"With all these resources, it beggars belief that NHS productivity is currently 11% lower than it was in 2019."
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem - and might lead Politicians towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all.
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis and - in 'peacetime' - to deliver service fit for a C21st developed nation.
One of the big issues is that a Govt’s health policy is only measured by what monies they make available, rather than the outcomes the NHS delivers. Thus insane levels of waste are excused, reforms are scoffed at, whilst the gaping maw of the NHS requires ever more billions to be shovelled into it, for ever-dwindling returns. Post-Covid the public are finally being slightly more clear-eyed about this problem.
A brilliantly informative comment Paddy. Thanks for that. I’ve used the comparison with supermarkets before, though more as a (hopefully) amusing metaphor about what our food supply would be like if it was run by NHS bosses. It’s easy to find in my list of posts if you’re interested, it’s called Alternative Medicine.
I think this line from your comment is key. ‘One of the big issues is that a Govt’s health policy is only measured by what monies they make available, rather than the outcomes the NHS delivers.’ This is absolutely at the heart of the problem. Unfortunately it seems that they are going to displace the blame from ‘not enough money’ to the public’s lifestyle habits.
A mixed system would be better in my opinion. People tend to be more vocal when they don’t feel they are getting value for money. Also, I’m sure huge numbers of NHS workers are themselves unhappy with working in such an incoherent system.
Thanks again for taking the time to comment and add so much.
What infuriates me about this topic is the quasi-religious devotion to the NHS, thus any talk of any reform is heretical in nature, and can therefore be condemned or dismissed. But we all want a Health service to achieve better outcomes, surely? If we can do that by more efficient and less costly means, then we should.
Commentators across the liberal media routinely praise the German model - and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy - it steers a path (in broadest terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation - and that is that if the previous Conservative Govt had tried to copy, say, the German Healthcare model in this country then those self-same liberal media pundits would have gone into meltdown as all their fevered dreams of "selling off the NHS" would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories wanted to destroy the NHS - though many such idiots infest our press. Conservatives may have different ideas about how to improve it, and some of their ideas have been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform - AND IT DOES - then we'll get no closer to a solution.
Possibly a Labour Govt will be given more leeway to reform the NHS - but will they dare? Time will tell.
We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
Would the NHS provision of care improve if more money was spent on it in a targetted fashion? Of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term - not simply look good for the term of the PM who gets the plaudits whilst saddling future generations with the cost. As Blair and Brown did. Some hospital trusts are currently spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal. Surely to God no one thinks that was a wise move that should be copied, do they?
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally - unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of a C21st developed nation - or deserving of the creepily devotional "Clap for Carers" we were invited to perform on the Thursday sabbath during lockdown.
I always felt that ritual was weirdly reminiscent of theatre audiences at the original staging of Peter Pan being enjoined to save Tinkerbell by applauding and reciting "I do believe in fairies, I do, I do".
If we just BELIEVE in the NHS then all will be well.
1972 joined NHS as a Cadet Nurse matron interviewed with my mum. Just to make sure I was a good girl, true not kidding. End if 1973 matrons were gone. The nursing hierarchy began with Nursing Officers above ward sisters. At the time Tories were in government and the "piggling" with the NHS.
1975 Labour are in charge more NHS "piggling" if memory serves me correct something to do with Regional Health Districts. At the same time the God awful programme "Angels" aired that began the deification of our so called glorious NHS.
By 1979 the Tories were back in more "piggling" The criteria to train as a nurse increased to needimg GCE A-levels during the 80s. The term used by us nurses at that time was that this new breed would get too posh to wash. More "piggling' the disaster of Care in the Community Act. Project 2000 was being banded around with talk of Diploma Nurses.
1997 Tony Blair implemented Project 2000 on speed and hence the reason we know have degree nurses. Blair privatised the NHS through the back door contracting out services like cleaning and meal provision to patients. All the while bloating the administration posts.
2010 Tories again pouring obscene ££££ into to pot without denanding better output.
2020 Covid shutting down the NHS what a stupid idea. I and my early retired nursing friends thought we'd go back. Forms arrived inches thick full of DEI and woke nonsense. We decided that we would be cancelled within an hour in the wards.
2024 Labour back in more "piggling'" but this time blaming us and the Tories for the awful mess.
Ive seen and heard it all nothing will change unless the NHS is Euthanised and a totally new model based on European models is implemented . It has never been the envy of the world and nurses are not Angels never have been.
Agreed Pat. Though I think that the threat of a. ‘American style system’
Is overblown. It’s used to scare us. As if there were only two possible options. The broken system we have. Or the broken system they have. Pick one. Nope. There are plenty other ways to go as you point out.
