- “Reconstruction: The truth about the chaotic decisions that led Britain into lockdown” – The pandemic inquiry has revealed the true scale of the turmoil behind the U.K.’s biggest political decisions since WWII, set out in detail by Gordon Ramsay and Janet Eastham in the Telegraph.
- “Britain will be condemned to another Covid-style lockdown. This pathetic inquiry proves it” – Even as the ineptitude of Whitehall is being revealed in its full horror, the focus remains on childish tittle-tattle, says Danial Hannan in the Telegraph.
- “What disdain for a brave scientist reveals about Covid” – “It is perfectly obvious the Covid Inquiry is not interested in any serious consideration the whole thing was a ghastly mistake, made in a condition of outright panic,” writes Peter Hitchens in the Mail.
- “Johnson tells Covid Inquiry he had to balance competing needs of U.K.” – Boris Johnson has told the Covid Inquiry he had a “duty” to weigh up whether lockdowns would do more harm than good, according to the Mail. So why did he impose three?
- “Nadine Dorries’ book reveals assassins who wanted Boris out of No 10” – In The Plot: The Political Assassination of Boris Johnson, Nadine Dorries identifies Michael Gove , Dominic Cummings and a powerful adviser called Dougie Smith as members of ‘the movement’, according to the Mail.
- “You have to die of something!” – The HART team looks at why Sweden has fewer excess deaths.
- “The red pill and the bitter pill” – Read the talk given by Laura Dodsworth at the ‘Holding Covid Times to Account’ session at the Battle of Ideas last month.
- “Trends in Excess Deaths” – HART fact-checks the minister’s response to Andrew Bridgen’s recent Commons speech.
- “The Hallett Inquiry – reason over foul language, flip flops and narcissism” – The evidence vacuum is ignored by the inquiry, say Carl Heneghan and Tom Jefferson.
- “Hamas, not Israel, is perpetrating ‘collective punishment’ in Gaza” – Laying the blame for Hamas’ abuse of civilians at Israel’s door only rewards its inhuman tactics, says Danial Taub in the Telegraph.
- “Germany puts Britain to shame with its zero tolerance of anti-Semitism” – Informed by their history, the Germans have displayed remarkable moral clarity in supporting Jews, while Britain has simply failed, says Zoe Strimpel in the Telegraph.
- “What People Think About The March” – Matt Goodwin polled Brits about the pro-Palestine march on Remembrance Day weekend.
- “How ‘hate speech’ laws appease the oldest hatred” – U.K. authorities cannot be trusted to police what we say, see or think, argues Spiked‘s Mick Hume.
- “Charity Commission ‘examines’ British mosques that hosted pro-Hamas hate preachers” – Sermons made since the terrorist group’s October 7th attack include calls to “destroy Israel”, “kill the Jews” and “wage your war for Allah”, according to the Telegraph. Delightful.
- “Guardian journalist who retweets pro-Hamas social media account” – The Guardian‘s pop culture columnist and podcast host Chanté Joseph shared posts casting doubt on the scale of Hamas’s October 7th atrocities and promoted conspiracies about Jewish power, reports Jewish News.
- “Met Police adviser led ‘from the river to the sea’ chant” – A hard-Left activist, Attiq Malik, who was filmed leading chants of “from the river to the sea” at a pro-Palestinian rally is an adviser to the police on their response to protests over the Israel-Hamas conflict, the Telegraph reveals.
- “MoD to cut ties with Muslim Council of Britain after ‘shocking’ arrangement revealed” – Ministers have ordered the MoD to cut ties with the MCB after it was revealed it endorsed imams to become chaplains in the armed forces, the Telegraph reports.
- “Judge slams Just Stop Oil activist after she asked for delay in trial so she could jet off to India as protester, 28, is charged alongside four others for storming West End performance of Les Miserables” – A judge has hit out at a Just Stop Oil protester who asked for her trial on charges of disrupting a performance of Les Miserables to be delayed for a few weeks – so she could jet off to India, reports the Mail. You can’t make this stuff up.
