There are doctors in the House

 

Before the last election Mr Cameron put out a plea for new people to join the Conseravtives as potential MP candidates.  He said we need a new influx of professional talent to help us with our deliberations on future policy, and in managing the public sector. He had in mind highly trained and well educated individuals like doctors working in the NHS.

A couple of doctors stepped up to the plate, and persuaded selectors to choose them as candidates. Sarah Wollaston and Philip Lee duly were elected. They have been keen to offer their advice to the government as it embarks on its NHS reforms. Surely, they asked, this was the idea of inviting them in to the Parliamentary fold?

On Wednesday in the House it did not seem like that. Dr Philip Lee, after months of trying to persuade the government in private of ways to reform the NHS, broke cover and offered a Ten Minute Rule Bill to Parliament. These bills do not usually stand any chance of making it to the Statute book, as there is not normally any time available to take them through a committee stage. However, the slot is popular as it is in prime time just after Questions. Successful Ten Minute Rule bills attract media and lobby group attention and may come to  influence the government’s own legislation.

Dr Lee feels strongly that people do not understand the costs of their healthcare. He proposed that everyone should receive an annual statement of the healthcare they have received over the past twelve months, with the costs of each service item. The healthcare would remain free, but everyone would then know what they were receiving from the system and would understand the costs involved. The NHS should already have good patient records recording all the treatments and consultations. It also has a lot of information about prices from its purchasing activites. He argues it would cost little for a computer to  collate and transmit this to each patient.  He also favours allowing co payments for treatments that go beyond the limited list of treatments available on the NHS, instead of forcing people who want such treatment into opting out of the NHS altogether and going private. He has a number of views on how the NHS could offer better quality at lower cost.

The government did not look keen on all of this. Labour hated it, and duly voted the proposal down.

Sarah Wollaston too has be driven to private members legislation to try to get her message across. She thinks binge drinking is one of the main causes of poor health in the UK, and is proposing legislative restrictions on alcohol advertising to try to control it. She has also been reported making  criticisms of the government’s NHS reforms.

It’s not easy being a doctor in the House. It appears that Doctors have bigger followings for their medical advice than for their political advice, despite the good intentions of the new professionals scheme. I would be interested to hear what you think about the government taking some medical advice.

 

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129 Comments

  1. Steve Cox
    Posted February 25, 2012 at 6:45 am | Permalink

    “He argues it would cost little for a computer to collate and transmit this to each patient.”

    ROFL. Either the good doctor is pulling our legs, or he has not followed the wretched history of national-scale public sector IT projects. I’m not saying that it’s not a good idea, just that it would inevitably be a massively expensive disaster.

    • Chris
      Posted February 25, 2012 at 9:20 am | Permalink

      I agree – hugely expensive and a waste of time. Stop focusing on paperwork solutions and concentrate on practicalities.

    • Bazman
      Posted February 25, 2012 at 1:30 pm | Permalink

      Absolute waste of time and resources, basically just funding Tory propaganda.

      • Disaffected
        Posted February 25, 2012 at 4:58 pm | Permalink

        NHS already wasted £12 billion on computers that do not work. No one sacked in Government, civil service or NHS. WHy not?

  2. lifelogic
    Posted February 25, 2012 at 6:54 am | Permalink

    Not only should they get a breakdown of costs but they should have to pay it when they are able to. Just as they pay for hair cuts, food, water, fuel and everything else. Then the services will respond to what the customers actually want, need and are prepared to pay for.

    An NHS “free at the point of rationing” – through delays, inconvenience, a lack of capacity and equipment is not a sensible health service. It is like most of government a very inefficient monopoly largely run for the benefit of its staff delivering what the staff think they should deliver when the staff feel like delivering it.

    • Disaffected
      Posted February 25, 2012 at 9:26 am | Permalink

      Stop subsidising alcohol at Westminster on the back of the taxpayer might be a start. Fewer assaults and insults might occur and healthier debates might emerge from this this discredited institution.

      I think the Tory party prefer people who think that social political correctness whims to change Christian religion are more important than the beliefs held by people for thousands of years. Some of the strongest Lib Dem supporters for gay marriage in Church are atheists. They do not care because they do not believe in God. Gay marriages can occur elsewhere, leave the Church alone. The Lib Dems also prevent any benefit from marriage through tax breaks- why? Atheism? How dare politicians try to change our faith and culture by abusing their position.

      Of course there are Lib Dems who fanatically want to change the British culture at every opportunity and use politics as a means to achieve their aims. It is not surprising when you look at the speech of Mr Clegg before the election and his subsequent insults of Britain as a “pygmy” nation. Another example, is the way the Lib Dems want the UK to become a region of a European state. Mass immigration is viewed by them as a way to achieve their aim by stealth. Perhaps an idea copied from a minority of fanatical muslims who exclaimed they can change the West by the wombs of their women.

      The idea to change the British culture started with Labour’s mass immigration policy ten years ago and is supported by the Lib Dems. The fanatical Lib Dems want to change British culture for personal reasons rather than what is best for the country and fails and/or ignores to consider whether this is what British people want.

      Why not promote the British culture and those who come here should adhere to our culture and values, not be allowed to change them. Why should first generation immigrants who enter politics have a disproportionate view to change our country?

      John, perhaps there should be more referendums because our political system has become so discredited and the corruption epitomised the stings that have highlighted the scandals by second jobs, lobbying and paying interest groups. It is clear, despite the false promises by political leaders, that Parliament is not changing and is becoming less representative of the views of the people of this country. The fact the Lib Dems can have such a disproportionate influence in government when it it has so few MPs is a striking point. They came a poor third at last general election and got fewer MPs. This indicates the British public do not want their policies or views to be upheld. Rather than accept and change their policies they tried to change the voting system to get better leverage to take control of the country and they got thrashed by the public.

    • Bazman
      Posted February 25, 2012 at 1:28 pm | Permalink

      What will be paid? Who will pay and what if the person cannot afford to pay? If you cannot answer these questions then you need to stop fantasising about a profit driven healthcare system or we will end up with the same problems as the American model. You are in cloud cuckoo land going back to the days when it cost half a months rent to visit a doctor turning patients into beggars.

      • lifelogic
        Posted February 25, 2012 at 4:38 pm | Permalink

        The existing NHS health care system is profit driven. The doctors profit, the nurses profit, the cleaners profit, PP partnerships profit and the administrators profit. Alas they so often fail to deliver what is actually needed by the patients due to the absurd way the system is run and the powerless nature of the patient in the system.

        After all they already have taken the “profit” in taxes – patients are thus just a liability and inconvenience to them.

        • Bazman
          Posted February 26, 2012 at 10:21 am | Permalink

          You believe that anyone who is paid for their work, for example a cleaner is somehow ‘profiting’ and ‘profiteering’ form their work. How naive do you think we are? You will never make this one stick.

          • lifelogic
            Posted February 26, 2012 at 8:47 pm | Permalink

            Of course people “profit” from pay for their labours!

          • Robert K
            Posted February 27, 2012 at 9:19 am | Permalink

            For goodness sake, Lifelogic is talking about the free exchange of labour for money. It’s what working people do!

      • Mike Stallard
        Posted February 25, 2012 at 5:36 pm | Permalink

        What will be paid? Money. By the patient.
        What if the person cannot afford to pay? They live with their complaint.

        SWAT analysis of patients paying:
        Strengths: It is good that people are in charge of their own health care. The doctors will see them as a source of income and not as people who come begging. They will also know what they can prescribe depending on who they have in front of them. Their attitude will change accordingly.
        Weaknesses: It is bad that under a free health system people suffer. I saw a lady walking round in the street in Australia once with a temperature of 104 because she had not got round to paying for her treatment. She had something infectious too.
        There is an opportunity here. We could charge say a fiver for every course of treatment or every visit to the doctor. People who wouldn’t pay would be left to suffer. Maybe it would bring a little respect for the patient too and end all those missed appointments and bring the fudgers to their senses.
        The threat is that none of this is ever going to happen. Everyone has fallen in love with the NHS. It is the third rail of British politics.

        • Bazman
          Posted February 26, 2012 at 10:24 am | Permalink

          This would lead to the situation we are in with dentistry.

    • uanime5
      Posted February 25, 2012 at 8:54 pm | Permalink

      Will the breakdown of costs also include how much a person has paid towards the NHS via taxes?

      • Pauline Kennedy
        Posted February 26, 2012 at 12:17 am | Permalink

        I agree.
        Also what about the elderly who have paid all their working lives and are not even looked after properly now, it is shameful.

