is it really necessary? Do patients care if a neurosurgeon is paid more per hour than a dermatologist, as long as they both provide a good level of service and a good outcome? Only the medical profession has an interest in parity of remuneration, along with maintenance of doctors’ inflation-linked pension schemes. Proper performance-related pay is crucial to incentivising doctors to spend more time in direct patient care and less time on non-clinical activity. I expanded on the issue of getting financial incentives correctly aligned in the NHS in a previous post and I see no reason to change that view.
The British medical establishment will resist tooth and nail any attempt to link pay to clinical activity. The very mention of the idea has British doctors reaching for the smelling salts – this should tell taxpayers something about how the system really functions. Arguments against change are classic features of the provider interest which pervades the NHS and is the real reason meaningful reform is highly unlikely to be implemented. Readers and the general public are likely to observe the provider interest in action in the near future if, as widely predicted, junior doctors vote to take strike action in pursuit of a 30% pay rise. The increasing political radicalism of the BMA junior doctors’ committee is highlighted by Andrew Gilligan in an important new publication.
The core tension in this argument goes to the question of who makes the decisions within the NHS and who subsequently pays for the consequences. Until the mid-1990s, a paternalistic medical establishment made most of the decisions. Since that point it has been an increasingly assertive but ineffective managerial cadre incorporating politically malleable former clinicians co-opted into the managerial structure as human shields for the executive. The taxpaying public has consistently footed the bill for multiple failed experiments masquerading as ‘reforms’, which in reality have been motivated by political ‘optics’ rather than meaningful beneficial change. Like non-player characters in a video game, the section of society paying for the NHS has been relegated to the role of impotent bystanders as the entire edifice collapses under the weight of its internal contradictions.
NHS reform does not mean adjusting the number of patients seen per clinic session, or arguments about maternity leave provision. Meaningful reform means a fundamental rebalancing of power in the system away from doctors and managers and towards the people who pay for medical care in this country. It requires disintermediation – the removal of middle men between the person paying for a service and the professional providing it.
Meaningful reform is obviously necessary. My expectation is that the NHS and medical establishment will adopt a ‘consent and evade’ strategy. Sensing public dissatisfaction with the manifest failure of the NHS socialist model, they will vocally endorse change. while simultaneously preventing any real shift in where economic power lies. We risk ending up with the worst case scenario of an inadequate politicised NHS run by and for the provider interest and a ruthlessly exploitative private medical sector. I rest my case.
The author, the Daily Sceptic‘s in-house doctor, is a former NHS consultant now in private practice.
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Many people support Hamas.
“I support Hamas.
Simply because I can’t ever again support Israel.
And if you continue to support Israel after witnessing its actions in Gaza, you’re more than simply an idiot.
You’re an immoral facilitator of genocide.
Sort of like the modern equivalent of a Nazi.”
Scott Ritter
https://t.me/ScottRitter/2218
Hamas declared war on the Jewish people and state by their actions in October, in wars innocents are killed, Hamas is no different from Germany, or the Japanese when they declared war on other nations then there was retaliation. Unfortunately as in all wars it is the innocent who are harmed. Hammas knew this, but they do not care.
Well said
War is something that’s supposed to involve soldiers fighting other soldiers and not mass murder of civilians. Insofar this happens in war, it’s considered a war crime. And there was no war between Hamas and Israel to begin with as these guys aren’t soliders. Just terrorist murderers.
You’ve got it the wrong way round.
The Jews declared war on the indigenous Palestinians 76 years ago.
The Palestinians are fighting back just as the French Resistance did against their foreign German occupiers.
Is Scott Ritter recommended reading?
He’s very good on the Ukraine war. I don’t agree with him with regards to Israel.
Aye same with Galloway. Great on the Deep State, but I remember him on the radio ridiculing anyone that questioned the World Order. I remember he was a champion for mass immigration but has seen the light over that too.