Thanks for that insight Pat. So helpful to have someone with genuine first hand experience of these changes. It seems to me that all of the ‘restructuring’ over the years were attempts to fix a fundamentally broken model. As I said in another comment, maybe the model could work with a much smaller, more cohesive population. But not now. As our economy changed and our society became ever more fragmented, it was never going to work.
I believe that Australia moved from a single payer to a mixed system reasonably successfully not that long ago. My worry is that the British way will simply to make the middle classes fork out for ‘supplementary’ state administered health insurance. And keep the rest of the system as is. So essentially just making people worse off, introducing a whole new layer of state bureaucracy, and leaving the central problems untouched. That’s the British Way!
I have experienced as a patient the French system needing minor surgery some 10yrs ago. It was far superior to the NHS even then. I began my career when the population was smaller and the demographic very different, due to improved living standards etc we have an older demographic but sadly have reverted to once again an unhealthy population, especially the young to middle age group.
I have always believed that one main failure was that the NHS failed to move from a service that was set up to cure and build up a malnourished nation during the post war years to one that by the 1980s needed to become more proactive in health promtion and education. Health care does need to be free at the point of entry. However does not a discussion need to be had by our politicians that whole N.I. contribution system needs to be looked at differently to allow change. Im not sure but I think in France if you can't afford health insurance the government funds the care via general taxes. We certainly dont want the US system. The stories I heard from a friend who nursed over there were horrific regarding care for those who couldn't afford it.
One of the issues the Tories have with any reform to the NHS is that as soon as they try anything the commentariat and the more brain dead on the left start screaming about not wanting health provision like the USA. Nobody wants that, but it kills any discussion stone dead.
The other thing that occurs to me is whether there are any stats showing where this huge workforce actually works. How many are frontline medical staff and how has the proportion changed over the years?
Brown has a lot to answer for. We got one of the shiny new hospitals here in Peterborough. With a growing population (as everywhere) it has less beds than the two hospitals it replaced. Who was the brainless twerp who signed that off?
Yes Ian. I’m always coming up against the accusation that I want ‘an American style system where they take your credit card before you get in the ambulance.’ I don’t. But as you say, it shuts down discussion. Also. I’ve learned a little about the ‘American system’ recently and it is incredibly complicated and broken, but not actually like it is portrayed.
I’m not sure where those stats could be found. All my research is quite surface level stuff. But I think the 11% drop in productivity over the last five years tells you a lot about the answer to your question.
I’ve tried not to actually criticise the NHS in this post. It’s not what it is about. But for what it is worth I think a broadly socialist system which relies on rationing for resource allocation has always been doomed to fail. While we had a smaller, more culturally cohesive population, then maybe it worked ok. But now it is simply unsustainable.
Sadly I think the solution will be the same as most leftist solutions to these problems. The rich opt out. The middle classes and working poor pay double. Special interest groups are given priority. Huge resources are wasted on non core issues.
I foolishly had hopes for Streeting. But nope. Same old playbook. Just with a public blaming twist.
The popular British idea of the American system is pure propaganda. I know, I have lived there and used it: my youngest was born in a US hospital. By Federal law anyone turning up to the ER is treated and frankly, what medical professional is going to watch someone bleed out because they do not have insurance? On discharge from the ER you simply fill out a form with your name and address, with no proof of ID. You can write M Mouse, Disneyland, Florida then walk away, the hospital soaking up the cost. Uncle Sam pays for the poor with Medicaid and the retired with Medicare. Everyone else has insurance, self-funded or employer-provided. Insurers are compelled by law to take those with pre-existing conditions at normal rates, the cost defrayed across the healthy. This part of why insurance is expensive. Obamacare was about compelling the ~5% not covered by the insurance or the government to get insurance. Mostly these were young people who did not want coverage as they are healthy. Having used both systems, I would take the US every time. For a start there is no 7.6 million person waiting list.
I have no stats to prove it but I maintain that the less time you spend with those pesky patients the posher your title and the higher your salary. "DEI Facilitator" anyone? Now there's non-job if ever there was one.
I think you’re right Iris. I took out a bit where I referenced a madly long and impenetrably obtuse NHS job title because I thought it was just too confusing and bonkers.
Thank you, LSO, for exposing yourself to these things, so that the rest of us don't have to.
There are certain things in life, including veganism and homosexuality, that I am happy for other people to indulge in, but which I am convinced will not suit me, even though I have not tried them.
I suspect that the wisdom of Jess Phillips is another item to add to that list.
Starmer always reminds me of Spongebob Squarepants in a permanently bad mood. And what I want to know is, why doesn't he tax fatness? I would have thought the so-called obesity epidemic brings more strain to the National Death Service with all those fatties needing knee replacements, stapled stomachs, having cardiac arrests and developing type 2 diabetes.