  3. Mike Stallard
    Posted February 25, 2012 at 7:28 am | Permalink

    Honestly if that is all they can come up with as doctors, then I am disappointed. The answer to binge drinking is certainly not to curtail legislation. People were smoking all over Singapore last week although on the front of every single packet of ciggies sold there is an appalling picture of something awful medically. More and more paperwork is certainly not the answer to the spiralling costs of medical services.

    But you are right. It would have been a good thing if Mr Lansley (whose reforms have been watered down apparently) had had them on the consultation panel which,(again apparently), has gone so very badly wrong.

    This government, very much like the Blair years, seems to talk the talk very well indeed.

    • Caterpillar
      Posted February 25, 2012 at 9:42 am | Permalink

      On smoking:

      What I like about Singapore is that in some places there are (very cool looking) people standing in marked out yellow boxes smoking. These zones are not in doorways to buildings or the patios areas of bars/restaurants from which non-smokers are now effectively excluded in the UK.

      What I like in Japan is smoking areas in bars and companies that simply use the solution of effective extraction. In the UK it is possible to discuss clean coal and celebrate Dyson vacuums/hand driers/fans; but to install an extraction unit to remove smoke … just too hard.

      • uanime5
        Posted February 25, 2012 at 8:56 pm | Permalink

        Fans aren’t used in the UK because all the medical evidence shows they don’t prevent passive smoking.

        • APL
          Posted February 26, 2012 at 8:40 am | Permalink

          uanime5: “Fans aren’t used in the UK because all the medical evidence shows they don’t prevent passive smoking.”

          Ha ha ha! One seconds thought about the mechanics of air conditioning and your statement is refuted.

          For a particular environment, in a typical office block, the whole atmosphere is changed every x number of minutes.

          Once you have air conditioning, it is trivial to zone an area and change the air in a that area at a faster rate.

          If, instead of persecuting smokers, rather like a second world war dictator, we accommodated them – the technology exists – then we could turn a contentious issue into a non issue.

          The fact of the matter is, socialists, fascists and totalitarians of every stripe need a bogyman in order to scare an ill educated population to conform to their demands. ‘Passive smoking’ like ‘anthropogenic’ climate change is a scare and like anthropogenic climate change is utterly without factual foundation.

      • Bazman
        Posted February 26, 2012 at 4:42 pm | Permalink

        Smokers can ram it. Do you think they care about the stink and what non smokers have to put up with? It is right that smoking is made as inconvenient as possible for them. They do not need fans and special areas. They need persecuting every step of the way.

        • APL
          Posted February 26, 2012 at 4:54 pm | Permalink

          Bazman: “They need persecuting every step of the way.”

          A socialist shows his true colors.

          • Bazman
            Posted February 26, 2012 at 8:59 pm | Permalink

            Yes. This is true. I am a Socialist and proud of it.

          • APL
            Posted February 27, 2012 at 7:38 am | Permalink

            Bazman: “Yes. This is true. I am a Socialist and proud of it.”

            But are you proud of the results of your policies of persecution?

            Or are you fully paid up ‘comrade Stalin’, just waiting in the wings for your opportunity, to purge those you simply don’t agree with?

          • Bazman
            Posted February 27, 2012 at 8:37 pm | Permalink

            I think everyone should be proud of the results of persecuting smokers. Lower levels of smoking. Freedom to choose? Don’t make me laugh. Smokers have little choice with their addiction. How many understand the word addiction?

          • APL
            Posted February 28, 2012 at 10:59 pm | Permalink

            Bazman: “I think everyone should be proud of the results of persecuting smokers.”

            Smokers and drinkers together contribute a very significant fraction of the revenue (via additional taxes) to the coffers of the government.

            That feeds through to employing nurses, doctors.

            If your policy of persecuting smokers (and drinkers) is carried to its logical conclusion* – assuming you mean persecuting in a purely financial sense of penalizing a pastime of which you disapprove – then that would imply a significant reduction of nurses and doctors working on the governments books in the health service.

            Given that more people die on the roads each year that deaths attributable to smoking, doing so would inflict a very great strain on the NHS.

            * logical conclusion – forcing everyone to stop smoking because of the penal rates of tax, no smokers, no revenue for the government from the sale of tobacco.

            OR, like other prohibited contraband, ‘grass’ and other illicit drugs, drive the demand and supply of tobacco underground this too would have the effect of depriving the government of a big fraction of its revenue, whilst incurring additional costs in the policing of the prohibition.

          • Bazman
            Posted February 29, 2012 at 7:21 pm | Permalink

            I’m only for persecuting smoking. Drinking is not the same.

  4. Mike Stallard
    Posted February 25, 2012 at 7:29 am | Permalink

    Sorry – for “legislation” please read “advertising”!

  5. Antisthenes
    Posted February 25, 2012 at 7:50 am | Permalink

    If the NHS was provisioned mainly by the private sector and funded by a mixture of state funding and private medical insurance then efficiency would improve and costs would be more transparent. It would not be the ideal answer but a considerably better system that is currently in place. Being state run and state funded means that there is no incentives for the providers to act any other than in their own interests and every incentive for them to milk the system to their own advantage. There is no incentive for patients to not abuse the system or act responsibly in matters of their own health. We see the medical professionals fervently opposed to any reform which on consideration is obviously out of pure self interest and not in the best interests of the patients or taxpayers. Without reform the NHS is going to continue to decline in the quality and breath of service it gives. Funding problems are going to escalate and inefficiencies will continue for many years to come a lethal combination.

    As for binge drinking that is a symptom of a deeper malaise of a society that has dropped it’s standards and values. Addressing the symptom is going to do little to solve the problem, apart from which the solution proposed is illiberal, draconian and punishes the innocent along with the guilty, only changing society will do that. A return to personal responsibility is the only answer which would not only solve this problem it would solve many others that currently assail society.

    • Bernard JUBY
      Posted February 25, 2012 at 3:00 pm | Permalink

      There is nothing wrong with the Australian nor, for example, the French systems where the State pays a percentage (up to 100%), depending on one’s income, and the patient pays the remainder – the latter often covered by insurance.

      • Bob
        Posted February 25, 2012 at 6:20 pm | Permalink

        We should adopt the French model. That would achieve the desired result and dismiss the illusion that health care is free, as somebody has to pay for it. It would also address the issue of health tourism.

    • uanime5
      Posted February 25, 2012 at 9:04 pm | Permalink

      “Being state run and state funded means that there is no incentives for the providers to act any other than in their own interests and every incentive for them to milk the system to their own advantage.”

      Actually this mainly occurs in private healthcare. In the US cost inflation is rampant because insurance companies don’t scrutinise hospital bills, they just charge their customers more money.

      “We see the medical professionals fervently opposed to any reform which on consideration is obviously out of pure self interest and not in the best interests of the patients or taxpayers.”

      Same old Tory lies. The Healthcare bill only benefits private companies; not the NHS, patients, or the taxpayer.

      “Funding problems are going to escalate and inefficiencies will continue for many years to come a lethal combination.”

      Since when have there been funding problems? As a percentage of GDP the NHS costs less than most other healthcare systems yet delivers the same or better results.

      • APL
        Posted February 26, 2012 at 8:49 am | Permalink

        uanime5: “Actually this mainly occurs in private healthcare. In the US cost inflation is rampant because insurance companies don’t scrutinise hospital bills, they just charge their customers more money.”

        You are pretty good at identifying a thing, then pretty good at getting the reason for that phenomena utterly wrong.

        Cost inflation is rampant in the US. Agreed.
        But they charge their customers more money because the government does not permit them to scrutinize the bills.

      • Bazman
        Posted February 26, 2012 at 4:52 pm | Permalink

        After all the other privatisation fiascos none is going to swallow private healthcare and any government who tries to stop the one real benefit and leveler. Not a leveling down as many fantasists see it, of living in this country and one of the largest employers is going to face a whitewash at the polls. What if private healthcare did save millions and left millions without treatment or sub standard care. Then what? Healthcare and housing is an entitlement in this country not a privilege and turning millions in this country into beggars to for political dogma and helping rich chums get richer as in the utility companies, is not going to happen.

      • Conrad Jones (Cheam)
        Posted February 27, 2012 at 1:34 pm | Permalink

        “Same old Tory lies. The Healthcare bill only benefits private companies; not the NHS, patients, or the taxpayer.”

        Unfortunately, Labour’s wish to improve the NHS with a new IT System lost the tax payer £12 bn.

        “It comes as Chancellor George Osborne has been warned he faces a £12billion black hole in his deficit reduction plan – the same amount as that lost to the NHS scheme.”

        http://www.dailymail.co.uk/news/article-2040259/NHS-IT-project-failure-Labours-12bn-scheme-scrapped.html

        “£12bn NHS computer system is scrapped… and it’s all YOUR money that Labour poured down the drain”

        If a private company was contracted (BY LABOUR) to provide a System and they didn’t provide it – then where’s the £12 billion gone ?
        To a private company?