He told someone on the radio “so you think there are men in cloaks sat around a table in some shady room do you”. He did read out some TXTs from me around 2009 when he was on TALKSPORT. He didn’t take kindly to me questioning or the significance of a ‘Chalk Board” but happy about a TXT I sent over the expenses scandal. “My boiler is broken, wish I could claim for that, getting used to clod showers”….Nice little bunce if you can get it, the boiler cost me 2K.
Scott Ritter is a lunatic.
‘Ritter is an example of a typical disgraced American – often a man – who discredited himself in the US and now wants to be perceived as a source of “honest analysis” in Russia as a means to achieve renewed or increased glory.
Desperate men like him have frequently come to Russia to get a fresh start. It’s true that Russians will overlook anything as long as you’re useful to them. They don’t care
If you follow the local Russian news as it reports on Ritter’s grand tour of Russia, in local outlets such as the Kazan or Izhevsk news, none of them mention his arrest record and conviction……
They don’t even say, ‘oh this man was wrongfully imprisoned, it was a conspiracy against him.’ They just don’t mention it at all…..(He) “gets a chance to reinvent himself and feel good about himself again, and the Russians will let him do it’
Natalia Antonova
Scott Ritter criticised US foreign policy and was adamant at the time that Iraq did NOT have WMD.
The US use a sex trap against him by a young looking detective on an over 18 website.
If it had happened in the UK he wouldn’t have been arrested as the age of consent is 16.
It can only happen in the US.
It hardly makes him a “paedophile”.
It doesn’t alter the fact that he is an experienced military expert who is still actively and accurately analyzing current world events.
“Scott Ritter. is a former United States Marine Corps intelligence officer. He served with the United Nations implementing arms control treaties, with General Norman Schwarzkopf in the Persian Gulf during Operation Desert Storm, and in Iraq, overseeing the disarmament of weapons of mass destruction (WMD), as a United Nations weapons inspector, from 1991 to 1998.”
I think you’re perhaps in the wrong forum to post that sort of vile hatred.
Anyone supporting terrorism is in the wrong bloody country! Not to mention they’re a completely dysfunctional human being.
It is MindHalfFilled.
“You’ll never let it lie.”
I will rephrase that for you “I think you’re perhaps in the wrong echochamber to post that sort of vile hatred.”
You don’t need to rephrase things for me, thanks.
Oh don’t worry, it is no problem. I assumed that youi just want an echochamber.
I have no idea what you are on about
You are mistaken. This is not a “forum”. It is the “comments” section for comments about the relevant article in The Daily Sceptic, the publication founded by Toby Young, founder of The Free Speech Union.
Freedom of Speech includes “vile” hatred, one of many normal human emotions, though that word “vile”, like the word “feckless”, is only ever applied to Ethnic Europeans, usually by Leftists.
Why are the Admins on here allowing this antisemitic racist to post?
“Why are anti-vaxxers allowed to tweet?
Why are we platforming climate deniers?
Anti-maskers need to be silenced!”
No. You, I, may disagree with what they say, but requesting that he is silenced is not what we do here.
Hear, hear!
Upvote!
As idiotic as his (I’m assuming male) opinion is, he’s entitled to it. In fact, I’d argue society is in the mess it’s in now because people hid their real opinions. Let people say what they want and let society judge.
I’m happy that people post what I assume they believe they think. It is educational to realise that some of us on here wer percetive enough to understand the whole Covid plandemic and its implications but were taken in by the Ukraine and now Gaza.
I do however agree with Mogwai “Anyone supporting terrorism is in the wrong bloody country! Not to mention they’re a completely dysfunctional human being.”
And yet there are millions of Irish people who supported the IRA terrorists in the UK and Ireland, and even put them in the government.
In which country do all those “dysfunctional human beings” belong?
