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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I like very much the Covid madness ratings and can add Thailand and Vietnam to this game of Top Trumps.
Both score very highly if we’re talking about immigration, I’d say 8 for Thailand and 9 for Vietnam. The shadow of Covid tyranny hangs over their respective points of entry, but masks and so-called vaccine so-called passports are not required for either. Oh, the same is true for Malaysia where I was quite briefly a few weeks ago. So SE Asia gets a collective score of 8.5 on the Watson Tyranny Scale.
But it’s out in the countries themselves where things get murky. I work in a school in Saigon where perhaps 1/3 of the children remain masked at all times. I regularly see children as young as 3 or 4 wearing masks. I visited a medical centre to arrange a mandatory medical check last week and was the only maskless person in the whole place. Still, no one said anything.
So masking here has become normalised for many people (helped I think by the fact that people already wore them because of smog). Yes, the shadow of Covid Tyranny looms large, but it’s a complex picture that, even after a month of being here, I can’t quite fathom.
I should also add, this experience has emphasised for me just how dehumanising masks actually are. Some of the kids I teach have started to come to school without them for the first time and it’s like I’m seeing them for the first time. With a mask on I had no idea what they actually looked like and I’m surprised when I see their whole face. ‘Oh so that’s what you look like’, I think to myself.
The next question for me is, when in two weeks I get my Vietnamese driving licence and start riding a scooter (overwhelmingly the most popular mode of transport here), do I go maskless and breathe in pollution, just to prove a point? Does that count as cutting of my nose to spite my face? Either way, I’m not putting one of those bloody stupid things on my face!
Oh, and to answer the question posed in the headline:
As the good doctor should by now be aware, Covid-19 never was about public health and the US still insists on vaccination because it’s agencies spearheaded the project and don’t want to let go, even while the whole charade has become untenable for ‘normal’ countries which still have some semblance of independence and whose policies are their own. ‘Vaccination’ is a proxy for compliance, surveillance and control, all of which have for a long time been the modus operandi of the US regime.
… and the US government played along with its agencies projects because they were all part of a routine Mencken Imaginary Hobgoblin.
Luciferase which is in all the injections fluoresces under blue lights which seem to have become very fashionable recently, is this how the injected can be identified? As per the now removed page from the WEF site boasted.
I thought the luciferase theory had been debunked.
Not as far as I’m aware of.
Ah! but, by whom was it debunked?
Indeed. I’ve always believed the mask was absolutely key to the control agenda. It signals a change to the default thinking; instead of assuming most people are friendly, the mask signals that most people are a threat. It is not only an indicator of compliance, but enforces dark beliefs of what risk others impose. Distrust, fear, and dislike is silently nurtured. It reminds everyone that there is a crisis that can only be dealt with by following the guidance given by authority. The mask is a much more powerful tool that most understand.
I absolutely agree and have always seen them the same way. They also promote collectivist thinking and discourage individuality. Rather like the population of a certain superpower just to the North of me.
Masks are today’s equivalent of Gessler’s Hat. And I never bowed before it.
Well, whoever Gessler is these days, he/they/she/it can eff off!
Great to read your news, crisis.
My view on masks was extremely simplified:
I’m not firkin wearing one. Anybody wearing a mask is a dozy, ignorant pillock.
That’s it.
Have the farmers had any success?
No, not to my knowledge. I haven’t heard anything meaningful in a while, not since the government declared they’d forcibly buy out up to 600 livestock farmers.
I like the look of this documentary which is currently being made about it all and the director talks with Del Bigtree here;
https://www.sgtreport.com/2022/11/documenting-the-dutch-farmer-saga/
So true. It is extremely antisocial, and has been referred to as a “tax on socialization”. All cleverly disguised as a virtue signal of altruism to “protect others”, of course.
Facemasks: the control agenda
Yellow Freedom Boards – next event
Monday 14th November 11am to 12pm
Yellow Boards
Junction A332 Kings Ride &
Swinley Rd, Winkfield Row,
Ascot SL5 8BP
Stand in the Park Sundays 10.30am to 11.30am – make friends & keep sane
Wokingham
Howard Palmer Gardens Sturges Rd RG40 2HD
Bracknell
South Hill Park, Rear Lawn, RG12 7PA
I always wonder about that when passing the local Apple store: They have a really big Face Masks Are Recommended sign at the door despite nobody inside the store is wearing any.