  6. PeterE
    Posted February 25, 2012 at 8:00 am | Permalink

    Unfortunately, given her strident and extreme anti-alcohol stance, I don’t regard Dr Wollaston as even qualifying as a Tory. This selection underlines the pitfalls of open primaries.

    • Brian A
      Posted February 25, 2012 at 9:47 am | Permalink

      Spot on. The desire to regulate and interfere should not be a Tory impulse. There is also a thin end of the wedge feeling to Dr Wollaston’s market rigging ideas – what next for ‘sin pricing’, bacon, butter, cheese etc?

    • Single Acts
      Posted February 25, 2012 at 9:58 am | Permalink

      I entirely agree. Such behaviour is not that of someone who supports freedom of choice and treats people like adults not sheep.

      Thanks for the advice doc, but I’ll make my own mind up.

  7. Paul Danon
    Posted February 25, 2012 at 8:37 am | Permalink

    But will the NHS costs be real, or will they be inflated by administration and burdened with PFI debt? One could also be given an estimate of what the treatment would have cost in the private sector (which could have been paid for with a tax-rebate). The Conservatives have an education task ahead of them: to persuade the public by 2015 that health and education would be better run privately. If we still want state-aid for those services, let us (not GPs or teachers) be given a budget.

    • Electro-Kevin
      Posted February 25, 2012 at 10:38 am | Permalink

      Paul Danon – I agree.

      Those who argue that those with means should pay at point of service must advocate a tax rebate too. Otherwise those proposals are unfair.

      Perhaps those individual statements could also include a breakdown of costs because of fraud, failed computer systems and the unrecovered costs for the treatment of uninsured visitors.

    • Marky_d
      Posted February 25, 2012 at 12:44 pm | Permalink

      The education task ahead of the Conservative lead government is impossible with a left wing state run biased media organisation like the BBC holding a near monopoly of non subscription TV and radio.

      • lifelogic
        Posted February 25, 2012 at 4:44 pm | Permalink

        Indeed nearly all staff at the BBC seem to be wrong on nearly every issue and certainly on the NHS, the every bigger state, the green religion, ever more regulation and the EU.

      • Mike Stallard
        Posted February 25, 2012 at 5:41 pm | Permalink

        It is time to nail this rubbish for what it is. Mr Gove’s education policy is nothing to do with privatising or freeing up the state education system. It is a crude take-over by the DfE from the County Authorities.
        If you look at the terms and conditions of Academy Progammes or at the Application forms for setting up a Free School you will soon spot that neither has anything much to do with freeing education.

    • Bob
      Posted February 25, 2012 at 4:30 pm | Permalink

      “The Conservatives have an education task ahead of them”

      I’m afraid that the Fabians have the upper hand since they seized control of the educational establishment and the public broadcaster.

      I think they may have infiltrated the Tory Party too!

  8. Brian Tomkinson
    Posted February 25, 2012 at 9:20 am | Permalink

    I must confess to being less than impressed with their contributions as reported above. With their intimate knowledge of the workings and shortcomings of the NHS, I should have expected far more incisive contributions. Then again there is little that comes from the House of Commons that is impressive these days. The calibre of politicians and political debate seems to have reached a low point. Instead of reducing your numbers by a token fifty I suggest they are cut by 75%. After all, since most MPs have been happy to allow Brussels to formulate the majoriy of our legislation, a proportionate reduction would seem appropriate.

  9. Alison
    Posted February 25, 2012 at 9:28 am | Permalink

    Given past disasters with computer systems I would think that the NHS would be completely unable to provide a statement of the costs of a cup of tea in a cafeteria let alone a detailed breakdown of everybody’s health care. If you factor in the impossibility of knowing the true costs of inefficiency, malpractice, late delivery of proper care the whole exercise would be a farce.

  10. Caterpillar
    Posted February 25, 2012 at 9:33 am | Permalink

    Conceptually I like the Dr Lee suggestion, but practically I would like to see a first step of a few hundred test patients costs actually be worked out – I’d like to see whether the NHS can actually do this and the costs worked out on different bases. I’d also like to see a full cost, activity based, variable and (for a similar patient) marginal cost.

    In terms of Dr Wollaston’s suggestion I am genuinely confused. Does advertising interact with some other variable(s), because it clearly doesn’t make the majority binge drink? What is(are) this(these) variables?

  11. Brian A
    Posted February 25, 2012 at 9:38 am | Permalink

    The BMA represents one of the key vested interests in the NHS, and despite their vigorous objections to the formation NHS they have been the main cheerleaders for this ‘envy of the world’ ever since. Their success in becoming amongst the highest paid medical staff in Europe may offer some explanation of their suppport for the creaking monolith that is our NHS. Expecting ideas for radical change of the NHS from the medical profession is like expecting the PCS union to endorse cost cutting and reform in the Civil Service.

    The debate on the NHS is often framed by the opponents of change as a choice between our system and that of the US. This argument ignores, of course, the fact that health systems in Europe have mixed economy models that routinely deliver better outcomes than the NHS. The government should be doing a much better job of explaining why NHS reform is necessary and, using the best European models as examples, show how we might improve our system of healthcare.

    • uanime5
      Posted February 25, 2012 at 9:09 pm | Permalink

      Healthcare systems in Europe also cost nearly double the cost of the NHS as a percentage of GDP. Funny how those who demand the NHS be sold to private companies always forget this.

      Also the Government can’t use European models as examples because then people would realise that the Government is proposing a US model.

      • Brian A
        Posted February 26, 2012 at 12:43 pm | Permalink

        Dodgy stats, or is it dodgy arithmetic, seem to be endemic in this debate. A quick Google search reveals that, as a percentage of GDP, health spending in the UK is 8.7%, Germany 10.5%, France 11.2%, Italy 9.1%, Spain 9%, Sweden 9.4%, Norway 8.5%. The US spends the most at 16%! (source: OECD Health Data for 2008). The OECD average is ca. 10%.

    • stred
      Posted February 25, 2012 at 10:27 pm | Permalink

      Spot on.

  12. backofanenvelope
    Posted February 25, 2012 at 9:40 am | Permalink

    I don’t know if binge drinking is really a problem; but if it is, I have a simple solution. Return licensing to the magistrates. Tell them that it is their duty, in league with the local police commander, to bring it under control. There are laws covering both the drinkers and the vendors. Ensure they are complied with.

  13. Leslie Singleton
    Posted February 25, 2012 at 9:56 am | Permalink

    Two individual doctors are not going to make much headway and in any event MP’s in general (present company excepted I’m sure) are held in contempt, partly because democracy in the House of Commons has to work within the cconstraints of the Party system. Is there anything to be said for letting go the dead wood in the House of Lords, in particular the Bishops, and replacing them with senior doctors, chartered accountants, lawyers and other professionals, ex officio as it were, from their various associations and institutes (ie no Government involvement in selection) so that we could have more people in charge who are clever and know what they are talking about. Trade Unions could be represented, which might bring the Left on board. Please no duplicative elections. I know the present system strives to achieve something this by appointment but it doesn’t work very well or if it does why is there so much criticism of the Lords? Let (real) Universities also send people as in the days of yore but now to the Lords and again not by election or Government say so. How could something like this not work? After a while the rather ridiculous House of Commons could revert to being the subsidiary Chamber.

  14. Damien
    Posted February 25, 2012 at 10:15 am | Permalink

    A few years ago I had to find out how many people lived in my immediate area and decided to ask a friend who happened to run the local practice. He told me he had 3,500 registered. I then checked with my local councillor who confirmed the my figure of 2,000 was correct. The GP said that there were a lot of EU migrant workers and others who would move on without informing the practice.

    The Audit Commission describes these patients as ‘ghost patients’. They estimate that there are 2.5m ‘ghost patients’. Each practice gets about £64 per patient. A recent exercise (National Duplicate Registration Exercise) discovered 95,000 ghost patients , many of whom were dead or deported years ago.

