I have long been a fan of the National Health Service (NHS), especially as so many members of my extended family have worked or are still working in it. My mother, mother-in-law, father-in-law, two of my sisters, sister-in-law and three nieces have all treaded or continue to tread the wards of the NHS.
My early years experiencing the health service were good and straightforward. When required, one picked up the landline telephone, spoke to a receptionist at any time of the day and made an appointment with either the doctor or dentist, at a time that suited. However, and sadly, my experience recently has left me thinking that it is time for a different approach to the way we treat the health of the nation.
I am a 60-year-old man with a health problem common in men over 50, prostate enlargement. In the U.K. one in three men suffer from enlarged prostates, whilst one in six are diagnosed with prostate cancer. My route to my operation started routinely. I recognised the problem, managed to call my local GP surgery and made an appointment with a doctor and a nurse for a full medical. As a result I had to have a scan on my bladder, and this also happened in a timely manner.
However, my experiences of the NHS took a dive once I received a phone call from my doctor, one Friday evening requesting that I urgently attend the Accident and Emergency department to have my bladder drained of urine, as the amount that I was holding and unable to release was starting to impact on my left kidney. I arrived in the A&E department at 8:30pm; the unit was packed. Where have all these people come from and what were they doing here? Eventually, I was seen, catheter fitted, and taken up to a ward at 3am. I was informed later that a wait of six hours in A&E was “a short one”. The following afternoon I was discharged, having been told by the consultant that my left kidney was fine, there was no sign of cancer in my prostate, but I would require an “urgent” operation to reduce the size of my prostate.
An urgent prostate operation on the NHS, I was initially informed, is 24 weeks, so I braced myself for the wait. I absolutely hated wearing the catheter, it prevented me from doing so much, and the thought of having it attached to my leg for the next six months wore me down mentally. I waited six weeks before I called the Urology Department, just to make sure that I was on the waiting list. The receptionist confirmed that I was, but my wait was now 58 weeks, some 64 weeks after my initial visit to hospital, and 40 weeks longer than I was initially informed. Remember, I was told that my case was “urgent”. I was informed that if I wanted to challenge the length of time that I had to wait for my operation, I had to contact my GP.
The following morning I called at 8am – you now can only call first thing in the morning if you want an appointment to see a doctor. I waited 40 minutes on my mobile, only to eventually get through to be told that there were no appointments available and I had to call back the following morning, which I did, with the exact same outcome.
This is the point that I decided to go against my principles and have my operation privately. My operation took place mid-February 2024, some 12 weeks after my November visit to A&E. The period between November and February dealing with the NHS was mixed. As mentioned, I failed to get through to the GP’s surgery. I had to call 111 on a couple of occasions. One time, after eventually getting through, my GP practice in Eastbourne was not listed on the NHS computer, so we spent several minutes going around the houses as I explained that the GP practice that was listed had closed several years ago and I had been transferred to a new one. I also had a second visit to A&E at the request of the 111 service. It turned out that I had a bout of pneumonia, diagnosed after another six hours wait. The community nursing team was brilliant, arriving at my home when that said that would.
The surgeon who carried out my operation was the same man who would have done it on the NHS. What was it Aneurin Bevan said in 1948, “I stuffed their mouths with gold”, referring to doctors and consultants being able to continue with their private practices if they accepted NHS patients.
During my time of recovery I spent a bit of time researching various aspects of the NHS and not a lot of this research filled my heart with joy. In England we spend £181.7 billion on the NHS annually. Twenty-five million working days are lost each year due to staff sickness. £136 million is spent on giving away medicines that can be purchased over the counter at any pharmacy or supermarket. 7.7 million people are waiting for an operation. 19% of NHS staff come from abroad, whilst 5,000 doctors left the NHS in 2022 to work in different parts of the world.
So much has changed since the National Health Service started way back in 1948. We can now expect to live, on average, 13 years longer, the population has grown by 17 million people and the diseases that our forefathers once died of are now treatable.