Don’t give him ideas Bettina. I think my instinct is to go the other way. Leave the fatties alone!! Fat people pay taxes. And the NHS is supposedly universal healthcare. Once you start putting a moral and financial cost on people’s lifestyle choices you are into a whole world of hurt. I think universal healthcare is like free speech. Either everyone gets it, or de facto, no one gets it.
But maybe prohibitively tax leggings over a certain size. I’ll compromise with you there….🤣
I believe I have sussed out the evil goal of Starmer from your post. In order to rid His country of all those pesky conservative working class British citizens, he is determined to make them miserable. Hence they will all want to leave.
I am reminded of an ancestor from Ipswich in the late 1600’s who was sent packing through indentured servitude. I assume he had killed a deer on the kings land. He went first to Jamaica then to Long Island. When done with his indenture he became a Quaker and moved to New Jersey. In time he married, bought 100 acres to farm and had 4 sons. His land was in Princeton NJ across the channel from the uni.
Three of his grandsons fought in the revolution ary war in New Jersey.
I am not sure how this relates here. I just hate hearing how your rights to speech, liberty of movement etc. are being systematically taken away from you with no end in sight.
You are not alone but it does seem you are being tested the harshest for now.
I’m thinking of emigrating Deidre. Narnia is currently top of my list. Great story. I think we’d all do better to try and become a bit more aware of our ancestors struggles. Maybe then we wouldn’t be so ready to dismiss them all as racist Neanderthal transphobes! ATB
The tax raised on smoking is small change compared to the enormous costs associated with nursing people in old age. Told to me by a very smart consultant at a London hospital who obviously knew his subject. So, governments trying to save money will WANT people TO smoke, they die younger, on average around retirement age. Smokers generally die quite quickly; heart attacks and lung cancers. But if you want to break the economy, as Marxist Labour dreams of, you want people living longer and needing expensive nursing care into their 80's and 90's.
It’s a grim subject Mrs B. I, and I know many readers have had relatives who have died from smoking. But as you say, the argument that smokers are a ‘burden’ is disingenuous. I read somewhere that a small coterie of patients take up a huge amount of NHS resources. Not saying at all that they shouldn’t get treatment. But let’s target the real issues. So much of the NHS ‘debate’ is just displacement and projection.
It is not a given that longer lives are sicker lives. Very often they are extra healthy years. True, they will pick up more pension, but shorter lives incur big health costs in attempts to put off death by a couple of years. You would think a £180bn enterprise would know a lot more about its business, but "health economists" are mostly university left-wing ideologues., so nothing to see.
Loved this piece and I know I shouldn’t laugh … but I couldn’t help it. Great writing. Thanks.
To be honest the pontificating of the new puritans has to be pointed out with satire.
Mr Starmer and all of the political muppets in Westminster were emboldened by the Covid debacle when so many went along with the lies and madness.
Simply put, they saw that the population tolerated tyranny in fact enjoyed it and joined in. I can still hear the distant sound of handclaps… what a nightmare time.
It’s not going to work though this “ I know better than you” sanctimonious codswallop and I predict it will backfire quite spectacularly.
Hi Saturdaydancer, as I was going to bed last night I caught a headline on X about ‘Labour fast tracking assisted dying’. Or something..But I didn’t get the chance to read it. Very grim indeed. I have a lot to say about that. Essentially look at Canada, or our anti-terror laws or ‘anti-hate- laws and see how they have been weaponised. Why do people think this will be any different? Very Logan’s Run.
I arrived late to your splendid assessment of 2TK’s plans to drain his peoples’ few remaining pleasures in life and chuckled at your nailing him as “a joyless puritanical scold” “empty eyed drone “ and “busy body happiness vacuum”. Hilariously spot on!
However, has it occurred to you that as a keen pupil of the WEF he appears to be dutifully following his master’s orders? There seems to me to be a contradiction about him and many other western leaders professing deep concern about improving their citizens’ lives when they have mostly signed up to the WEF / UN doctrine of depopulating the planet. WEF are notorious for their mantra “You will have nothing And be happy.” Of course our leaders can’t admit to that publicly and have to dress up their policies as if they were all for the long-term “good” of the people, however painful in the interim. But since COvid, they all seem to be in a great hurry to restrict our lives increasingly more on many levels.
Thanks Alexei. Very kind words. I don’t really see a contradiction because I don’t buy into the ‘WEF is trying to depopulate the world’ theory. It doesn’t make any sense to me. They are awful people sure, but I’m not convinced they want to kill me, I’m less easy to control and exploit dead.
I also don’t think a government incapable of filling a pothole, much less running a health service, is capable of embarking on such a huge undertaking.