I was fortunate/unfortunate enough to manage major project work over 2 years in Belfast in the latter years of the troubles. I learned that whatever I had read in the then MSM hopelessly oversimplified the issues which were nested and complex. Dysfunctional human beings were massively overrepresented on both sides and the process had taken over the original issues that separated them. Same in several other conflicts i had some experience with and, as I hear from others who have relatives there, same in Ukraine. Lethal madness, borne of intransigence, creates such dysfunctionality that encourages a bifurcation in a previously reasonably accepting social group, town or nation and it takes a great deal to de-fuse these situations.
Of course, given time, the previously homicidal combatants mellow or mature and the sides turn to the complexities of political conflict over what was simply an indulgence in murder.
What no society needs, is such madness being embraced by dysfunctional idealogues embracing an apparent cause they barely understand and imposing their side of a conflict on those of us remote from its origins.
There are always those globalists who will encourage both sides of this process while their own nefarious objectives are benefitted.
Not all Terrorism is the same though. The IRA mostly targeted infrastructure and state agents.
I’m not sure I agree Ron. One man’s terrorism is another’s freedom fight. Other than the viewpoint, both are the same. And targetting is not even precise, nor casualty free. I remain haunted by the experience of a young hotel receptionist in Co Down whose parent’s house, in which she lived, was burnt down one night, because they were living on the wrong side of the sectarian divide.
What a f*ckin stupid thing to say. And I say that as someone who does not get even close to condoning Israel’s actions. What do you mean by saying you ‘support’ Hamas? What is it, exactly, you’re supporting? The rape and murder of civilians – oh, let me guess, that’s all made up? Do you support the growth of an Islamist state, which will see your wife and daughters treated like second class citizens, and will brook no dissent? Do you support the actions of terrorism as long as it’s a worthy cause? Do you support the protests by hundreds of thousands of Muslims on British streets? Do you support the raging antisemitism that’s sweeping the West? Do you support the eventual destruction of Christianity? What is it that you support? Because it sure as hell isn’t as simple as saying the idiotic words “I support Hamas”.
Permit me to address your points.
What do you mean by saying you ‘support’ Hamas? – He is quoting Scott Ritter, a US military analyst, who worked with the Israeli military in the past. Scott is aware of the devastation to civilian life caused by the Israelis and calls Gaza an open-air prison. He considers 7th October was a pure military operation and that a very large number of civilians were killed by ‘friendly fire’ due to the uncoordinated Israeli reaction.
The rape and murder of civilians – oh, let me guess, that’s all made up? – Actually, yes, it is Israeli propaganda, except that there are now sources saying that IDF personnel have raped Palestinians, besides of course murdering countless civilians – both Palestinian and Israelis.
Do you support the growth of an Islamist state … – What has that got to do with anything here?
Do you support the actions of terrorism as long as it’s a worthy cause? – That is a difficult one! If something is a worthy cause, there should be no need for terrorism.
Do you support the protests by hundreds of thousands of Muslims on British streets? – They are protesting a genocide, which I consider to be a worthy protest. They would stop protesting if a politician or two had the courage to openly criticize UK’s unquestioning support of Israel in this matter.
Do you support the raging antisemitism that’s sweeping the West? – Now I think you are exaggerating because all mainstream media in the western world only print articles favourable to Israel.
Do you support the eventual destruction of Christianity? – Again, I think you are a bit off-topic. All religions claim to be exclusively right, but that is hopefully a discussion for another day.
If you are interested in learning alternative viewpoints to those presented by the mainstream media, I recommend antiwar.com, thegrayzone.com, electronicintifada.net, ukcolumn.org, and on YouTube The Duran and Judge Napolitano. Scott Ritter has his own websites but also appears regularly on Judge Napolitano.
I personally take the attitude that everything presented on mainstream media is untrue, but maybe I am extreme. All mainstream media only print what the government allows them to print, which makes everything very one-sided.
Look at the photographs of the destruction taking place in Gaza on the websites I recommended. It is simply disgraceful. Imagine UK had fought the IRA by carpet bombing all of Northern Ireland – not really acceptable, surely.
The Daily Septic blocked me from seeing these replies for 24 hours.
So much for freedom of speech.