Taking everything into consideration – my own experiences, those of my family and friends who currently work int the NHS, the publicly available facts and figures – I feel that it is time a massive overhaul of the way we care for the U.K.’s population. I predict that the main political parties will be falling over themselves during the upcoming general election to ‘Save the NHS’ or ‘Invest in the NHS’, but none will promote the idea of a different approach like the social insurance models that work so well in other countries or consider the idea of privatisation.
I am no expert in medical matters, but what I do know is that £180 billion that is currently being spent is not delivering a service that is fit for purpose for the 21st century.
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Excellent article. This is an organisation that can spend £1000 on individual pots of moisturiser and not realise. An organisation whose doctors recently voted it ‘racist’ to chase the tens of billions it is owed in treatment bills from other countries. An organisation who start squealing and fast clapping like children on Christmas day when they get a new box of Covid masks delivered to the office that happen to be a different colour (a friends’s story). Whose management turn up at 10 and knock off at 3 and spend most of the day having meetings about having meetings about having meetings and regularly vote themselves inflation busting pay rises.
If the NHS were a private company it would have gone bust years ago and its managers would still be in prison.
My daughter in law is a consultant paediatrician specialising in allergy, she deliberately chose not to be a GP as she didn’t want to “examine old ladies’ fannies” as she so delicately put it! Of the people who make up my children’s extended families I think she is the only physician amongst several who is hospital based, the rest are in GP land. There is a move towards advanced clinical practitioners even in A&E, both nurses and paramedics. This is also happening in primary care both urgent care centres and GP surgeries, certainly in my area. I was a nurse practitioner (I didn’t undertake the prescribing course and therefore wasn’t considered “advanced”) seeing, treating, discharging or referring patients autonomously, although I did have access to physicians, but usually it was just me and another (non physician) practitioner.
Is the NHS broken? Yes. Is that because it wasn’t intended to be the leviathan that it is now? The thinking behind it at the time was sound, people didn’t have to be worried about not being able to pay at the point of delivery. Hospitals should be able to demand payment from overseas patients or their country of origin, the only part that is free to all is emergency or urgent care, as soon as you are transferred to a ward or need follow up care then that is no longer free.
The other problem as I see it is there’s a bullying culture that has developed, with nepotism and favouritism added.
Whether it is broken, or not, might depend on the specification. One of the unusual items is the fact that some specialists work both for a branch of the NHS, and privately, at the same time. In many industries, that is not allowed by contract, as they don’t want you to work for the competition etc. There have been quite a few occasions when, as a patient, I have used someone on the private side – in private hospitals that happen to be physically close to the nearest NHS one. I’m reasonable sure that I saw the same specialist whose ‘waiting list’ I would have been on for quite a while round the corner, but that’s how it works.
One of my kids recently needed knee reconstruction surgery. The NHS surgeon told us the waiting list was as long as a piece of string, he thought at least a year but that his 3 operations that week for this particular op had all been cancelled. Alternatively he could do the op privately, which he did, same surgeon, same anesthetist, but in 3 weeks not 60 weeks. This struck me as the worst kind of insider trading. The NHS funnel a never ending flow of patients through his door, he cherry picks the ones with the cash to pay. Lots of the people in the private hospital were in the same situation. Like it or not we already have the waiting list managed by cheque book.
That reminded me of something else along the same lines. At the dental surgery I use, they do private and NHS in the same place, and the same dentist would do both. On one occasion, at least 20 years ago, when I had some work done, I went for the private option to get a somewhat better looking artificial crown installed. Alright, a cynic might observe that the dentist was a good salesman, as it were – but the crown mounted on a gold rod is still in place, and works well.
Is worse than that: even more brazen and incestuous.
I recently booked private treatment at a Nuffield hospital. The tests that were arranged by them were at the NHS hospital across the road. I promptly got an appointment and received the confirmation direct from the NHS. In the Introduction it states,
“By electing to become a Private Patient in a NHS hospital you may, amongst others [sic]:
Avoid the NHS waiting list
Choose your own Consultant
Enjoy a more convenient time for treatment”
You couldn’t make it up!
I understand the machinations of the private surgery being undertaken by the same team as in the NHS trust, not necessarily in private hospitals but in the NHS hospital where they work.