Obviously covid etc. but again, I see that as a combination of idiocy and opportunism. It certainly went a bit evil towards the end. More because the could see the publics appetite for authoritarianism. But again. I don’t believe these numpties are capable of a co ordinated approach.
I’m sure there are countless videos ‘proving’ me wrong. But for now I’m just unconvinced. Good to hear from you.
So you're correct in identifying the British public's "appetite" for it. Not so much the case over here (US), even less today. This however raises the question as to what might be their future purpose in testing our obedience......
The smoking ban is the child of the Epidemiologist’s Fallacy: correlation is causation This gives the Public Health Nazis infinite ammunition to ban stuff they don’t like (eg was smoking, now pubs) by linking it to stuff we all agree is bad (eg cancer). Parametize the model correctly and you can make anything correlate. Check out http://www.tylervigen.com/spurious-correlations for amusing examples. For the Love of God, do not show anyone from Labour this website or 2TK and his mid-wit chums will be banning all sorts. For example, they could use one chart on this website to close all our nuclear power stations in the interest of reducing the distance between the Sun and Uranus.
Great article LSO. Important to see how different systems work in the world vis a vis providing healthcare, or not. I am, though, equally interested in how words are chosen or used by those who use or provide things. For instance, “XX percentage of patients did not respond to treatment.”, so treatment was fabulous, but the silly wretch refused to respond. Or, “XX percentage of patients displayed adverse reactions to the medicine.” Once again, silly wretch didn’t manage to display the correct outcomes. Never the treatment, never the medicine coming up short. Anyway, I am always reading with an eye for phrasing and word choice - so much is set by it (scene setting) for what the tale teller is about to sell us, including those who purport to want to “help”.
Thanks Amp. And that is such a good point. It reminds me of a similar framing in a different context: ‘Van kills three people at Christmas market’. Same thing.
Regarding our Glorious Leader, it would not be unreasonable to expect that the provision of stupidly expensive spectacles would enable him to see more clearly in the mirror what an absolute donkey's todger he really is. But no, he uses them to portray his scholarly wisdom and legal judgment - in which case he really ought to be banging on the door of whichever optician it was who saw him and his bulging wallet coming and demanding his money back. Or 'Lord' Alli's money ...
Ha ha Agreed no-one. I know it’s all borne of a sense of entitlement but isn’t a bit pathetically demeaning for a man to have another man buy your glasses and clothe your wife?
The sanctimony surrounding the NHS reminds me a great deal of the German BfV (Federal Office for the Protection of the Constitution), where an institution created to serve the people has clearly mutated into an institution served by the people.
"With all these resources, it beggars belief that NHS productivity is currently 11% lower than it was in 2019."
Perhaps a comparison between 2 equally vast, but vastly different, organisations would be illustrative of the problem - and might lead Politicians towards the solutions that every one of them can see, but vanishingly few dare mention.
The overriding rationale behind our national response to Covid was to protect the NHS from being overwhelmed. The economy was broadly shut down to allow the NHS to cope, with most other NHS services curtailed to meet Covid-related demands. The butcher’s bill for this single-minded focus on Covid, to the exclusion of almost any other medical condition, is yet to be fully tallied, and will affect this country for years to come.
The initial spike in demand due to Covid amounted to between 2 and 2.5% of the NHS’s annual provision of service. To allow the NHS to achieve that we crippled the national economy and trashed many thousands of businesses and livelihoods.
The Supermarket industry had to meet a spike of over 30%. They managed to achieve that thanks to their ability, as businesses, to change working practices, supply chain demands, deliveries etc in a matter of days.
If we had an NFS (National Food Service) that reacted with all the inefficiency of an organisation like the NHS, we might have starved. We almost certainly would have faced severe rationing.
We need to look at the Private Sector and Public Sector business models of each and note the difference in reaction time and capacity to adapt to a crisis situation. The structural inefficiencies of the NHS, with its top-down, lumberingly bureaucratic nature, means it struggles to provide better outcomes.
Supermarkets were able to meet the demand by being more agile, less bureaucratic and far, FAR more efficient. Supermarket chains have spent years competing with each other and so have ruthlessly cut down on waste. If a process can be streamlined it will be, almost immediately, and across all stores in the chain. If an innovation is identified that brings even the slightest improvement or saves the smallest amount, it will be adopted and rolled-out as fast as possible.
No one, not even the biggest cheerleader of the NHS model, could pretend our health service does that. At all.
That, I would suggest, is the principal differentiator in their relative abilities to react well, and quickly, to a crisis and - in 'peacetime' - to deliver service fit for a C21st developed nation.
One of the big issues is that a Govt’s health policy is only measured by what monies they make available, rather than the outcomes the NHS delivers. Thus insane levels of waste are excused, reforms are scoffed at, whilst the gaping maw of the NHS requires ever more billions to be shovelled into it, for ever-dwindling returns. Post-Covid the public are finally being slightly more clear-eyed about this problem.