- “In Denial about the Science – Part 2, ARC in London” – Read Jennifer Marohasy’s report from the ARC conference, where she defends the importance of saving science from the propagandists.
- “The baby bust: female perspectives” – After Alex Berenson’s article last week on falling birth rates, a lot of men blamed generational selfishness, he says. Here’s what the women had to say.
- “Jeff Bezos ditches Seattle for Miami after buying $79m mansion in ‘billionaire bunker’” – The virtue-signalling billionaire leaves high-tax Democrat Washington for low-tax Republican Florida, the Telegraph reports.
- “Ukraine has blown its best chance to defeat Putin” – Deprived of the weapons it needs to win, and with global attention shifting to Israel, the outlook is terrible, laments Richard Kemp in the Telegraph.
- “Body to fight cancel culture formed by 100 top academics” – London Universities’ new Council for Academic Freedom will defend free inquiry, intellectual diversity and civil discourse, the Telegraph reports.
- “Grooming our children, Part 2: ‘Smash heteronormativity’” – Belinda Brown’s latest dispatch from the sex ed wars in TCW.
- “Transgender activist who said ‘would not matter’ if the number of female murders increased if men were allowed to self-identify as women is devising ethics rules for therapists” – Philosophy professor Sophie Grace Chappell is on the core team revising the British Association for Counselling and Psychotherapy’s (BACP) national ethical framework, according to the Mail.
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I understand IHDrs piece.
However, I think there is some very straight-forward management actions that can be made to improve the current “inadequate” system.
By placing proper KPIs and holding remuneration as part of the accountability, 80-90% of the problem will disappear in a 2-3 year business cycle.
Apply the same to Councils, Teachers, Police, Civil service etc…
Proper accountability (reward and punishment, equally meted-out) is the sunlight disinfectant all these organisations – and the NHS in particular need.
Maybe, but I think KPIs are tricky to set and easy to fiddle. Better to have the incentives at a structural level e.g. provide good service at a sustainable price or lose customers and go out of business.
I could think of many SMART KPIs with would modify Executive behaviour very quickly to suit the customer i.e. the those in need to medical care. These people need to know that they cannot run large Companies (Trusts) taking big salaries and always find an excuse why they cannot deliver without a bigger budget. We need to change their behaviour.
KPI 1 of 10: Reduce non-medical administrative staff by (pick a number – say 5%) across the board in the next 12 months.
Desired Outcome: How many diversity officers, Woke officers, Climate change officers survive the next 12 months when a good portion of the Execs (and his officers and line management have bonus is on the line?
I think KPIs can be made to help but would prefer to let the market do the work. Who would set the KPIs? Secretary of State for Health and his assistants? They’ve been doing such a fantastic job. And then Labour get in and re-write the KPIs or water them down and we are back to square one.
I want the state out of my life as much as possible.
Simple answer, see ‘gaming’ comment above, all of these ‘non’ jobs will be reclassified so as to escape the axe. The NHS has become particularly creative in this area for many a long year.
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There is little incentive to perform to KPI’s when your organisation seeks only to spend every penny allocated to it. There is no ethos of constant improvement in the NHS as that means fewer pennies and fewer minions in your empire. For the limited experience I have of the NHS, every KPI or attempt to have a KPI like Ambulance response times, has been fiddled.
Of course, the nuclear option would be to ‘Zero budget’ on a one or three year basis. No more of this ‘what you got last year plus index’. You start at £0 and have to justify what you get. With a body as big and complex as the NHS, I think this would be extraordinarily difficult to produce, and probably require more managers and clerical staff even than they have now.
KPI – Ambulance response times.
who was specifically held accountable and faced either financial or employment consequences? Exactly. No one. It is not a KPI – just a jargon.
Jargons become KPIs when specific people are held accountable – and no, I dont mean at the ballot box. I mean in terms reprimanding executive management for mis-management and failing to perform.