My Mum has some medical issues and she’s been waiting months to see the NHS specialist who treated her. She got fed up in the end and is spending £150 to go and see the same specialist privately this week.
I can help you out a bit here John
When I worked in the NHS, my colleagues and I to a man thought that “nurse practitioners”, were grandiose, self serving individuals, who rather than sticking to basic, useful nursing care, (“examine old lady’s fannies” maybe), preferring instead to adopt a “pretend doctor” persona, inflating their egos and pay packets, whilst allowing medics to abdicate some of their more mundane responsibilities.
Using my past experience working with Nurse Practitioners has had it uses though; I now know to regard your postings on the NHS to be completely worthless.
I think it’s important for you to have this insight.
BTW, your daughter in law’s unpleasant characterisation of what elderly medicine consists of is exactly the type of arrogant mindset that has turned a section of society against the medical establishment for good.
Thank you for your insight. I certainly didn’t see myself as a pretend doctor (or noctor as a consultant colleague in A&E disparagingly called them) any more than physicians assistants are.
There are advanced nurse practitioners who perform minor surgeries.
When I worked in primary care as a triage nurse we identified patients that could be seen in the urgent care centre or needed A&E. That decision was ours to make. We regularly identified possible sepsis and I identified two cases of spontaneous pneumothorax after listening to their chests.
My advanced practice simply extended those skills and we still had protocols that we needed to follow when dispensing medication under patient group directions, which all nurses can do, even on the wards.
I would never have worked outside of my competency and I had access to other clinicians. A lot of my time when seeing children was reassuring parents. It doesn’t take a GP to diagnose a urine infection, they would follow the same guidelines.
One issue that primary care has is if there’s a poorly patient requiring blue light ambulance transfer, the patient is considered to be in a place of safety and so is not given as high a priority as they should be. The result is that someone has to monitor the patient.
Agree with your last paragraph. It seems to apply especially within the nursing fraternity and it’s an insidious process that is never addressed. Senior nursing management is made up of individuals who want the extra money involved but have zero leadership skills or the emotional intelligence required to be an effective manager.
My wife was a totally committed specialist nurse who was studying for a degree in her specialisation. Older, less committed colleagues, didn’t appreciate her being ‘above her station’ so bullying took place. Complaints to her managers were ignored. A pharma company headhunted her for her skills. Net result being the loss of a committed worker from the NHS and a much happier private sector employee.
I don’t think you’ll get much argument from many here.
I’ve never really had much of an axe to grind either way about the NHS until covid, but the use of the NHS as a sacred cow in order to f*** up my life for two and a half years and counting put the old tin lid on it for me. I’d now be happy to see it demolished and replaced.
Impossible not to second that.
From being slightly dubious about rNHS the last couple of years have convinced me to be bloody feared of it. Full of medieval witchdoctors and plenty who are utterly stupid and therefore dangerous.
I tend to think in general that small organisations work better than large ones. Inevitably most providers in the healthcare field will tend to be on the large side, but creating a virtual state monopoly just makes that worse. I expect people in the medical profession in the private sector are sometimes like witchdoctors, and goodness knows medical professions in most countries have been terrible over covid regardless of their healthcare system, but at least in other countries I wpuld not be bullied by force of law to pay for the idiots.
Similar issues in Australia.
When I started my medical training 42 years ago, most GP’s were male, worked long hours, and practised obstetrics, anaesthetics and surgery.
All had hospital admitting rights and performed house calls, often for free.
The feminisation of the medical workforce, as well as the bureaucratisation of the profession has led to GP’s working less hours, engaging in non-procedural medicine, and being estranged from hospital work.
Not saying that there is anything wrong with GP’s being mostly female, or that the health departments shouldn’t be involved in setting standards, but that there are definite consequences of these changes.
Access to quality health care in a timely manner is one.
Very interesting article. I had no idea the doctors numbers had actually gone up with the population growth. But then I got most of my news from the BBC until a year or two ago.
Without a massive overhaul of some kind the cost will never go down and will become completely unaffordable. If it isn’t already.