    I can understand the motive behind Dr Lee’s bill but I do not see how legislation alone can change the culture that would permit 2.5 million ‘ghost patients’ on their books and for those practices to profit from that ‘anomoly’.
    http://www.audit-commission.gov.uk/pressoffice/pressreleases/Pages/ndripr.aspx

  15. Magnolia
    Posted February 25, 2012 at 10:30 am | Permalink

    John I have a degree in Medicine and I am married to an NHS hospital consultant who works at one of the country’s cancer centres. We are lifelong Conservative voters and both voted for Mrs Thatcher in 1979 while at Medical School.
    Labour have done much to destroy my profession while hiding it’s consequences from view with extra spending. It starts at Medical School where about 70% of medics are now women. We know that much of the core science has been removed from the course and has been replaced with the spurious specialty of ‘Medical Education’ which is a fake entity and subject to political interpretation. It must put the clever boys off. The Research Assessment Exercise has destroyed Academic Medicine. We now have much shorter postgraduate training times since the introduction of run-through training which removed much of the weeding out of inferior people through competition that used to happen under the old system of applying for a higher grade job when you were ready for it. That, combined with the lack of experience from the loss of the consultant team led system of hospital patient care (which was replaced by a shift system for junior doctors in response to the EU working time directive) has resulted in new consultants who are still not adequately prepared for the responsibility that they must take on.
    All of this happened under labour’s watch together with paying some GPs the same as hospital consultants where as previously their salaries used to be about half that of the more specialised and highly trained hospital consultants.
    I know of several married couples who are both doctors like us who have clever children who are not choosing to go in to Medicine because we all recognise that it is now a dead end job.
    In the department where my spouse works there has never been any measure of productivity. Rules have been added with layer upon layer but there has never been any evaluation later of whether these time and financial cost adding rules are worthwhile or not. Many of the rules are laid down directly from government and professional bodies at the top due to fear of litigation or because of targets. Recently the department has not replaced staff as they have left or moved on, as you have suggested many times, but this has increased the workload on those left behind. For those who are already working at a very intensive rate the consequences have been horrible.
    You are right to recognise that non-medical people do not understand Medicine and I think this is Mr Landsley’s greatest failing. He has given everything to the GPs thus alienating everyone.
    There are Conservative voting doctors who feel strongly about the NHS and their profession and such doctors in the HOP should be worth their weight in gold to the government if they would only recognise it. I fear that the health reforms will put labour in to power because they will make things look worse to the general public.
    For yourself, if you are really interested in the problems of the NHS then I suggest that you go and speak to some old retired doctors.

    • A Different Simon
      Posted February 25, 2012 at 6:21 pm | Permalink

      Magnolia ,

      Sorry to hear that the medical profession has not escaped the general dumbing down .

      Even sorrier to hear that smart kids who might otherwise have chosen the medical profession have been put off . That definitely needs to be addressed .

      What are they choosing instead if you don’t mind me asking ?

    • Electro-Kevin
      Posted February 26, 2012 at 9:47 pm | Permalink

      Frightening.

  16. Alan Wheatley
    Posted February 25, 2012 at 10:33 am | Permalink

    As to Sarah Wollaston’s views on binge drinking, I support her concern and bow to her knowledge as to the impact on health, but think her remedy is aiming in the wrong place.

    Binge drinking seems to me folly, and should be discouraged. Targeting advertising is yet another wet solution: we must not criticise the people who err but put the blame elsewhere. Those who want to binge drink will do so irrespective of the advertising. You have only to look at cigarette advertising to see the lack of impact it has on those who really want to smoke.

    The way to make a difference is to target the binge drinkers. For a start it would help if the public rhetoric was hostile rather than jocularly supportive.

    Where drinking leads to being drunk and disorderly in public the law should be enforced and people arrested. A night in the cells and find you own way home would be a message that gets noticed.

    I also suggest “penalty points” for being drunk in public – rather like speed cameras. If in the opinion of a police officer you are drunk you get a penalty point. If you wish to contest the officer’s judgement you can go to court and plead your case at the risk of more points if you loose. This does not constitute a criminal offence.

    For repeat offenders if points exceed a threshold an automatic fine is imposed and this is a criminal offence.

    Points have a lifetime and drop off after a period. The idea is to send a message at minimal administrative cost. For those who get the message there is no long term consequence.

  17. Adam5x5
    Posted February 25, 2012 at 10:40 am | Permalink

    The government, and indeed all politicians, could do with taking advice from professionals of all disciplines such as engineers and scientists – not vested interest groups. That way we could avoid huge problems and massive bills, such as the ‘green’ global warming agenda which has produced a load of useless windmills to blight the landscape and add hundreds of pounds to energy bills, driving business and industry away. Brilliant that.

    Indeed, it seemed better when the politicians (and the better of the current politicians, such as yourself) actually had a history in business and/or industry before becoming a politician.
    That way they gain an understanding of how the real world works instead of just becoming a professional politico straight out of the starting blocks.

    In this day and age, it would be easy (and cheap) for politicians to seek advice – this forum would be a good tool for example. There are plenty of people who would gladly give professional advice for free on a forum such as this – which would cut government costs.

    • uanime5
      Posted February 25, 2012 at 9:14 pm | Permalink

      Most scientists agree that global warming is real, so the result would be the same if the Government talked to scientists.

  18. Yudansha
    Posted February 25, 2012 at 10:47 am | Permalink

    Binge drinking:

    Colourful and sweet flavoured alcopops don’t help. Nor do baby-ish fizzy lagers.

    Go to any beer festival and see if there’s much drunkeness or fighting.

    The last one I went to was attented by around 2000 people. One doorman – no policemen (on duty that is !)

    Absolutely no trouble, no peeing in the street and no vomitting.

    The UK problem with binge drinking has been caused by the infantalisation of the drink itself. If one needs an adult palate to take the drink one is more likely to have an adult temperament to deal with it.

    It has nothing to do with cheapness of alcohol for the simple reason that the worst outbreaks of disorder are outside over-priced night clubs charging £5 a pop with punters more than happy to pay it.

    • Yudansha
      Posted February 25, 2012 at 10:55 am | Permalink

      I’d add also that the adoption of curry as the new national dish is that it resembles baby food.

      Ironic that a good night out is now considered to be:

      A portion of baby food downed with fizzy pop followed by a tantrum, a bout of incontinence and puking.

      Want to get a grip on this ?

      Start actually prosecuting people for being drunk in public. Send them the bills for their hospital and police costs.

      Sending out statements to OAPs to make them feel guilty about the costs they incur on the NHS is totally wrong. And they are about the only ones in this country likely to feel obligated by such a thing.

      • uanime5
        Posted February 25, 2012 at 9:16 pm | Permalink

        Why not prosecute bars, pubs, and clubs for selling alcohol to people who are drunk? That would soon fix the problem.

        • Yudansha
          Posted February 25, 2012 at 10:41 pm | Permalink

          Uanime5 – The Drinking Barns are set up to capitalise on infantile nature of our people and and the manufacturers of booze have created a range of drinks to maximise consumption (profit.)

          If there were a cost to getting p****d (i.e it didn’t taste nice) then a fraction of the people would do it.

          If there were a cost to getting nicked or hospitalised (i.e a bill for costs incurred) then a fraction of the people would do it.

          Yes. The pushers should be subject to policing. However, I feel that treating drunks as casualties (after the event) is a big mistake. As is treating as casualties those who take drugs.

        • Mark
          Posted February 25, 2012 at 10:46 pm | Permalink

          That’s a question for the police and the CPS. The laws are on the statute book.

          • Yudansha
            Posted February 26, 2012 at 9:49 pm | Permalink

            Mark – Clearly they are applying a lot of discretion. Perhaps too much.

  19. alan jutson
    Posted February 25, 2012 at 10:48 am | Permalink

    You outline the confusion in government minds.

    The idea of having professions (proven winners) in all walks of life as Mp’s from Construction, manufacturing, retailing, doctors, nurses, armed services, transport, finance, banking, IT, Accountants, Union reps and the like is excellent, in fact so bloody obvious many of us out here wonder why it is not done rather more readily.

    The problem even when you have these people on board as you have just demonstrated, is that they all seem to be ignored by those who hold the real power, in preference to outside consultants/friends who charge huge fees.

    Agree we need to educate the population that the NHS is not a free service, but free at the point of use service which is a very, very different situation.

    Why go to the huge expense of sendng out 60 million letters a year when you can just simply say it takes x% of the total tax take to run it, or have a genuine amount on every payslip headed NHS tax deduction.

    If you are looking to get some income, then charge patients who self harm on alcohol for their transport, treatment and hospital stay when admitted drunk.

    The government has a diabolical record on large computer programme systems, I would have thought everyone should have learned this lesson by now.

    Your doctor is offering the wrong prescription, and has misdiagnosed the illness.

    • alan jutson
      Posted February 25, 2012 at 10:50 am | Permalink

      Note:

      I did not include Lawyers.

      We have more than enough of them as MP’s, all it seems intent on making the world a far more complicated place than need be.

      • A Different Simon
        Posted February 25, 2012 at 6:36 pm | Permalink

        Alan Jutson ,

        The HOC seems to be full of clones .

        I know someone who got a PPE from Oxford and he has been effective in the army and is a smart guy .

        Can’t for the life of me understand how David Cameron gained admission onto an Oxford PPE course or became director of Carlton Communications .