Take ambulance as an example. So the response time start, when? Supposed to be the connection time to an operator, but was fiddled to be when the vehicle was despatched. On arrival at hospital, when does the ‘seen within four hours’ start, and when does it end. Seen by who.? Ever wondered why if your plane is delayed departure, they still load, close the doors and push off 5 metres from the gate.? Its because you have ‘departed on time’, even if you sit there for another 45 minutes. These are all fluffy targets, especially when your performance is dependent on someone else’s performance, as it the case with much of the NHS. It isn’t a clearly defined hierarchy. It is a merry-go-round of opportunities to cover one’s posterior, and ensure blame cannot be attributed to one person (also why we have committees). I do get where you are coming from, and nothing would make me happier, but in my experience the KPI has to come from the corporate plan, i.e. the objectives set by the board of directors in a private company. These are disseminated to the departments, usually with hard percentages and targets of what they have to achieve, and then its up to them to formulate their plan, argue what is possible and reasonable and deliver the results. That’s one that can’t be as easily fudged or argued, but that’s not the option in this case. The NHS is highly complex and planned/managed from the top. I’d welcome some ideas, if you have them, but I doubt personally if I would take on a performance monitored position where I wasn’t in control of the mechanisms by which I was being judged.
A classic KPI from the airline world, to add to the example you gave. The plan was to improve customer service. One KPI was to decrease the time taken to get luggage into the baggage hall. When the plane landed the fittest member of the baggage team was given a small piece of luggage and he ran to the belt and deposited the case. KPI achieved! The rest of the luggage followed in the normal slow time!!
It is made worse when your organisation doesn’t have to create the money it spends, or more apprpriately, wastes. This basic commercial understanding is absent from the DNA of all state enterprise employees.
After 40+ years in sales and sales management I can guarantee you only one thing. If you set a target (a KPI in polite management speak) it will be gamed and not achive its desired outcome.
The other issue is that it is evidently possible, from the perspective of an experienced patient, for doctors to work for the NHS part time, and for another firm for the rest of it. Quite often for a firm that happens to have a private hospital physically next door. That always looked a bit odd to me, as in the industry I worked in, it was normal to to have contractual terms that did not permit one to work part time for potential competitors in the market, even if one’s employment contract was part time. It was usually OK to do voluntary unpaid work in the trade, but not to take business away from the main employer at the same time.
This is a very useful summary of UK private health care, an area that has always been a mystery to me, even though I have mostly used private services for all five of my cancer cases.
Why am I so ignorant? Because I have private medical insurance paid for by my employer, both as an employee and, for the last 25 years, as a retiree. The first mystery has always been knowing when to “go private” when my GP has flagged up a problem. Luckily I have had mostly non-doctrinaire GPs who will honestly tell me when I’m better off – or just as well off – sticking with the NHS.
Over the course of my retirement my employer has changed insurance providers and policy conditions. When I first retired I could go to any private practitioner referred by my GP, always the private insurance gatekeeper, and all costs were paid by the insurer. More recently two changes have reduced the attractiveness of the insurance:
(1) above ensures that I will always be treated by the most reasonably-priced specialist, but not necessarily the best. I suppose (2) helps to save the insurer money and is an incentive for me not to bother them with trivial medical problems.
A recent change of insurer has slightly modified (1) in that, if I really want a particular specialist, I can use him/her but must pay any difference in fees between what is charged and the insurer’s agreed rate for the procedure.
I’d welcome comments on this arrangement. It seems reasonable to me but I have no idea how it compares with what most people use in the private sector and I still feel somewhat mystified by the relationship between NHS and private care and when to use which.
Good post. I prefer a pure and direct private market. No faffing around with GPs. Pay per usage against your insurance. If people want to use socialised/communist health care go right ahead. But don’t mandate it for the rest of us.
Basic principles: Competition, Choice, Access in a market based, self correcting system. We don’t have that in the UK. It is as the author states quite a mess.