The last line in the article sums it up. “Nice idea, never works”
I joined the NHS clinical workforce as a Speech & Language Therapist. It was a Cinderella profession then with huge caseloads (over 100 patients per therapist was standard) & remains so now. In paediatrics the complexity of patient has increased. Routine sound articulation problems such as substituting [s] for [sh] aren’t treated – parents given a programme & left to it. It’s now language problems, really disordered speech & frequently a combination of the two. The educational implications of delayed/disordered speech & language skills is worsening which will result in a larger proportion of these children ending up with criminal records. Evidence has been growing for the past couple of decades.
Adult neurological issues like stroke, multiple sclerosis, MND have always been present & similarly under resourced. Communication isn’t important you know… The only increase in SLT provision came when hospital management worked out that treating a swallowing disorder was better for them as their death stats improved. When I started out in 1988 over a third of stroke patients died of aspiration pneumonia due to swallowing problems. I had 6 hours allocated to a district hospital with 10 wards, a day hospital & a special care baby unit. This was increased to 49 hours a few years later when the hospital expanded but it was still nowhere hear enough as the number of patients increased too….
I’m still in touch with my boss. Stroke numbers have gone through the roof since the toxic bioweapon injections & the number of young patients without drug or alcohol addictions has increased, mirroring those roll outs. The boss sees the link but nobody else does.
The NHS is broken & has been broken for many, many years. In the days of NHS services mirroring postcodes, the bulk of the money was swallowed up by hospitals. There was a little bit of a rebalancing with community trusts, but not a lot. Primary care was seen as a cheaper option. Quality care is clinician intensive.
But that doesn’t tick the right boxes, doesn’t meet the Key Point Initiatives & it’s a universal service so universally crap is good enough!
I’m no longer proud of the service on offer. A reduction from up to 12 months of input to 8 weeks for post stroke therapy? An improvement in quality? Not in my book.
A friends had a stroke in Dec 2019. She was in a rehabilitation unit and doing very well when it was closed because of Covid and lockdown. She was then sent to a small local hospital with 2 physios and little in the way of specialist equipment. She was there for 10 days then the hospital was closed because of lockdown. The hospital had 4 people admitted for Covid – 4 people in total over the various lockdowns.
She was given the choice of the local nursing home but chose to return to her own home and cope. She had one telephone call from a physio and a sheet of exercises sent through the post. She paid to have her home adapted to her needs.
She is a Covid victim despite never having had Covid. She is disabled but can cope within her own home. She was told that she had had the potential to return to almost what she’d been before the stroke but finds that little consolation. As do we…
That is just evil & totally negligent. Criminal. Physiotherapy is a hands on skill, particularly for stroke rehab as errorless learning is crucial to
She is most definitely a victim of the politicisation of covid & the NHS ineptitude.
Physiotherapy, even this far down the line from a neuro specialist physio – private if she can afford it- would be beneficial to prevent further worsening of her physical condition. There may even be some progress, albeit slow.
Good for her having the strength of character to do this.
Abolish the NHS. Everyone has horror stories of infections and iatrogenic injuries. Typical is the the healthy older person who goes in after a fall and comes out in a body bag.
Just get the state out of healthcare altogether and make individual citizens responsible for their own and family’s health. Maybe a funded safety net for children. A richer, more free society will generate more private charity. Aligning incentives with good outcomes is humane, whereas spending other people’s money on insatiable demand produces a giant tapeworm that feeds itself on us.
The reason the NHS is failing is because it is a State run enterprise and all State run enterprises fail.
They are operated to meet political objectives, they have no private investors and are budgeted cost, not profit, centres so they do not have any fiscal discipline, or need to serve consumer needs that competition brings in the private, free market.
The NHS can never go bankrupt no matter how much it ‘fails’, nobody will lose their job, there is absolutely zero incentive for anyone in it to bother about improving and a perverse incentive to do as little as possible.
it is unfixable.
IMHO, very valid points, bar the last one. I am sure everybody has plenty of anecdotes and a thereby formed opinion about what really ails the NHS.