        You any ideas ?

        • alan jutson
          Posted February 27, 2012 at 9:16 am | Permalink

          Simon

          Ref: Ideas

          Good educational results, good Contacts, and a very good presentation of himself I would guess?

  20. Atlas
    Posted February 25, 2012 at 10:55 am | Permalink

    “Government take Medical Advice”

    An excellent idea. However one little snag – governments usually only want advice that chimes in with their goals. They normally select people who are going to produce the answers that fit the political policy. Hence I don’t thing the idea would run if the intention is to have real advice and not crony advice.

  21. Neil Craig
    Posted February 25, 2012 at 11:02 am | Permalink

    As a convinced free marketist I consider the advertising industry to be the major market failure. Fre markets work because the entrpreneur makes money by satisfying cuntomer demand. However the advertising industry exists purely create new demands forthings people didn’t knoew they “needed”. As such it is a legitimate area for government interference.On similar grounds aldohol taxes are a sensible way of raising money.

    The question of providing cost information depends very much on how much it would cost as a % of NHS spending, or as a % of spending on individual’s care which may not be the same thing.

  22. Brigham
    Posted February 25, 2012 at 11:18 am | Permalink

    The idea of patients being told the cost of their treatments is OK, if the amount of money each individual has paid into the NHS is on the other side of the balance. How this could be done, I don’t know, however it strikes me that to have just one side of the balance sheet is blatently unfair.

  23. Anne Palmer
    Posted February 25, 2012 at 12:00 pm | Permalink

    I am of an age when I remember we paid a “penny” a week for hospital fees at a time when ten pounds a week was a good wage. Many then thought the NHS would not last, it has. I have one son in Hospital at present and I am having to “stand in” for him in his Music Studio. I doubt he could pay for his treatment or keep his shop open if he had now to pay and it certainly would be a tad more than a “penny” a week. What are the elderly supposed to do especially if they live on their own?

    The Health and Social Care Bill is flawed should it go through as it is at present. The inclusion of fluoride in it, classes “fluoride” it as a medication, and as such may be seen as enforced medication. In the Convention for the protection of Human Rights etc, Article 5 states: ‘An intervention in the health field may only be carried out AFTER the person concerned has given FREE and informed consent to it. To the best of my knowledge the people have not been asked.

    I am aware that the UK has declined to sign the Convention, and claims not to be bound by the principle set out in Article 5 of the Biomedicine Convention, however the Government is still paying and applying a medication-now in the HEALTH Bill- against many people wishes and they know it, and they also know they could save money by not applying it, and use that money in other ways.

  24. forthurst
    Posted February 25, 2012 at 12:24 pm | Permalink

    Obviously medical practioners have expertise and life experiences unavailable to a PPE clone. It would be a mistake, however, to take such expertise, arising from junior members of a profession, to be equivalent in value to that of a senior consultant in a specific discipline and therefore all that would be necessary for policy formation; in the same way, an army officer may well have specidic expertise in unarmed combat, but is he the right man to advise when we need to organise yet another war against people who claim not to be our enemies on behalf of people who claim to be our friends? It would, nevertheless, be preferable for politicians to be recruited from a wide range of professional backgrounds demonstrating a breath of intellectual and vocational expertise. There are far too many in parliament with a narrow and foetid educational and vocational background believing their legitimate role is as social enginneers.

    The way to solve a problem is to analyse it. When a problem has been analysed properly, the solution usually becomes self-evident. For a politician this should mean talking to as many people with relevant expertise as possible, not attempting to use in-house expertise or by using the fallible skills of one tame ‘guru’.

    Dr Wollerston has a strong case when she claims that binge drinking is a serious problem; the problem however needs to be contextualised by talking to senior medical staff and examining the social backgrounds of those inflicting self-harm. Does the problem extend beyond the unfortunate cohort of addictive personalities? Has the situation become significantly worse? When did it get worse? Does it affect one social class? Is location relevent, e.g. where the English working class are beset by exposure to unfamiliar cultural practices. Where do children purchase their alcohol; surely not in supermarkets which have strict procedures? What about all the other shops with drink licences? Does the practice of buying ’rounds’ encourage overindulgence? Would it be better to enforce sitting down and waiter service in (larger) pubs with payment on leaving, otherwise how can pubs ensure that they are not serving drunks?

    With regard to Dr Lees idea of ‘billing’ people with their NHS costs, I believe my IT expertise trumps his; it would be surprising if the NHS employed cost accountants or systems which were capable of producing realistic figures and it would be surprising if the costs of collation and dissemination were not significant. In any case, no IT project should ever be undertaken without first doing a feasibility study to establish the full costs, timescales, benefits. and risk factors. A lot of people do not see their doctors very often; those who frequently use NHS services would probably rather not, having either a serious chronic or life threatening illness.

    • forthurst
      Posted February 25, 2012 at 12:39 pm | Permalink

      A more useful exercise would be to establish why private healthcare on the Continent is so much cheaper and why public healthcare is so much poorer than here.

      • forthurst
        Posted February 25, 2012 at 3:19 pm | Permalink

        (than)

      • uanime5
        Posted February 25, 2012 at 9:31 pm | Permalink

        As a percentage of GDP private healthcare is more expensive on the continent.

        • forthurst
          Posted February 25, 2012 at 10:21 pm | Permalink

          Je ne comprends pas.

  25. sm
    Posted February 25, 2012 at 12:40 pm | Permalink

    Governments/Executives take sensible advice – mostly like a prophylactic that is never used.Irrespective of the suggestions above, lets just say the advisors may well end up single and pregnant. Why not just consult the public using referenda?

    Perhaps we need more physcological profiling of our leaders? Around a discussion of representative democracy.

  26. Steven Whitfield
    Posted February 25, 2012 at 12:41 pm | Permalink

    Like most messages from David Cameron. his pre election plea was more about political chest beating than any serious indication of practical intention.

    Promises of robust Border control forces, referendum’s, standing up for EU interests etc. disapear like melting snow.

    Any policy that doesn’t pass the Coalitions acceptability test isn’t going to gain any traction however worthy -does the policy follow the doctrine of political correctness ?. Does it de-toxify the Conservative party ‘nasty party’ brand. ?.Will the policy kick sand in the face of traditional Conservative voters and Mp’s and make Labour voters more likely to vote Conservative ?.

    This isn’t the only doctor who is being ignored by the Coalition – New Labour would have cut the drugs budget first before tackling waste and frivolous spending. More evidence we have the same wretched government with a different face.

    Mr Redwood and other Mp’s must wonder sometimes why they bothered campaigning for a Conservative victory at the last election.

    http://www.dailymail.co.uk/news/article-2106300/Cancer-drugs-held-Government-save-money-says-GlaxoSmithKline-boss.html

  27. Julian
    Posted February 25, 2012 at 12:51 pm | Permalink

    It would help to itemise the costs because it illustrate how unnecessarily high many of the costs are – same old story in the public sector. The underlying problem is housing costs because this drives all the pay deals. If the average house cost 3 times average pay (say 25k ) then houses should on average £75,000.

    • David John Wilson
      Posted February 26, 2012 at 12:27 am | Permalink

      Median pay is £26k. Average pay is quite a lot higher, approaching £30k

      To get median pay you list all people receiving pay in order of their pay and the median pay is that earned by the middle one in the list.

      To get average pay you add everyones pay together and divide by th enumber of people.

      Thus house prices on your method of calculation should be around £90k

      • David John Wilson
        Posted February 26, 2012 at 11:24 am | Permalink

        If you extend this to household income, where let us assume two people earn salaries, then the house price corresponding to average income will be around £190k.

        In a London suburb this is about half the price of a small semi. Interestingly this ratio is almost exactly the same as when my wife and I bought our first house in the London suburbs in 1963. The difference is that in those days the only furniture that we had for the first year was a new bed (a wedding present) a cooker and and old settee suite. We used tea chests as tables and had to wait until we could afford more, even secondhand furniture. The floors were bare boards.
        I don’t know any young couples who would be prepared to start a new house in such circumstances today.

  28. Joe McCaffrey
    Posted February 25, 2012 at 12:54 pm | Permalink

    Dr Woolaston’s authoritarian proposals on alcohol are not a result of a greater than average understanding of health and medical care but a result of immersion in a public sector culture that the state knows best – they should be rejected by anyone who cares in the least about freedom and civil liberties. Despite being an unacceptable assault on individual freedom they would do nothing to solve the cause of the problem which is a third party payment system in medical care – I would expect any good doctor to understand that the patient gets better by tackling the disease and not its symptons.

