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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Climate change?
And what were the rest caused by? “Protect the NHS”?
“In previous waves, almost all excess deaths could broadly be explained by Covid.”
Really? Some, probably. But almost all? Shutting down the NHS, throwing the old and frail out of hospital, isolating people…
I think they mean they can be explained by Covid magically curing dementia and cancer deaths. They were doing it last year and the same think seems to be happening, periodically now…some weeks when Covid deaths are up, some of the usual suspects are down.
Ah yes of course, how silly of me. Lots of things that used to kill people seem to have become much less dangerous because of covid.
…and the magical disappearance of flu …
No, no no – lockdowns caused the disappearance of the flu which proves that lockdowns work…
That was amazing but it’s because we weren’t circulating apparently? Does this mean covid can travel from an infected person, out of their letterbox and into next door via the same route? It’s a bloody clever virus
Damn right, it also knows the difference between shops and pubs
And it knows it should stay away from supermarket employees.
“All deaths within 28 days of receiving a positive test”
For whatever reason :97 years old, 32 stone, Suicide, etc.
Feel free to add any other type of death.
And Midazolam.
“could broadly be explained”
If Guy Fawkes were alive today, this column might argue, his target should be the government’s health science establishment.
I’d strongly suggest, Fleet Street instead.
When I was growing up, the Fourth Estate openly prided itself as the guardian of society, the monitor of the government. The Fourth Estate had as its duty, factually informing the public and – as needed – sounding the call to arms.
Today (partly because of the rise of the Web, and then social media) the Fourth Estate has largely turned tabloid in a desperate rush to maintain revenues.
It’s pursuing the eternal truth expressed by America’s H. L. Mencken: “The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.”
Without the Fourth Estate, the health science establishment would be a housewife yelling across her back yard fence.
(And so would Boris and Donald be ….)
More pointless duff data.
Carry on regardless.
I find this a puzzling article, only a few days ago they published an item discussing how age adjusted mortality was at normal levels;
https://dailysceptic.org/2021/11/29/octobers-age-standardised-mortality-rate-was-equal-to-the-five-year-average/
I would have thought this article today would have taken the previous item into account to give a balanced consideration with regard to UK deaths. Is there cause for concern in any way? Of particular concern is deaths in the under 40s and do they give any indication of possible vaccine effects.
The problem there is ‘age standardised mortality’. It is a concept that tends to be misunderstood and is often used inappropriately.
It certainly does nothing to highlight additional deaths in younger age groups — it, like the raw death rate, will mainly be sensitive to changes in the death rates in the elderly and will be unlikely to show any shift at all with even substantial changes in the death rate in the young.
Specifically wrt covid, it is idiocy to use age-standardised mortality to describe deaths during a pandemic which has a very strong age dependency for deaths.
My father died of a heart attack at home on 21st November, he is one of the non Covid unexpected deaths at home . He had had his booster vaccine the day before, he’d then immediately felt unwell, the following morning he had chest pain, he died that evening. We will never know whether his heart attack was caused by the vaccine, but I strongly suspect it was the straw that broke the camel’s back. What I do know is that I had only seen my dad for 4 hours since March 2020, because he was scared of catching Covid. His last 20 months were lived in fear, away from his family. People must wake up and realise that Covid is not worth giving up our lives for. Life is for living, not just avoiding dying. We are not merely cells to keep apart, in order to avert death, we are social creatures who need human touch and love to thrive. I hope that in saying all this, one person might go and see their family, one person might stop being so afraid of Covid that they hide away from life. If my comment helps anyone, then Dad’s death will not have been wasted. Please live your life today, because nobody knows what tomorrow will bring.
Sorry to hear about your Dad. Beautifully put. The state of fear that these lies have created in the old (and the young) will last for years and will not be easily undone, and this is one of the most egregious of the many evils perpetrated in the name of “saving lives”. To use “saving lives” as an excuse for political and financial self-aggrandisement, and to knowingly destroy lives in the process, is simply wicked.
So sorry to read about your Dad. I will wager that there are many people who have been led to a similar and horrible situation. Hiding from a entirely survivable disease and being given experimental vaccines that likely cause significantly more harm than good. Scared witless by government and pseudo medical propaganda.
One day there will be a reckoning, people are awakening to the truth and every day I hear more and more of my friends and family express disgust at the actions of the government. The slow drips of truth are forming in puddles, soon there will be streams and rivers which will begin to wash away this madness, our time is coming.
help! I’m not in a good place at the moment. Fallen out with my mother who I love dearly over my refusal to have the Covid jab. I have put forward all the reasons for me not having it but she cannot see my point of view at all. She basically thinks that by not having it I am dicing with death and not only that want to kill her too. Any thoughts or suggestions would be appreciated – I really do despair.
Depends on how old she is and how much you value the relationship…you could just lie to her and say you’ve had it? It’s not like she will ever suspect the truth because all the jaboids seem to catch awful wu flu anyway. You’re not putting her in any additional “danger” so morally it’s only a white lie.
I get the same from my mother and sister, both work in the national covvie service so are regularly dosed with extreme propaganda. I haven’t yet found a way to break through I’m afraid, I guess it’s going to take something bigger. I just refuse to talk to them about it – divert all conversations to topics that are much more pleasant and entirely unrelated, ideally that emphasise how much better life used to be. There you go, nudge theory being used for good instead of evil.
In the first wave, covid and excess deaths were closely aligned at 51.6K to 50K
Whereas in the second wave covid deaths exceeded excess deaths by 23.4K (151.5K vs 128.1K) so even tho’ the NHS was closed to everyone except covid cases we are asked to believe that there were 23.4K fewer deaths from CVD & cancer etc.
And the ones that are linked to covid are exaggerated because of the bizarre policy of counting a death from any cause that occurs within 28 days of a positive test result as being due to covid.
There Are Now 365 Studies that Prove the Efficacy of Ivermectin and HCQ in Treating COVID-19. Any hospital administrator who mandated the shots to employees to comply with the government mandate for Medicare and Medicaid reimbursement and who refused to allow alternative treatments to be tried, doctors who pushed their patients to take the EUA drug without giving fully informed consent, anyone who forcefully administered the shot, the AMA, AAP, Boards of Health, CDC, FDA, NIH, WHO, scientists who participated in the development, Big Pharma (Pfizer, Moderna, J&J, Astra Zeneca, et.al.), anyone who pushed the sick into nursing homes resulting in deaths, all must be arrested, prosecuted, tried and if found guilty sentenced to prolonged imprisonment and fines or death for intentional homicide. Get your ivermectin before it is too late! https://ivmpharmacy.com
Yes many linked to the vaccine. You know things like heart attacks, strokes, pulmonary embolisms. Little things like that. Any autopsies done on the victims? Any history taking? History of Covid vaxx?
So how come, then, that the FOI requests to local authorities showed that across the country there were few ”excess” burials or cremations?