I’ll pin down mine and a few observations from the German system, which is no longer much or maybe even any better overall.
My first ‘encounter’ with the problem was watching the ‘Can Gerry Robinson fix the NHS’ documentary over 20 years ago.
It’s main conclusion was that political infighting between doctors, nurses and admin/management stood in the way of better practices and more efficiency. Astonishingly, the ones between doctors themselves and between doctors and nurses were most often the biggest issues.
I doubt that much has changed in that regard, likely though, the ever more bloated admin side has gained more prominence and created even bigger impediments to better practices since then.
My first appointment years later was also quite telling.
I seem to have been the only one who showed up that day for the appointment scheduled 3 months earlier and because of that general long lead time, the cancelled slots were not filled, if it was tried at all.
As a result, the doctor came in at 11 and went home at 12.30 that day.
My experiences then and later with the quality of work and equipment used were always good.
Just recently, I accompanied an elder friend to a radiology appointment and was surprised by the, to me, state of the art equipment and facilities in that hospital. The efficiency was also excellent- in my view to a good part because of the necessarily shorter appointment lead times here.
They were also all very friendly and did not even dare to bother me once about my always bared face, which was a nice bonus.
That same friend and also his son had a not so nice experience at A&E most recently though (long waits, first night spent on the ambulance bed etc.)- this is really where the main problem seems to be in hospitals right now.
His GP has now become just a tele/google/prescription dispensing without contact doctor, and although it’s in the countryside and my friend is old and now quite immobile and ill, house calls are totally out of the question.
My GP in the practice in London, where I registered 14 years ago, changes weekly, my wife was thrown off the list there because she is too healthy and never had an appointment after registration.
This is still very different in Germany.
GPs work long hours, do house calls, see all patients face to face, stay put until retirement and earn good money.
It used to be that ‘gesetzlich Versicherte’, the NHS comp, could schedule their own appointments with specialists without having to see a GP first. This has now changed, but neither is a problem to get. The problem is that the wait time for them at the specialists is now long, often 3-6months.
To a good part, this is due to all doctors earning 2.3 to 3.5x more for the same treatment if the patient is privately or quasi privately insured, so they focus on seeing them first. And naturally now, the civil servants like teachers, policemen etc. are all quasi privately insured for those matters, which on top of that is paid for mostly by the taxpayer, not themselves, so that group of patients is much larger than just the properly privately insured ones (15%), reducing the slots for the gesetzlich Versicherte.
This brings me to explaining why the last suggestion here will likely fail: the decentralised and gesetzlich/private mixed system in Germany has created other problems, injustices, costs and a similar, if not even bigger bureaucracy: There are hundreds of small private health insurances, dozens of gesetzliche Krankenkassen and hundreds of regional fiefdoms within all of them, all with their highly paid boards and many layers of ‘management’. And none of that has led to any meaningful price competition or quality improvement.
Note also that the monthly bill for healthcare is in the many hundreds of €, for some privately insured retirees who did not switch back in time to the GKV, it can go well over €1000 per month even if they don’t have such an income anymore.
Now, with regard to appointments and long lead times creating the later problems, note that when gV Germans were still allowed to schedule appointments at specialists without a GP referral, the specialists complained about being swamped and about too many missed appointments.
The government then introduced a nominal charge of 10€ per quarter to be paid by the patient to each practice he went to during that time.
This was supposed to weed out the hypochondriacs and I thought at the time it would not make any difference, but it was so successful, that the specialists complained about too little income and it was therefore quickly abolished.
The GP referral system was introduced instead, resulting in the long wait times again…
In sofar, Sunak’s proposal of charging patients for missed appointments could indeed make a (slight) difference too.
And if the German experience is repeated, a very big one could be obtained by allowing patients to schedule specialist appointments without GP referrals, but with paying a nominal quarterly fee (which would also reduce the ‘stress’ on GPs).
Now, imho, the turnover in GP practices here is just ridiculous and their telemedicine approach and general work ethic is now appaling and totally unacceptable.
To their sole defense, I must mention the pension cap issue though, which is nothing but outdated and imo also plainly criminal, pure theft:
You are punished for saving AND for successful risk taking and investing, for performance.