Oh, that reminds me. I think you’re probably referring to the one in the Oracle. I stomped angrily away from that store during June 2020 when the staff insisted on face masks to gain entry before they were made mandatory. Good that nobody is wearing them now.
Yep. I’ve occasionally seen a doorman wearing a mask, but that’s it.
Spain and Portugal have now both dispensed with all covid restrictions, and South Africa, which is great, but I gather from travel.gov.uk webpages that sadly Eswatini ( previously Swaziland ), and India, Bangladesh and Pakistan all still want either a proof of vaccination or a negative pcr test less than 72 hours old.
Why are India et al still persisting with this rubbish? 
I have a feeling that Turkey and Morocco are too, but can’t remember what the travel.gov. uk pages said about them.
Spain still require masks on public transport
Not going there until they drop that
True. Yes, I second that.
I’m now wondering why Dr Watson says/seems to think that “every other country” has dropped restrictions. Does he mean that the US is one of the very very few remaining or just “every other” as in every 1 in 2 countries? ie about half of them? In which case the US isn’t such an outlier for keeping them.
For the unvaxxed (or the vaxxed who are unwilling to use a vaxx passport):
Open for travel. COVID-19 testing or quarantine is not required.
129
countries
Test & Travel
Open for travel with required
COVID-19 testing.
51
countries
Test & Quarantine
Open for travel with required testing and quarantine upon arrival.
13
countries
Closed
Only returning citizens or people in special circumstances may enter.
34
countries
As per Where can I travel to? Travel Restrictions by Country | KAYAK
Plenty of the 129 countries that have no covid travel restrictions still have mask mandates.
I wouldn’t be running around so much and I’d be avoiding pressurised environments if I was able to show a valid vaccine passport. Although, with the levels of excess death currently, I wouldn’t risk running for a bus with my compliance card..
The reason the USA is keeping vaccine passports is because it is a part of the Emergency Declaration that allows for extended mail-in voting, to which the Democrats are particularly attached.
Great detailed posts to this good detailed sceptic traveller story.
In 2021 friends of nearly 20 years responded negatively to my refusal to give consent to the jabs (not anti vax) asked me quote “ aren’t you going to be upset if you can’t go on holiday?” And that “ it is our duty to take it” I was told that what I said had made them feel uncomfortable. I know they were frightened!
I do feel bitter and angry about all of this.
What to respond too when the response now is “well we are not masking now and may not need more jabs because the vaccines have helped produce the milder version and herd immunity” I feel it’s a loss for people who put the head above the parapet because the virtue signalling smug compliant believe they made it safe and we are still the conspiracy disinformation crew. Me.
How to reply politely without keeping my cool and calm so that I don’t lose the discussion. 5:1 the battle will commence at lunch next week. May be my last. Sad.
I have been going around my local town ripping off those stupid mask signs for sometime (estate agents, newsagents, banks, etcetera) however there is still one very stubborn pharmacy that has all the original fear mongering signs and still insists on only one customer at a time enter their shop. I and a colleague of mine from my local SITP have challenged them on separate occasions but to no avail. What is going through these people’s heads? Extraordinary.
Well done
we have still got those visual dictatorship signs stuck on our playground but there are the state control cameras watching so I am not brave enough! to rip of those left. I started to dig one off as they are stuck with super puritanical glue, the worst kind of glue ;)but my daughter was worried so I stopped.
I hilariously thought I would go in the dark and rip them off. Granny in a hoodie. No doubt a prison sentence given. During the authoritarian time, I took my grandchildren there and they had taken off the swings and taped things off and no water running on the play water machine and only 3 allowed , made my blood boil because it had no basis in science.
We need reparations the ‘IN’ word at the minute! But I call it justice.
You can add launderettes to my business mask vendetta. Just ripped a couple down as I was delivering The Light thought I’d leave a couple there for anyone interested! There are CCTV cameras there but I thought sod it come and get me I really don’t care anymore there’s no justification for these fear inducing notices and never was. RESIST DEFY DO NOT COMPLY!!!
Joe Biden, cdc, fda, all bought and paid for.