    Dr Lee’s proposals however are very admirable and though they of course do not solve the inherent problems of socialised medical care they would be a step in the right direction – if nothing else because when people realise how drastically expensive and wasteful the system is they will be less sympathetic to the continuation of the status quo – however, I am entirely unsurprised that the government and the labour party oppose them as they would go some way to showing just what a mess the political elite has made of medical care in this country

  29. Stephen Britt
    Posted February 25, 2012 at 1:16 pm | Permalink

    Another Doctor stepped up to ‘the plate’ and was duly elected in 2010 – Dr. Dan Poulter MP.
    He is currently doing his bit scrutinising The Department of Health and their reforms as part of The Commons Health Select Committee.

  30. stred
    Posted February 25, 2012 at 1:21 pm | Permalink

    I see doctors are being paid for possibly 2.5 million missing or ghost patients, some of whom have been found by the Audit Commission. This goes back a long way. I wrote to the minister about this when in opposition.

    If the real cost of this was to be sent to each patient, 2.5 million letters would go astray and the and the cost would be enormous in auditing time.

  31. Tim Hedges
    Posted February 25, 2012 at 1:29 pm | Permalink

    I’m fed up with medical professionals wanting to restrict individual liberty in order to improve the alcohol consumption figures. The minimum pricing idea is just as bad.

    Here in Italy, good wine is €1 per litre (60p a bottle) and you never see anyone drunk, there are no disgraceful scenes of youngsters sprawled over the pavements of even market towns. Young people think being drunk is unattractive, and that they would be letting their families down if they were caught in such a condition.

    That’s our problem. As for the computer programme I agree with the first respondent. And do you think people who live off the state are going to worry if they have received £20,000 of help last month? They think it is their right.

  32. NevermindtheMolluscs
    Posted February 25, 2012 at 1:30 pm | Permalink

    A junior doctor I know was challenged recently by a ward manager complaining at great length about how unreasonable it was to discharge patients from the ward without a prescription for Calpol, the childrens’ painkiller. The doctor explained that Calpol is something every parent should have as a matter of course ; it costs about £1.50 from a chemist whilst a script costs around £25 to administer, excluding the cost of the item.
    I dont think that people are made sufficiently aware of the cost of treatment and take the “free NHS” for granted. Philip Lee is on to something but maybe he is trying to do too much at once. If there was a campaign to inform people about the cost of prescriptions I think this would a good start.
    Also if everyone had to pay £1 per item on prescription, it would stop stockpiling of some drugs and encourage purchase of alternative 35p ish supermarket basics such as aspirins and paracetamol.

    • uanime5
      Posted February 25, 2012 at 9:24 pm | Permalink

      At present people have to pay £7.40 for every item on their prescription, unless they have an exemption, so I don’t know why you think reducing this charge to £1 would make a difference.

      • NevermindtheMolluscs
        Posted February 26, 2012 at 9:27 am | Permalink

        Ah, you missed the vital word- EVERYONE including those who live on benefits (have no money for prescriptions but plenty for lager, all pensioners (many of whom are very wealthy and CAN afford to pay) etc. Pre payment cards should be available for those who need many drugs and face particular hardship. Placing a cost on something gives it value and prevents abuse. It also gives people ownership of a principal- saving money for the NHS.

    • Mark
      Posted February 25, 2012 at 10:43 pm | Permalink

      In England, most of us pay prescription charges. My GP has always told me to buy over the counter medicine where that is a suitable treatment, and on occasion I have also bought such medicine on the recommendation of a chemist, saving the GP’s time. But perhaps you are referring to those who are exempt from charges currently.

  33. wonderfulforhisage
    Posted February 25, 2012 at 1:35 pm | Permalink

    ‘It appears that Doctors have bigger followings for their medical advice than for their political advice’.

    Advice, Mr Redwood, advice. Not left wing legislative nannying

    Seems to me the ‘selectors’ would be better selecting conservatives (note the small c) not meddling statists.

  34. Paul Goodman
    Posted February 25, 2012 at 1:51 pm | Permalink

    It would be interesting to see in such an annual statement the amount that one has paid out in tax for the NHS as well as the cost of the treatment it has provided.

  35. David Langley
    Posted February 25, 2012 at 2:15 pm | Permalink

    There is certainly something sensible about knowing what ones treatment costs, if only to feel some satisfaction that the personal contribution to NI paid over many years and in other taxes has in some measure been of personal benefit. Perhaps the initial simple statement could be provided by GP,s who have a financial interest in providing effective and cost effective treatment. Prescriptions could have a costed column provided, and medicines and visits/treatments etc could be printed when a prescription is issued. Simply a receipt which one would expect when shopping anyway. Costings are probably available by the senior practitioner on the grounds that they do it already when buying drugs/services/personnelUtility bills etc., agreed their would be a need for initial data input but practitioners calculate their budgets and record costs anyway. One could imagine a scenario where local politicians would compare different practices detailed budgets to understand the real costs delivered by efficient/inefficient practices. The expansion of this idea would also go a long way to enable the Government to examine and explain policies/National budgets.

    Regarding politically motivated medical practitioners commanding primacy in political proposals, one has to be careful about their possibly biased or even damaged experiences in their own professional experience reflecting in their seemingly more learned views. In the same way that an armless war veteran MP could make a convincing exponent of an anti war stance. When supporting an armed intervention could be the correct solution. Many MPs have valid experience of a variety of professions and are influenced by that. We now have more politically trained MPs it seems who have no real job experience and they may have uncluttered minds or no minds at all.

  36. iain gill
    Posted February 25, 2012 at 2:25 pm | Permalink

    Doctors already have too much say, we need to hear from patients with lots of experience of healthcare preferably those who do not have vip status, those that the nhs let’s down constantly such as those that move address frequently

  37. frank salmon
    Posted February 25, 2012 at 2:51 pm | Permalink

    Well, if we can have this breakdown, we can also have another column saying what similar treatment would cost in the private sector. Further than that, where the private sector is cheaper, we can make the NHS do something about it. Where the private sector is more expensive we can offer patients to ‘go private’ by paying the extra…..
    Or will this government do the same as the last, and make it impossible to do like for like comparisons between the private and public sector?

    • uanime5
      Posted February 25, 2012 at 9:26 pm | Permalink

      How will the comparator work if you had complications? Most private clinics send their patients to the NHS if anything goes wrong.

  38. Bernard JUBY
    Posted February 25, 2012 at 2:56 pm | Permalink

    Not just medicine, John. Listening to experts who know what they are talking about – and then acting on that advice – seems long overdue in any Government of whatever colour.
    The NHS lost its way when they took decisions away from Matron and the Hospital Secretary!
    MRCS, LRCP, MRCGP

  39. Andrew
    Posted February 25, 2012 at 3:01 pm | Permalink

    During the introduction of the NHS by the 1945-50 Labour Government the medical profession did exert tangible political influence (although I am not sure how far this was exerted or represented within the House of Commons ). Aneurin Bevan ,the Labour Health Minister with a Left Wing (within the Labour Party and national politics ) reputation and outlook , nevertheless pragmatically gave GP’s self -employed status and protected the option of any private practice work beside an NHS contract for hospital consultants.

    With regard to Philip Lee’s Bill I would be interested to know what was proposed to be “co-purchased”,– this sounds like part-privatisation at the point of supply. ?

  40. English Pensioner
    Posted February 25, 2012 at 3:38 pm | Permalink

    I would like to see the costs incurred by the NHS for standard treatments or diagnostic tests published along with those in other developed countries as I suspect that, other than the United States, our costs are probably the highest in Europe, if not in the world.
    I would like to see some figures for the administrative costs per patient, administrative to medical staff ratios, nurse to patient ratios, etc, with comparison between the various trusts and with other countries.
    Having, unfortunately, experienced hospitals in various parts of the world, one thing I have noticed is the huge number of staff who seem to be wandering around our hospitals, seemingly doing nothing other than carrying a folder or some similar piece of paper.
    I’m sure that comparing our NHS costs with countries in Europe would provide far more interesting information than each individual knowing what his/her treatment had cost during the past year. Certainly from the little that I have been able to find out about costs within the EU, it would seem that our overall costs, per capita, are amongst the highest, but our outcomes are certainly not matching those of France or Germany.

    • uanime5
      Posted February 25, 2012 at 9:29 pm | Permalink

      As a percentage of GDP the NHS is far more cost effective than healthcare in the US and Europe. This is because private companies always charge more so they can make a profit.

      • Mark
        Posted February 25, 2012 at 10:36 pm | Permalink

        Because the NHS never makes a loss, it can spend whatever it thinks: I don’t see that makes its healthcare more cost effective. My experience has been that the “targets” culture that has prevailed in the NHS results in short term corner cutting with longer term expensive consequences.

        • APL
          Posted February 26, 2012 at 8:57 am | Permalink

          Mark: “Because the NHS never makes a loss, ”

          The NHS makes a huge loss, we just don’t know what it is?