That is truly unique in the world and absurd.
In particular, when you consider that such a million£ pot now buys you barely a £20k p.a. pension indexed and joint survivor.
For just a low level civil servant, teacher or policeman pension, one would have to have a pot at least twice as large already, not to speak of the ones of headmasters, spies and other lazy WFH Whitehall s**m.
This example alone shows one what is really wrong with the sizes and relationships between the public and private sector these days.
I think, they can only get away with it because they have dumbed down most of the population to a level of total innumeracy.
You mention the Gerry Robinson programme. For what it’s worth, my experience in business is that in every organisation there is an ‘us’ & a ‘them’. The role of management is to ensure that the ‘them’ are their competitors. In every failing business I’ve looked at the ‘them’ is something internal; sales hate production, the warehouse blame the sales office, marketing blames product development, the Didcot branch blame the Leeds branch, you get the idea. If you can get people to focus on shafting their competitors rather than their colleagues you’re almost guaranteed success. In the public sector I suspect it’s harder to find an external target you’re trying to beat & competition turns inwards. A recipe for disaster.
Add to this the finance issue. Even in the most poorly run commercial concerns there is an understanding that you have to generate the income before incurring costs. This basic understanding is not in the DNA of the vast majority of state employees. As far as they are concerned the taxpayer will always turn on the money tap when they whine and complain of underfunding. The Unions, which dominate most of the public sector, have this approach as their ‘one trick pony’ attitude.
In aeronautical terms Sunak’s proposal has the glide capability of a brick. It would cost far more to administer than it would bring in. A classic example of gesture politics from an out of touch politician. Charging up front for an appointment, other than for those who are on free prescriptions, could well have a benefit. It would stop the time wasters who are lonely and just want to chat to someone. Things which are free at the point of use are perceived to have no value. Economics 101. I have visited doctors’ ofices in various parts of the globe. The only country where you see overflowing waiting rooms and massive delays in getting an appointment is the UK. Mind you, that was when the lazy blighters were actually seeing patients.
“The NHS is socialism in practice. Nice idea. Never works.”
Says it all really – no need for the rest of the article brilliant though it is.
As Margaret Thatcher said “Socialiism is fine until they run out of other people’s money”
For me, I feel the only way to resolve this is to make the NHS a separate charge from National Insurance and allow other companies – Bupa and the like – to compete, so the NHS effectively becomes a government-owned heath insurance company among several other private ones. Private health costs would inevitably drop if there was no NHS monopoly and many people would sign up for the other firms.
Put it this way: my home town has no available NHS dentists, so I have to go privately (£25 a month insurance paid to the local surgery, roughly.) My optician’s runs a £9/month insurance scheme that gets me a free eye check-up annually, a discount on any glasses I need, plus additional services.
So I’ve ended up having to pay extra for these services when I’m forced to pay for the NHS as well. I really ought to be able to get a comprehensive care package that includes GP, hospital treatment, dentistry and ophthalmic care and not pay for the state organisation on top.
The NHS is like the BBC: fat, bloated and poor quality, because everyone is obliged to pay for it and there’s no incentive for it to work more efficiently. It lets down its patients, its doctors and its nurses.
It also fascinates me that trades unions are will willing to bargain collectively for good deals with privatised power companies, but not private health firms…
Our GP left the practice Sept 2020. In one month he was gone and switched over to work in research. He was a great GP, but I had the sense he did not want to participate in the covid mandates, testing, vaxxing with an unsafe and ineffective experimental biological which we now know is causing severe adverse events and deaths.