Government meddling, price setting, controls, GP gate keeper access and various regs is not a private market per se. Same with the US. The US does not have a direct private market system, but entirely a government controlled and price extension of socialised health (yes they have it called Medicare, Medicaid, worth £1 trillion a year).
France and Holland have good models that could be implemented and improved upon.
Because of the ingrained attitude of the UK health system, your basic principles will hit problems. The current private system as I see it (and have experienced once) is that it serves as an express way to treatment with the same or the majority of NHS-based medical professionals (and a nice room to recuperate in).
Why the hell should I get the permission of a NHS GP to go and have treatment of my choice if I elect to pay for it?
I am all for competition – private or state but unless we change the internal competition rules within the medical structures, nothing will change, costs will go up and/or care/care outcomes will go down.
Private healthcare won’t take off in the UK in a big way for a very simple reason: regulation.
Put yourself in the position of a private healthcare provider, be it a doctor, a private clinic or a larger private healthcare company. You see a potentially growing market driven by the disarray in the NHS, so you consider to invest in creating a new clinic, or hospital.
The problem is the lack of regulatory certainty. These kind of investments are made with a horizon of many years and require predictions on costs and revenues well into the. future. However, what is the government’s policy on private healthcare? Does it want to encourage it or discourage it? If you set up a new clinic can you be sure that this government or the next one won’t introduce legislation or regulation that will radically affect your market?
In the absence of clarity, capacity will not grow much because no one will dare invest too much in the private healthcare sector. So private healthcare will just get more expensive and worse in quality as more people make a demand on the same amount of supply.
I had a little snort at ‘affability’ being a prerequisite for private practice. One thing I detest about the NHS is the propensity of some staff to be rude and dismissive- okay, I know its certainly not all, but I feel sure I am not the only person who has been made to feel small and angry during NHS ministrations, and had their dignity compromised, with the attitude that one should just put up with such treatment and be grateful. Most of my treatment is now private, and yes, affable the practitioners certainly are.
Private practitioners – be it nurse, doctor, whatever – always introduce themselves unlike many NHS practitioners who enter a room and don’t speak beyond asking questions if you’re lucky.
Why do you or does anyone think that shifting to a European health insurance style system solves any of the problems you mentioned?
You are mixing up correlation with causation big time here.
The French or German system do not work better because of the insurance model, but inspite of it, as the added payment related bureaucracy increases overall costs by about 15% compared to a tax financed system like the NHS.
That GPs over there see patients, and that hospitals don’t have waiting lists has nothing to do with how the contributions to the system are raised and allocated, whether through taxation via NI or via insurance fees.
The German private health insurance system is also not an add-on one like Bupa etc. are in the UK, but an exclusive one: once you take out private HI, there is no way back into the public insurance system (very few exceptions, and those only up until age 55). Premiums are low when you are young, but extortionate when you are old.
About 100k people are now actually without any health insurance, as they can’t afford the private premiums anymore but have no way back into the public system.
But the medical service and providers there are actually the very same for each group, again in total contrast to the UK: any doctor or hospital treats the publicly and the privately insured patients- and needs its own separate admin for that, as the latter are just charged 2.3x to 3.5x as much. As such, the privately insured just have faster access, which upsets the former.
For decades, consultants (Professors, Chefaerzte) at the big renowned clinics (mainly university clinics) could earn 1-2 million€ p.a. by focusing on treating mainly privately insured patients, leaving treating the plebs to their assistants.
That has changed, as the hospitals are now cashing in the professors/privately insureds surcharges for themselves, which has made private clinic conglomerates like Helios, Asklepios etc. a big and profitable, industrial scale business.
The big Uni etc. aka publicly owned clinics do the same and can compete, smaller publicly owned ones are unprofitable and are being closed, leading to supply problems in many rural areas.