A brilliantly informative comment Paddy. Thanks for that. I’ve used the comparison with supermarkets before, though more as a (hopefully) amusing metaphor about what our food supply would be like if it was run by NHS bosses. It’s easy to find in my list of posts if you’re interested, it’s called Alternative Medicine.
I think this line from your comment is key. ‘One of the big issues is that a Govt’s health policy is only measured by what monies they make available, rather than the outcomes the NHS delivers.’ This is absolutely at the heart of the problem. Unfortunately it seems that they are going to displace the blame from ‘not enough money’ to the public’s lifestyle habits.
A mixed system would be better in my opinion. People tend to be more vocal when they don’t feel they are getting value for money. Also, I’m sure huge numbers of NHS workers are themselves unhappy with working in such an incoherent system.
Thanks again for taking the time to comment and add so much.
Thanks LSO,
What infuriates me about this topic is the quasi-religious devotion to the NHS, thus any talk of any reform is heretical in nature, and can therefore be condemned or dismissed. But we all want a Health service to achieve better outcomes, surely? If we can do that by more efficient and less costly means, then we should.
Commentators across the liberal media routinely praise the German model - and rightly so. By almost every conceivable metric the German Healthcare model delivers better outcomes, better service and with less bureaucracy - it steers a path (in broadest terms) between the NHS and US healthcare models.
There are few certainties in this world, particularly at the moment, but one thing is beyond contestation - and that is that if the previous Conservative Govt had tried to copy, say, the German Healthcare model in this country then those self-same liberal media pundits would have gone into meltdown as all their fevered dreams of "selling off the NHS" would be coming true.
That is not a left/right issue. Only an idiot could imagine the Tories wanted to destroy the NHS - though many such idiots infest our press. Conservatives may have different ideas about how to improve it, and some of their ideas have been proved wrong, but they want a functioning and sustainable health service as much as anyone else.
But until we all accept it needs reform - AND IT DOES - then we'll get no closer to a solution.
Possibly a Labour Govt will be given more leeway to reform the NHS - but will they dare? Time will tell.
We need a grown-up debate about how we fund the NHS, with EVERY OPTION on the table. We need to look at the successful medical insurance models used across Europe and elsewhere and dial down the partisan hyperbole.
Would the NHS provision of care improve if more money was spent on it in a targetted fashion? Of course. But any sensible Govt has to look at an NHS funding model that is SUSTAINABLE for the long term - not simply look good for the term of the PM who gets the plaudits whilst saddling future generations with the cost. As Blair and Brown did. Some hospital trusts are currently spending almost 20% of their entire budget just on servicing PFI debt incurred under Nu Labour. That is an absolute scandal. Surely to God no one thinks that was a wise move that should be copied, do they?
If NHS funding increased at the same level it did between 2000 and 2010, during which it nearly doubled in real terms then, by 2040, spending on the NHS would make up 100% of the current level of state spending. Everyone would, presumably, agree that is clearly – definitionally - unsustainable.
Until we drop this absurd belief that the NHS model is perfect and not to be touched, and its problems only stem from mere underfunding, we cannot get to a point when we can have a health service worthy of a C21st developed nation - or deserving of the creepily devotional "Clap for Carers" we were invited to perform on the Thursday sabbath during lockdown.
I always felt that ritual was weirdly reminiscent of theatre audiences at the original staging of Peter Pan being enjoined to save Tinkerbell by applauding and reciting "I do believe in fairies, I do, I do".
If we just BELIEVE in the NHS then all will be well.
1972 joined NHS as a Cadet Nurse matron interviewed with my mum. Just to make sure I was a good girl, true not kidding. End if 1973 matrons were gone. The nursing hierarchy began with Nursing Officers above ward sisters. At the time Tories were in government and the "piggling" with the NHS.
1975 Labour are in charge more NHS "piggling" if memory serves me correct something to do with Regional Health Districts. At the same time the God awful programme "Angels" aired that began the deification of our so called glorious NHS.
By 1979 the Tories were back in more "piggling" The criteria to train as a nurse increased to needimg GCE A-levels during the 80s. The term used by us nurses at that time was that this new breed would get too posh to wash. More "piggling' the disaster of Care in the Community Act. Project 2000 was being banded around with talk of Diploma Nurses.
1997 Tony Blair implemented Project 2000 on speed and hence the reason we know have degree nurses. Blair privatised the NHS through the back door contracting out services like cleaning and meal provision to patients. All the while bloating the administration posts.
2010 Tories again pouring obscene ££££ into to pot without denanding better output.
2020 Covid shutting down the NHS what a stupid idea. I and my early retired nursing friends thought we'd go back. Forms arrived inches thick full of DEI and woke nonsense. We decided that we would be cancelled within an hour in the wards.