My husband invited to see dermatologist (in Exeter) for suspected skin cancer and ganglion cyst on finger x 4 years. Dermatologist referred him to surgeon in Torquay, who referred him for an X-ray of the finger in Newton Abbot and if and when he is invited for surgery, it will be in Teignmouth. MEANWHILE, he has rec’d NO TREATMENT. Yes, the nhs is broken. I can think of reasons why, but to be honest the reasons are many and have probably gone past a reasonable time for these varied reasons to be addressed.
yesterday I visited the nightingale hospital in Exeter for an appt. I was horrified to see all staff, doctors, nurses, ancillary, clerical, volunteers ALL wearing masks. This despite multiple studies concluding masks DO NOT prevent transmission or contracting of sars cov2. Just another nail in the coffin for highly trained doctors and nurses who refuse to stand up for their rights. I actually told my consultant he could remove his mask, and he thanked me and did so. Guys, if doctors are taking their orders from non medical authorities, you know you are in trouble.
Great article.
The many years experience the author has working in the NHS reveals a great deal. I like the Charlie Munger quote “show me the incentive, I’ll show you the outcome”. The author explains how the NHS management could incentivise doctors to treat more patients. Very true.
By logic, the quote works the other way – “show me the disincentive, I’ll show you the outcome”. This might be how the Government has stealthily and malevolently attempted to limit health expenditure by reducing opportunity for accessing healthcare. I have certainly seen how this has happened in Dentistry where it has got to the point now where many patients can’t find an NHS dentist and where some of these patients, out of desperation, have even been attempting to take their own teeth out.
When it gets to this point:
1. (it’s too late);
2. you need to scrap the whole existing system, introduce radical change that treats the patient as as a highly valued respected customer, and start all over again.
The issue relates to both supply and demand.
Re supply, your points are well made, however, one gets a little tired of the ‘back in my day’ arguments. Conditions for many doctors (male and female) were terrible in the past, and remain not good in many specialties. Society has moved on and people (realistically or otherwise) expect more from their lives nowadays than a solid salary and a ‘vocation’. Meanwhile, NHS doctors look around at the comfortably-off laptop class and wonder why they should slug it out as a public servant. Some of the onus is on society to adapt to the changing needs of the medical workforce.
You acknowledge two issues with demand- older patients and patients more prone to complaining. However, you’ve omitted another major issue- the ‘Wellbeing’ movement/industry. Socialised medicine can only ever work (if at all) if there is an agreement on what level of problem falls under its remit. In psychiatry, I would estimate it is something like the top 10-15% of a spectrum ‘mental health problems’- mostly actual mental illness, substance misuse, and more severe personality disorders. Instead, vast sums and resources are spent on promoting and delivering ‘wellbeing’ interventions- mostly of dubious benefit- for the other 85-90% of the spectrum, while our basic services are genuinely under-resourced. I suspect similar issues play havoc with other specialties also. Boutique ‘wellness medicine’ should be strictly confined to private providers. Perhaps then a public system would have a chance.
The Government are too cowardly to address any of the issues raised in this article, let alone do anything about them. They are choosing to let the public do the job for them ….. or those who have some money, anyway.
In the 1970s there were very few private dentists; everyone used NHS dentistry. Then private dentists started emerging in the early ’80s and now 40 years later, NHS dentists are like hens teeth.
The NHS is so appalling slow at treating non-life threatening medical matters that anyone who can afford to pay for their cataract op; hip replacement and a myriad of other elective treatments is doing it and even more will do it in the future.
The NHS will still cost us a fortune and will treat serious/life threatening/emergency conditions ….. but we’ll be paying twice. And all because the Government doesn’t dare change the funding model of the NHS
UK health expenditure is now one of the highest in Europe; about 12% of GDP. It was about 8% in the 1980s. Now there is about one doctor on the medical register for every 200 people. Back then it was about one doctor for every 650 people.
Over the same period, the number of hospital beds available in the UK has halved from about 300,000 to less than 150,000. Overnight bed occupancy now regularly exceeds 95%; well above the level, many consider safe.
Meanwhile the role of the “family doctor” has largely become extinct as General Practice has been steadily reformed. Most practitioners find the new arrangements challenging, so 80% work part-time; many have resigned but maintain their name on the register, waiting for things to improve.
Now we have more money and trained medical practitioners but fewer beds in struggling NHS hospitals and demoralised NHS GPs. We are in transition; everybody who can pay is being encouraged to buy their own care. Your new doctor is sitting patiently in a comfortable office ready for you to open the relevant app.