Wow, they’re even more mongtarded close-up than I thought. Have they been collectively lobotomized? Well at least it makes a change from yelling your hatred of Jews and love for terrorists ( 2mins );
https://x.com/AzzatAlsaalem/status/1791469928731586720
Articulate little buggers, aren’t they?
So what her visa has been revoked, most ilegals here don’t have a passport much less a visa and they get to have free housing, benfits, NHS, etc, etc, and the Government hasn’t removed them, what do you think the chances are that this woman will still be here spouting her hatred this time next year.
Another example of meaningless virtue signalling by our Government
To be fair, I’d totally forgotten about Houthi and the Blowfish. Classic;
https://x.com/ShutupLyle/status/1767590984529899854
Well done. More!
I trust that as she is without a visa she is no longer enrolled at UoM?
Ha, so there we go. Now we know why Egypt reinforced their already big-assed wall. The human shields must be kept at bay at all costs to perform their sole function whilst the terrorists get to scurry through to safety via the tunnels. I’d imagine ‘Big Lugs’ and his family is already safe and sound in Egypt then;
”Israel has found 70 tunnels in Rafah so far, 50 of which cross the border into Egypt.
That’s what Egypt was hiding. These tunnels were used to smuggle arms and ammunition to Gaza. Mystery solved. No wonder Egypt and Joe Biden were against Rafah invasion.
One can speculate that Yahya Sinwar with other Hamas militants together with some hostages are already in Egypt.”
https://x.com/ImtiazMadmood/status/1791408030795391443
And soon she will no doubt realise why she left that hell-hole to come here… She won’t be allowed to say anything about Hamas, or rather she will only be able to say it once..
I feel a taxpayer-funded appeal in the wind.
In the words of the great Terry Wogan ‘..is it me?’
There would have been a predictable response to this action.
When does she leave then? Terms have pretty much all ended and she has no Visa, so when is she on a plane? Vote Reform and she’d have already gone.
Visa revoked. Nothing states that she has been shipped out.
I wonder why?
We don’t “ship out” —-We “ship in” more and more sectarian clutter
I know but we live in hope.
I think the horse has bolted. The clutter is taking over.
Actually I wholeheartedly agree with this point of view.
Well I might not be around to see the Islamification as I might only have a quarter of a tank of life left in me, but it is sad when you compare this country in the 50’s and 60’s to now and what will soon be.
I bet she’s bombarded with offers of well paid work from all the usual suspects.
All who come on here, born in the UK, are more likely to actually be deported than she is.
“46 comments” but I only count 18.
Tut, tut. Has the DS censor been active? No critical comments allowed against Israel? That has little to do with free speech.
When it comes to censorship the DS just as guilty as the BBC/Guardian etc who don’t allow criticisms of mRNA jabs, Ukraine, climate change etc.
Hypocrits.
Comments by a few on here have advocated the extinction of Palestine.
But that’s ok
My comment was removed and The DS expect me to carry on paying £5 a month for the privilege of being censored.
I was the first to comment and when I checked this morning it had been removed.
Here was my comment ……
Many people support Hamas.
“I support Hamas.
Simply because I can’t ever again support Israel.
And if you continue to support Israel after witnessing its actions in Gaza, you’re more than simply an idiot.
You’re an immoral facilitator of genocide.
Sort of like the modern equivalent of a Nazi.”
Scott Ritter
https://t.me/ScottRitter/2218
Going, going……
She won’t be going anywhere. We can’t even depart rapists, so she’s not going to be frogmarched onto a plane.
This country is crying out for strong leadership, something we haven’t seen for 35 years, and even then she was a one-off.
Going on a self-deating killing spree in Israel is neither resisting oppression nor war, it’s senseless murder. That the other guys are morally just as bad, but with jet planes, doesn’t excuse this. At best, this so-called war is a pretty pointless dicksizing contest between a shrew and a grizzly. At worst, it’s just what Netanyahu needs to win the next election, as per the old recipe Trouble at home? Make war on some foreign country!