I repeat what might actually make a difference, besides the many necessary anyway organisational revamps: Introducing a nominal fee for each visit. It (10€/quartee) worked so well in Germany, that the same doctors who wanted to see it introduced, screamed for its abolition after a few months.
Refreshingly, the doctor who wrote an article here a few days ago came to the same conclusion.
The political class don’t have the cojones to properly reform and remodel the NHS – at best they will tinker around the edges.
Medical treatment will slowly go the way of NHS dentistry. In the ’70s hardly anyone paid for private dentistry. It started to take off in the ’80s and by the end of the ’90s there were large areas of the country (including the area of Surrey where I used to live) where there were no NHS dentists for miles around. Now, NHS dentists are as rare as hens’ teeth (unless you’re a criminal migrant).
Already people who can afford it, or have insurance, are paying for elective ops like cataracts, hip replacements etc and that will only increase as NHS provision becomes even less reliable and the waiting lists get longer.
I have Beneden Healthcare cover. A couple of months ago I needed to see a GP to get a prescription for a minor problem which MIGHT have become significantly worse if ignored. My NHS GP offered me the earliest available appointment in 6 weeks’ time. I consulted a Beneden GP over zoom the same day and he issued the prescription. It cost me £56 rather than the £12 NHS one, but tbh it was worth it.
French insurance system works fine, and nobody is excluded.
“Why the Health Service works in France”
https://edmhdotme.wordpress.com/why-the-health-service-works-in-france-11-2022/
All GPs are private/self-employed. They work under contract to the NHS not as direct employees. Not a lot of people know that.
The private medical insurers/providers operate in a highly distorted market dominated by a State non-contestable monopoly, therefore not in a competitive, free market.
For those inclined to argue and say the presence of private hospitals means there is no non-contestable monopoly…. this latter means that no enterprise can compete for your money as you are obliged to pay it to the monopolist, whether you use it or not. (Private monopolies are usually contestable – unless the Government interferes – so other enterprises can compete for consumer money. All monopolies ultimately end therefore.)
Which is why private providers are ‘less good at managing complex conditions needing multi-specialty input over extended periods, and totally useless at dealing with emergency situations’.
The market volume is not there to recoup capital outlay needed to provide complex and emergency cover, and give return to that capital, and cannot be built up, because the large majority of people having paid for NHS insurance/provision cannot afford or want to pay again.
The solution is remove that non-contestable monopoly. Let people choose whether to pay into the National Insurance scam or instead pay that money into a private insurer.
‘Ironically, the greatest ally private medical providers have in the U.K. right now are NHS zealots.’
No not really.
Actually it is market forces which eventually bring State monopolies down because without that wonderful tool of market intelligence and regulation – pricing – and without private capital and competition, they will simply cost ever more, but continually fail to supply enough to meet consumer demand. (As we – who lived through it – saw with the other State monstrosities as a result of Labour’s post-1945 nationalisation spree.)
If the UK were a free market in medical care, this would be very attractive to insurers; competition would be fierce as it is for other forms of insurance, as would competition among providers – and consumers would get a far better deal than with the ghastly, lumbering, walking-dead NHS.
Accident & Emergency cover could perhaps be part of motor or household insurance or a levy on each health policy.
But of course the NHS is a god – private is Satan. All bow low and hail the NHS.
Of course, it’s “our NHS, the envy of the world” NOT
Interesting if depressing reading (as so much is these days). However, he doesn’t mention Benenden, a kind of cooperative group with a hospital in Kent. I wonder how he views them?
In Australia most doctors work in both private and public systems.
The public system sounds similar to the NHS.
The private system has to compete with this or people drop out, therefore it works.
In general it is relatively cheap (my wife and I at age 60 pay £2500 per year between us for all hospital, dental, optometry, physio, etc) and have plenty of say in how and where we are treated.
Sorry mate, the dual system works better than any other option.
A perfect summary of the atrocious ‘health service’ in the UK, thank you. In layman’s terms “life’s a bitch and then you die”
Thankyou for this summary, very informative.