2024 Labour back in more "piggling'" but this time blaming us and the Tories for the awful mess.
Ive seen and heard it all nothing will change unless the NHS is Euthanised and a totally new model based on European models is implemented . It has never been the envy of the world and nurses are not Angels never have been.
Agreed Pat. Though I think that the threat of a. ‘American style system’
Is overblown. It’s used to scare us. As if there were only two possible options. The broken system we have. Or the broken system they have. Pick one. Nope. There are plenty other ways to go as you point out.
Thanks for that insight Pat. So helpful to have someone with genuine first hand experience of these changes. It seems to me that all of the ‘restructuring’ over the years were attempts to fix a fundamentally broken model. As I said in another comment, maybe the model could work with a much smaller, more cohesive population. But not now. As our economy changed and our society became ever more fragmented, it was never going to work.
I believe that Australia moved from a single payer to a mixed system reasonably successfully not that long ago. My worry is that the British way will simply to make the middle classes fork out for ‘supplementary’ state administered health insurance. And keep the rest of the system as is. So essentially just making people worse off, introducing a whole new layer of state bureaucracy, and leaving the central problems untouched. That’s the British Way!
Good to hear from you.
Thank you for your reply.
I have experienced as a patient the French system needing minor surgery some 10yrs ago. It was far superior to the NHS even then. I began my career when the population was smaller and the demographic very different, due to improved living standards etc we have an older demographic but sadly have reverted to once again an unhealthy population, especially the young to middle age group.
I have always believed that one main failure was that the NHS failed to move from a service that was set up to cure and build up a malnourished nation during the post war years to one that by the 1980s needed to become more proactive in health promtion and education. Health care does need to be free at the point of entry. However does not a discussion need to be had by our politicians that whole N.I. contribution system needs to be looked at differently to allow change. Im not sure but I think in France if you can't afford health insurance the government funds the care via general taxes. We certainly dont want the US system. The stories I heard from a friend who nursed over there were horrific regarding care for those who couldn't afford it.
Thank you Pat. X
One of the issues the Tories have with any reform to the NHS is that as soon as they try anything the commentariat and the more brain dead on the left start screaming about not wanting health provision like the USA. Nobody wants that, but it kills any discussion stone dead.
The other thing that occurs to me is whether there are any stats showing where this huge workforce actually works. How many are frontline medical staff and how has the proportion changed over the years?
Brown has a lot to answer for. We got one of the shiny new hospitals here in Peterborough. With a growing population (as everywhere) it has less beds than the two hospitals it replaced. Who was the brainless twerp who signed that off?
Yes Ian. I’m always coming up against the accusation that I want ‘an American style system where they take your credit card before you get in the ambulance.’ I don’t. But as you say, it shuts down discussion. Also. I’ve learned a little about the ‘American system’ recently and it is incredibly complicated and broken, but not actually like it is portrayed.
I’m not sure where those stats could be found. All my research is quite surface level stuff. But I think the 11% drop in productivity over the last five years tells you a lot about the answer to your question.
I’ve tried not to actually criticise the NHS in this post. It’s not what it is about. But for what it is worth I think a broadly socialist system which relies on rationing for resource allocation has always been doomed to fail. While we had a smaller, more culturally cohesive population, then maybe it worked ok. But now it is simply unsustainable.
Sadly I think the solution will be the same as most leftist solutions to these problems. The rich opt out. The middle classes and working poor pay double. Special interest groups are given priority. Huge resources are wasted on non core issues.
I foolishly had hopes for Streeting. But nope. Same old playbook. Just with a public blaming twist.
Thanks for taking the time to comment.
The popular British idea of the American system is pure propaganda. I know, I have lived there and used it: my youngest was born in a US hospital. By Federal law anyone turning up to the ER is treated and frankly, what medical professional is going to watch someone bleed out because they do not have insurance? On discharge from the ER you simply fill out a form with your name and address, with no proof of ID. You can write M Mouse, Disneyland, Florida then walk away, the hospital soaking up the cost. Uncle Sam pays for the poor with Medicaid and the retired with Medicare. Everyone else has insurance, self-funded or employer-provided. Insurers are compelled by law to take those with pre-existing conditions at normal rates, the cost defrayed across the healthy. This part of why insurance is expensive. Obamacare was about compelling the ~5% not covered by the insurance or the government to get insurance. Mostly these were young people who did not want coverage as they are healthy. Having used both systems, I would take the US every time. For a start there is no 7.6 million person waiting list.
I have no stats to prove it but I maintain that the less time you spend with those pesky patients the posher your title and the higher your salary. "DEI Facilitator" anyone? Now there's non-job if ever there was one.