  41. Chris Bowley
    Posted February 25, 2012 at 3:47 pm | Permalink

    The reporting of health care costs per person would be interesting to carry out as an experiment in a limited geographical area. Do GPs already receive this sort of information or are they only aware of direct costs incurred within their practice? Given all the stories about lengthy mis-diagnosis we might see just how often it is happening, what the costs are and whether it is worth fixing. The outputs from the experiment would show whether it is worth implementing more widely and what is required to integrate the various systems. However, under no circumstances should such a scheme be implemented using a big bang approach driven by the major IT consultancies. I’ve worked for a couple of them and seen how they spend much more effort extracting money than actually implementing anything and how bad they are at innovation.

    The disconnect experienced by most people between personal expenditure and major, public expenditure is something that also concerns me. I’d like to see costs interpreted in other ways than simple money to make them easier to understand. For example, a road has recently been built close to where I live. It cost £25 million and is 1.5 miles long. If, as a rough guide, we take the economic value of a lifetime at around £2 million then this could be presented as 1 person’s working lifetime per 211 yards.

  42. Alstair Barter
    Posted February 25, 2012 at 3:52 pm | Permalink

    What an excellent idea, but too sensible to get any backing in to-day’s House of Commons.

  43. Barbara Stevens
    Posted February 25, 2012 at 4:00 pm | Permalink

    Who ever these persons are they do not really know how people would afford private care, as personal debt is at the worst high level for years, I doubt there would be many who could afford it. I couldn’t. This is what they are really hinting at, but not coming right out and sayins just shows the level of ignorance they have. The NHS can be reformed from within and does not need a new bill, I’ve worked in it and trained in it so I have some knowledge of it. If the Conservatives think the public will be brainwashed into believing what they say then they are bigger fools than I thought. The NHS is not safe in Tory hands as they have shown by this bill which was not mentioned before the election, that is decieving people. You continue with this bill at your peril, your election results will show that. Health is important to people when they have no money, the safety net is there with the NHS, remove for the sake of the £ sign and you will make enemies across the country. Yes health is expensive, but stop foreign health tourist from using it at a cost to the taxpayers, make them pay before treatment don’t trust them to pay it after. Do as the rest of the world do get the money first. At some 55 million per year its a disgrace. Daily Mail Friday the 24, and English women living in the USA gave comments on both systems, she thought the NHS best out of the two for service, health care, and staff, now that’s proof it works. There’s nothing wrong with the NHS, but keep finding faults to impose privisation, and making people pay is wrong, it won’t work, and most of all people can not afford to pay for health care in this country. Why should they when all governments give away our money some £29 billion in foreign aid, this should be going to into our care not foreign governments pockets. MPs should get real.

  44. AJAX
    Posted February 25, 2012 at 4:08 pm | Permalink

    The Welfare system is an out of control wasteful Statist behemoth rampaging continually thru England’s finances which requires an extraordinarily talented government to reform it into what it should be, i.e. a well provisioned safety net to prevent deprivation

    Does the current government look like an extraordinarily talented administration to you?

    It seems most of the medical professionals working in the NHS (the docs inc. who, thanks to the New Labour disaster, are drawing H.M. Treasury busting pay packets now), don’t want any other reform to try to bring the behemoth under a semblance of fiscal discipline other than to continually cry for it to be fed ever more taxation regardless of any other consideration, this despite the fact that at the front end delivery, particularly the new generation of GPs – the 1st to inherit New Labour’s bumper funding bounty – are now sttracting an increasing reputation amongst their patients for being greedy, self-centred & providing a poor standard of treatment with 1 eye all the time on the clock.

    What needs to be done is for the public to have it rammed home to them just how extraordinarily wastefully expensive this system is, & that it’s their money via taxes that’s being used to fuel it, which the government to fund it compels from them in ever more taxation, impoverishing them by stealth

    Then a clear alternative grand vision has to be proposed as to how to do it differently & what the advantages are for England

    This “giving people an itemised list” sounds like an idea Shirley Williams was touting 20 odd years back, where she proposed something similar to get support from the public for Statist spending (presumably as an antidote to the Thatcher administration’s revolution, which had the Left rattled at the time?). Bitty, isolated idea, that went nowhere much as it wasn’t part of a grander vision.

    • AJAX
      Posted February 26, 2012 at 12:11 am | Permalink

      … memory may be playing tricks on me in the last para, it might have been Barbara Castle

  45. Matt
    Posted February 25, 2012 at 4:48 pm | Permalink

    Doctors’ skills should be recognised for what they are; diagnosis and treatment of disease.

    It doesn’t qualify them more than anyone else to direct how a national health service is run.

    It’s not as if there is any consensus view among medics as to how a health care is delivered. Most doctors in the United States think our system is inferior to theirs – medics in other countries seem to be in no hurry to copy our system.

    So I don’t think that doctors’ views should carry undue weight in deciding how deliver care on a macro scale.

    Every area of industry looks to improve the cost and the quality of its products. Car producers every year build a unit vehicle with less man hours, while improving the vehicle quality.
    Every item on every very long bill of material is analysed for cost reduction.

    The same is true for aircraft production, house building any industry that you name.

    Why should this not be true of the NHS? It has to do more with fewer resources. They can’t be allowed to stand still.

    May doctors come onto TV to say that they don’t wish to see a profit motive in the NHS, this seems barmy to me.

    The drugs that the doctors’ use have been developed by large multinationals’ spending billions of dollars on R&D, likewise the equipment, scanners and test procedures – doctors don’t seem to object to the profit motive here – indeed the public often credit the doctor with the improvement in medical outcomes when the real credit is with the profit orientated multinationals.

    Introduce quality private enterprise into every area of healthcare – it’s good enough for aviation and aerospace – it was good enough to put man on the Moon.

    After this start to introduce charges for minor treatments – one thing to start – just pay GP’s for consultations – like a lawyer or dentist – no one comes – they don’t get paid.

  46. Colin Adkins
    Posted February 25, 2012 at 5:11 pm | Permalink

    In principal the concept of an annual statement detailing the cost, of NHS treatment provided, is an excellent idea but I share the reservations of others regarding the ability of government to enable an effective system. Perhaps a relatively small pilot might be a good idea. There are many reasons for the inability of the general publics extreme reluctance to consider any change but complete ignorance of the cost of the service they are recieving has to be a significant factor.
    In relation to the goverments current difficulties in respect of the changes they are proposing to the NHS, much of the opposition is self inflicted. In my view the government has utterly failed to make a coherent case that the general public can follow and understand. Cameron himself has performed abysmally and his shouting matches in question time are a disgrace. It was well known that any change to the “sacred” NHS would be political dynamite. Why not produce a single A4 sheet explaining the reasons for the proposed changes and send to every household.
    It might also be a good idea to produce a similar sheet in respect of the reduction of the deficit and eventually the national debt. Failure to communicate effectively almost always leads to the failure of any project. Perhaps the conservatives should employ somone with communication skills. Oops they already do, well they should sack them!

  47. Bazman
    Posted February 25, 2012 at 6:39 pm | Permalink

    Probably need more doctors in the house given the level of commitment to their arguments of some MP’s. The accusation made by some that the Eric Joyce was dragged off after getting “a few good ones in” is completely false and inaccurate say many witnesses refusing to give their political affiliations.

  48. Ferdinand
    Posted February 25, 2012 at 7:17 pm | Permalink

    Unfortunately doctors never know if they are any good because customers have great difficulty in moving to other surgeries. In any market where demand exceeds supply standards fall. The pressure on doctors through sheer numbers makes any active attempts to improve unnecessary.

  49. Gordon McCann
    Posted February 25, 2012 at 8:41 pm | Permalink

    There is to my mind no doubt, that if patients were made aware of the cost of their treatment it would make them appreciate the cost of providing it.
    Missed appointments for no good reason should also be listed.
    It would also have the side effect of highlighting the difference between the cost of treatment and the cost of administration.

  50. Brett
    Posted February 25, 2012 at 8:46 pm | Permalink

    Took a very ill neighbour in for a hospital appointment for 09-00 , still waiting two hours later. When I remonstrated with the attending clerk, or nurse I was told all the morning appointments are made for 09- 00 so it’s more efficient on the doctors time – patients not showing up.

    I hope the genius who devised the system has the same problem, in the real world when they, catch a flight, book a train, service their car. Oh it will be a different set of parameters then.

    Can’t hear many doctors complaining about this sort of thing – If the market can do it better and cheaper then let the market loose.

  51. uanime5
    Posted February 25, 2012 at 8:51 pm | Permalink

    Dr Lee’s idea to send people an annual statement of how much they’ve cost the NHS is a horrible one. Does Dr Lee feel that people are less likely to develop cancer or have organ failure because they’ve been told about how much their treatment has cost the NHS? Will women who have stillborn babies be told how much they cost the NHS? I dread to think how these bills will affect people suffering from depression.

    Dr Lee’s idea is little more than trying to make people feel guilty for using the NHS. The first time an error is made and someone gets told how much it cost to look after their dead child expect a media circus.

    • Mark
      Posted February 25, 2012 at 10:30 pm | Permalink

      I expect the circus would be about inadequate treatments and poor standards of care in some hospitals that cost large sums of money. However, some public debate about how much is spent on some of the most expensive to treat diseases might be valuable – as might be some public assessment of such modern trends as gastric band surgery. There is a great danger that money goes to medically glamourous fields at the expense of improving more lives.

    • Electro-Kevin
      Posted February 25, 2012 at 10:55 pm | Permalink

      Those with the decency to feel responsibility on reading the statements probably do so anyway.

      Those who are wasteful and careless by nature will probably feel unmoved.

      A pointless exercise … unless you’re trying to get the genuinely sick and consciencious to give up their healthcare entitlement – however much it is.

      There are far more obvious examples of fraud and waste which could be dealt with but which politicians don’t have the balls to tackle.

  52. Woodsy42
    Posted February 25, 2012 at 9:54 pm | Permalink

    I would not ask my MP to diagnose my health, even if they were the health minister. Why should a doctor, trained to treat people, neccessarily be better than anyone else at medical planning and management strategy?

  53. Mark
    Posted February 25, 2012 at 9:58 pm | Permalink

    AA Milne’s the Dormouse and the Doctor seems strangely appropriate in our modern times of politicised medicine:

    http://www.glirarium.org/bilch/literatur/doctor.html

    It’s clear the yellow chrysanthemums have done nothing to help with a cure, but neither have the delphiniums (blue) or geraniums (red).

  54. Mark
    Posted February 25, 2012 at 10:20 pm | Permalink

    For those looking for data on NHS England, try here:

    http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937

    There are some interesting trends in the incidence of illnesses and lengths of hospital stays and recorded waiting times. It is quite hard work to organise the data even to make those comparisons. Nothing on costs, though.

    Some financial numbers here:

    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_130154.pdf

    Broken down for the convenience of Whitehall, not of those wishing to understand where the money really goes.

  55. bluedog
    Posted February 26, 2012 at 2:06 am | Permalink

    surely the cure for binge drinking is reduced access to alcohol, but not prohibition. Simply return to the pre-Blair liscencing regime and its problem solved.

    Unless of course the Coalition is funded by the liquor industry,

    • APL
      Posted February 27, 2012 at 7:58 pm | Permalink

      bluedog: “surely the cure for binge drinking is reduced access to alcohol, ”

      Or, the withdrawal of free emergency medical care when you turn up at the Accident & emergency steaming drunk.

      My fairly recent experience of A&E explained to me why there were so few police on the streets, many of them are in the A&E ward protecting the medical staff from the drunkards.

      If you turn up in A&E drunk requiring treatment, then you get charged for the treatment.

  56. Dan course
    Posted February 26, 2012 at 10:54 am | Permalink

    It’s a brilliant idea! It should however be specced out for tender by someone like me who is a technical director and who’s company makes web and phone apps. Then put it out as a small tender project to trial it with the TSB (technology strategy board). No more than £20,000 for a prototype.

    After that, see what works and doesn’t and improve again. None of this silly NHS and post-office systems for a few million and then fail to deliver.

    Dan Course

  57. Jane
    Posted February 26, 2012 at 1:30 pm | Permalink

    I agree that the public should know the cost of their healthcare. In France, every item that is used in your care is costed – even swabs and you are provided with this costing. I can assure you that this brings frugality into play. I have elderly neighbours who have stockpiled medications. It appears that if prescriptions are changed following on from NICE amended guidelines, surgeries are not always efficient at ensuring that medication on repeat prescriptions are not reviewed. I know that some of this stock piled medication costs a lot of money. Certain inhalers for COPD cost over £30. My neighbours must have thousands of pounds of medication stored. I have made suggestions on this issue but without success. If this was rife throughout the country the cost implication is frightening.

    I have read some of the contributions above which has enlightened me as to why politicians are frightened of the public knowing how much services cost. We have all been left alarmed by how much maintenance contracts under PFI cost – the £100 light bulb etc. If we actually were able to compare NHS Costs to the Cost of similar services in Europe we would probably be angry. An example comes to mind for diagnostic services. In this country you visit a GP. You then have to obtain an appointment for a simple test which may entail a visit to a hugely expensive hospital. You then have to visit your GP a week later (does not matter that technology has speeded up the process) to obtain results. If you should dare want a copy of these results you must put this in writing as they really believe that all information belongs to the NHS. Think of the cost of this service and compare it to what happens in other parts of Europe. In most countries after seeing your GP, you are given the request form for tests, attend a small clinic without an appointment (not an expensive hospital), are given the results in a short time and if further tests are required the letter to your GP is typed immediately and you then return to your GP with a letter and results – often in the same day. In my area, referrals between consultants at the same hospital are given a two week turn around!!! Add this to the drawn out process of simple tests. Think of how much cheaper the European systems must be and how much more focussed it is on the patient’s needs. Add to this that our doctors and administrators are paid twice as much as their European counterparts and the costs again soar. Politicians are frightened of us knowing how much waste there is and how much influence medical staff have in holding us all to ransom.

    As to alcohol intake and the cost to the health service etc, these are old arguments that have been around for years. I am also aware of the criticism of the Health and Social care Bill made by Ms Wollaston and have largely ignored her contributions. You must forgive me if I tend to feel that the medical profession always protects its own interests. As to binge drinking this is a cultural issue as it is tolerated by society and until such time that it is classed as shameful by all (such as domestic violence which was once acceptable), it will continue. It is a social problem not necessarily a medical one.

  58. Keith Peat
    Posted February 26, 2012 at 4:33 pm | Permalink

    The NHS can never work or be sustainable. When it was conceived under Aneurin Bevan, ambulance men were just glorified van drivers with stretchers and nurses were really uniformed skivvies; neither were highly qualified pseudo surgeons as they are now. The range of procedures available were just a fraction of those costly procedures available now. That these are available to all of us is not only impossibly costly, but increases longevity and thus extends the demand, the cost and the problems. Thus the NHS is insatiable and unsustainable. It is also a massive contributor to over-population and shortage. In many respects it is the antithesis of natural selection, the survival of the fittest and natural culling. Maybe very good for the individual but not so for society. The pennies just do not add up. At some point the NHS must return to being very basic for those who cannot pay for the full service. There are simply not enough of us producing in this country to support such a demanding monolith.

  59. Martin
    Posted February 26, 2012 at 4:39 pm | Permalink

    It is not just doctors. Parliament misses outside expertise in many areas, Science, Engineering, Economists, Business & the Arts come to mind. There are too many professional politicains and not enough prople with real experience of the real world.

    Perhaps the deficiency could be remedied in a reforemed house of Lords but we couls all benefit if our representatives had moer experience of the world in which we all live

  60. Cathleen Mainds
    Posted February 26, 2012 at 7:01 pm | Permalink

    Very many thanks for this posting, Mr Redwood. I’ve forwarded it to GPs in my family who have been, at least initially, supportive of the general thrust of the Government’s reforms to the NHS. The sheer folly and ineptitude of the Government failing to consult and listen even to medics who are MPs on their own benches should be astounding – but alas, seems all too typical of the Cameron inner-circle/clique, who seem either too arrogant or too afraid or too contemptuous of their own MPs to listen to them or consult them – despite those MPs surely being one of their best resources for friendly, Conservative-attuned advice.

  61. REPay
    Posted February 27, 2012 at 3:47 am | Permalink

    30% of all the money that Labour put into the NHS went into the unfunded pensions…I know many doctors and consultant who knopw the value of their pensions and the fact they have made a low contribution. I hope Tory MPs will be supporting any reforms on the cost of their retirements.

  62. alastair harris
    Posted February 27, 2012 at 1:15 pm | Permalink

    Dr Lee is most probably correct in his thesis, but even if it was possible to devise a reliable method of costing healthcare provision to an individual within a specified period, you would have to question the usefulness of such a statement. Knowing what it costs to provide is hardly going to alter much of the demand. And in any case it somewhat misses the point of the provision of free healthcare. A better case might be made for much of the more non-essential surgery that is provided for free, although I can’t imagine any politician would be interested in opening that can of worms.
    No time at all for the alcohol restrictions idea. Is it right for governments to spend our money hectoring us on what we do with what is left, so long as it is not illegal?

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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