I think you’re right Iris. I took out a bit where I referenced a madly long and impenetrably obtuse NHS job title because I thought it was just too confusing and bonkers.
“An evening with Jess Phillips”.
(Shudders) 😖
I have bought us tickets Ady, for next time.
Most people would pay not to have to go, surely?
I had to check whether that was a real thing. It was. I shuddered too.
Oh yes Geoff. And there’s a book. 🤣
Thank you, LSO, for exposing yourself to these things, so that the rest of us don't have to.
There are certain things in life, including veganism and homosexuality, that I am happy for other people to indulge in, but which I am convinced will not suit me, even though I have not tried them.
I suspect that the wisdom of Jess Phillips is another item to add to that list.
Christ, no. I had no idea.
Oh for the halcyon days of recent yore when we enjoyed a government that was merely incompetent and spineless rather than downright evil.
Ha ha 👍
Steady on old chap you're not pining for the feckless rudderless fossil party again are you? Go lie down in a dark room and consider yourself berated!
It’s all relative!
Starmer always reminds me of Spongebob Squarepants in a permanently bad mood. And what I want to know is, why doesn't he tax fatness? I would have thought the so-called obesity epidemic brings more strain to the National Death Service with all those fatties needing knee replacements, stapled stomachs, having cardiac arrests and developing type 2 diabetes.
Don’t give him ideas Bettina. I think my instinct is to go the other way. Leave the fatties alone!! Fat people pay taxes. And the NHS is supposedly universal healthcare. Once you start putting a moral and financial cost on people’s lifestyle choices you are into a whole world of hurt. I think universal healthcare is like free speech. Either everyone gets it, or de facto, no one gets it.
But maybe prohibitively tax leggings over a certain size. I’ll compromise with you there….🤣
Yeah, I was joking LSO. You know my mantras are ‘all taxation is theft’ and ‘all government is a slave system’.
I believe I have sussed out the evil goal of Starmer from your post. In order to rid His country of all those pesky conservative working class British citizens, he is determined to make them miserable. Hence they will all want to leave.
I am reminded of an ancestor from Ipswich in the late 1600’s who was sent packing through indentured servitude. I assume he had killed a deer on the kings land. He went first to Jamaica then to Long Island. When done with his indenture he became a Quaker and moved to New Jersey. In time he married, bought 100 acres to farm and had 4 sons. His land was in Princeton NJ across the channel from the uni.
Three of his grandsons fought in the revolution ary war in New Jersey.
I am not sure how this relates here. I just hate hearing how your rights to speech, liberty of movement etc. are being systematically taken away from you with no end in sight.
You are not alone but it does seem you are being tested the harshest for now.
I hope we can find a way out of this alive.
I’m thinking of emigrating Deidre. Narnia is currently top of my list. Great story. I think we’d all do better to try and become a bit more aware of our ancestors struggles. Maybe then we wouldn’t be so ready to dismiss them all as racist Neanderthal transphobes! ATB
The tax raised on smoking is small change compared to the enormous costs associated with nursing people in old age. Told to me by a very smart consultant at a London hospital who obviously knew his subject. So, governments trying to save money will WANT people TO smoke, they die younger, on average around retirement age. Smokers generally die quite quickly; heart attacks and lung cancers. But if you want to break the economy, as Marxist Labour dreams of, you want people living longer and needing expensive nursing care into their 80's and 90's.
It’s a grim subject Mrs B. I, and I know many readers have had relatives who have died from smoking. But as you say, the argument that smokers are a ‘burden’ is disingenuous. I read somewhere that a small coterie of patients take up a huge amount of NHS resources. Not saying at all that they shouldn’t get treatment. But let’s target the real issues. So much of the NHS ‘debate’ is just displacement and projection.
It is not a given that longer lives are sicker lives. Very often they are extra healthy years. True, they will pick up more pension, but shorter lives incur big health costs in attempts to put off death by a couple of years. You would think a £180bn enterprise would know a lot more about its business, but "health economists" are mostly university left-wing ideologues., so nothing to see.
Loved this piece and I know I shouldn’t laugh … but I couldn’t help it. Great writing. Thanks.
To be honest the pontificating of the new puritans has to be pointed out with satire.
Mr Starmer and all of the political muppets in Westminster were emboldened by the Covid debacle when so many went along with the lies and madness.
Simply put, they saw that the population tolerated tyranny in fact enjoyed it and joined in. I can still hear the distant sound of handclaps… what a nightmare time.
It’s not going to work though this “ I know better than you” sanctimonious codswallop and I predict it will backfire quite spectacularly.
Oh god…. The handclaps 😩 Thanks Maria!
I suspect Labour being the Midwife of the NHS will also be its Grim Reaper.
It’s what comes next is the problem….
Logan’s Run?
Hi Saturdaydancer, as I was going to bed last night I caught a headline on X about ‘Labour fast tracking assisted dying’. Or something..But I didn’t get the chance to read it. Very grim indeed. I have a lot to say about that. Essentially look at Canada, or our anti-terror laws or ‘anti-hate- laws and see how they have been weaponised. Why do people think this will be any different? Very Logan’s Run.
I arrived late to your splendid assessment of 2TK’s plans to drain his peoples’ few remaining pleasures in life and chuckled at your nailing him as “a joyless puritanical scold” “empty eyed drone “ and “busy body happiness vacuum”. Hilariously spot on!
However, has it occurred to you that as a keen pupil of the WEF he appears to be dutifully following his master’s orders? There seems to me to be a contradiction about him and many other western leaders professing deep concern about improving their citizens’ lives when they have mostly signed up to the WEF / UN doctrine of depopulating the planet. WEF are notorious for their mantra “You will have nothing And be happy.” Of course our leaders can’t admit to that publicly and have to dress up their policies as if they were all for the long-term “good” of the people, however painful in the interim. But since COvid, they all seem to be in a great hurry to restrict our lives increasingly more on many levels.
Thanks Alexei. Very kind words. I don’t really see a contradiction because I don’t buy into the ‘WEF is trying to depopulate the world’ theory. It doesn’t make any sense to me. They are awful people sure, but I’m not convinced they want to kill me, I’m less easy to control and exploit dead.
I also don’t think a government incapable of filling a pothole, much less running a health service, is capable of embarking on such a huge undertaking.
Obviously covid etc. but again, I see that as a combination of idiocy and opportunism. It certainly went a bit evil towards the end. More because the could see the publics appetite for authoritarianism. But again. I don’t believe these numpties are capable of a co ordinated approach.
I’m sure there are countless videos ‘proving’ me wrong. But for now I’m just unconvinced. Good to hear from you.
A quick reply to confirm the WEF's recent admission re. Covid - "It was a test of our obedience". -
https://www.thegatewaypundit.com/2024/09/world-economic-forum-finally-tells-truth-about-covid/
So you're correct in identifying the British public's "appetite" for it. Not so much the case over here (US), even less today. This however raises the question as to what might be their future purpose in testing our obedience......
Ha yes Alexei. Don’t get me wrong. They are definitely up to something awful!
The smoking ban is the child of the Epidemiologist’s Fallacy: correlation is causation This gives the Public Health Nazis infinite ammunition to ban stuff they don’t like (eg was smoking, now pubs) by linking it to stuff we all agree is bad (eg cancer). Parametize the model correctly and you can make anything correlate. Check out http://www.tylervigen.com/spurious-correlations for amusing examples. For the Love of God, do not show anyone from Labour this website or 2TK and his mid-wit chums will be banning all sorts. For example, they could use one chart on this website to close all our nuclear power stations in the interest of reducing the distance between the Sun and Uranus.
Thanks Dan. A very Quick Look tells me I’m going to enjoy that site. Thanks for the link!
Great article LSO. Important to see how different systems work in the world vis a vis providing healthcare, or not. I am, though, equally interested in how words are chosen or used by those who use or provide things. For instance, “XX percentage of patients did not respond to treatment.”, so treatment was fabulous, but the silly wretch refused to respond. Or, “XX percentage of patients displayed adverse reactions to the medicine.” Once again, silly wretch didn’t manage to display the correct outcomes. Never the treatment, never the medicine coming up short. Anyway, I am always reading with an eye for phrasing and word choice - so much is set by it (scene setting) for what the tale teller is about to sell us, including those who purport to want to “help”.
Thanks Amp. And that is such a good point. It reminds me of a similar framing in a different context: ‘Van kills three people at Christmas market’. Same thing.
Regarding our Glorious Leader, it would not be unreasonable to expect that the provision of stupidly expensive spectacles would enable him to see more clearly in the mirror what an absolute donkey's todger he really is. But no, he uses them to portray his scholarly wisdom and legal judgment - in which case he really ought to be banging on the door of whichever optician it was who saw him and his bulging wallet coming and demanding his money back. Or 'Lord' Alli's money ...
Ha ha Agreed no-one. I know it’s all borne of a sense of entitlement but isn’t a bit pathetically demeaning for a man to have another man buy your glasses and clothe your wife?
Do not stare into 'a black bronchial abyss' it will cough back at you!
🤣
The sanctimony surrounding the NHS reminds me a great deal of the German BfV (Federal Office for the Protection of the Constitution), where an institution created to serve the people has clearly mutated into an institution served by the people.
I think I need to read up on that Sathanas. Not on my radar. I’ll try and catch up with Eugyppius more often.