New economic policy A better NHS

An important feature of the Brexit campaign was to take back control of our money. Many want to see cash from our cancelled EU contributions spent on NHS matters. I set out a Brexit budget for the referendum as an illustration of what can be achieved.

That budget included money to train, recruit and retain 4000 extra doctors and 60,000 extra nurses. It included cancelling student loans for nurses, and returning to grants. It offered extra money for a wider range of new drugs on the NHS.

The NHS can also be improved by reducing the rate of gr0wth of demand. This can be brought about by moving to a system of controlled migration, cutting the extra numbers needing NHS cover. It can be assisted by a better designed way of invoicing anyone coming to the UK from a foreign country for non urgent health treatment, who currently often receive it free.

The NHS needs to be encouraged to be better at determining who needs hospital treatment. At present too many people go straight to hospital instead of going  through the process of GP evaluation. In hospital many elderly people are detained when there is little or nothing  that the doctors and  nurses can do. Sometimes they have to stay in because there is insufficient social care arranged to allow them back home or into the community. There needs to  be more care outside hospital and better access to it.


  1. Jerry
    July 30, 2016

    “Many want to see cash from our cancelled EU contributions spent on NHS matters.”

    Indeed, including those who travelled on or stood beside a certain Brexit campaign bus that was emblazoned with such a message – regardless of actual amount.

    But do we actually need to spend as much of our post Brexit windfall as we might think when all it needs is to get rid of the so called NHS internal market, or more precisely those who have built careers and whole pyramids to over see – but would any Tory government be brave enough to unpick 30 or so years of government level mismanagement in the NHS?

    “It included cancelling student loans for nurses, and returning to grants.”

    Good, but perhaps the principle could also be extended beyond the NHS to include practical trades were we have a skills shortage and thus employers have had to encourage recruitment of migrant labour. Actually the whole education system needs a rethink post compulsory FE and Universities, along with (and especially) trade apprenticeships.

    1. JoeSoap
      July 30, 2016

      Indeed perhaps we can now fulfill that promise on student loans … At least for bright kids in stem subjects

  2. Iain gill
    July 30, 2016

    I don’t agree with gp evaluation as you call it, especially when there is no choice of gp. The quality of the bottom quartile of gp’s is very poor and even the best have had less than an hour lecture on many important conditions. One of the worst parts of the NHS is gp as gatekeeper to care. Decision making should be handed to patients.

    1. Lifelogic
      July 30, 2016

      Certainly the GPs as gate keepers can significantly delay proper diagnosis and lead to death or permanent damage in very many cases.

      1. stred
        July 30, 2016

        It is called ‘bounce back’. One of our friends was bounced back and delayed by her GP last year. She died in her mid- 50s from a treatable cancer. Our national treasure.. hmmm.

        1. Henry Kaye
          July 30, 2016

          My story is not quite so dramatic but makes the same point. A routine blood test revealed an abnormal Thyroid level. My GP said that no further treatment was necessary. I insisted on seeing an endocrinologist which took two months but resulted with my being put on the necessary medication. When challenging my GP on his decision his reply was: “If I referred all of my patients with a thyroid problem to an endocrinologist the consultant would not be able to cope”.

          1. Jerry
            July 31, 2016

            @Henry Kaye; Without specific data no one can make an educated comment on such stories, not even the patient them,selves unless they are medically trained to the level of the specialist! Also for every “GPs and the NHS are useless” comments on this site elsewhere there are the ‘GPs and the NHS saved my life, I would have been dead within six months, and I only went to the doctor because my finger hurt’ sort of comments.

      2. JoeSoap
        July 30, 2016

        Indeed it must be possible to devise an expert system which covers most gp visits. Turn up at a proper clinician with your diagnosis pay a small entrance fee and take it from there

        1. Jerry
          July 30, 2016

          @JoeSoap; “Turn up at a proper clinician with your diagnosis pay a small entrance fee and take it from there”

          People have already paid, by way of their taxes and NI contributions, or are you suggesting that those contributions are not enough to fund such a service, if so that is a political problem, not a medical or management issue?…

          1. Bob
            August 1, 2016


            “People have already paid, by way of their taxes”

            A small charge at the point of service might cut out some of the GP botherers that have too much time on their hands.

            Not everybody pays tax.

          2. Jerry
            August 2, 2016

            @Bob; A small charge at the point of service might cut out some of the GP botherers”

            Yes and it might also stop or even prevent some people visiting the GP when they are carrying an infectious (perhaps public health notifiable) illness, or have early signs of a treatable but otherwise terminal illness. For some, even a modest charge might mean going to the doctor or missing a meal, and no I do not mean those on top-up or income related benefits and such like.

            “Not everybody pays tax”

            Very few do not pay any tax, even children pay VAT.

          3. Bob
            August 3, 2016


            “even a modest charge might mean going to the doctor or missing a meal”

            We hear this all the time from the lefties, but I don’t think anyone would really put off a trip to the GP if they were really ill (for a fraction of the cost of a packet of cigarettes). In any case, exceptions could always be made for the rare cases of genuine hardship.

            “Very few do not pay any tax, “

            If someone is living off of state benefits, they are not contributing anything to the tax pot, but rather they are removing money from it, even if they return a little by way of vat.

      3. Lifelogic
        July 30, 2016

        Of course if you charge patients the market rate you do not need “gate keepers” at all. Fee paying customers would all be rather welcome to the health provider at they are funding them.

        Gate keepers are just part of the inefficient NHS rationing systems, this due to the dreadful way the NHS is funded. We have your money already so get the patients to go away if at all possible is the general NHS approach. This is sensible from their position, given the way they are funded and structured.

        1. Jerry
          July 30, 2016

          @LL; You seem to want to turn the clock back to a pre 1939 health care system, something all political parties were committed to prevent in 1945. Oh and who would decide and set what the “market rate” should be?

        2. Iain gill
          July 30, 2016

          The average educated diabetic knows more about their condition than a gp. Most educated patients would be better going directly to the relevant consultant specialist. The NHS is crap and politicians like John should really stop endorsing this crap.

    2. JJE
      July 30, 2016

      As I posted earlier this week, my daughter tried to get an urgent GP appointment on Tuesday this week. The earliest available appointment was August 17th.
      She was told that emergency appointments are only booked at 9.00 and 1.00. She was calling at 1.30. She waited four hours at an NHS walk in centre.
      On Friday she tried again for an emergency GP appointment, calling at 9.00. She was told none were available.
      Kafka comes to mind.

      I don’t really know what GPs are for except cost control

      1. Lifelogic
        July 30, 2016

        This is all perfectly normal with Cameron’s priority in three letters , free at the point of need the N H S. It was bad when he took office and has deteriorated hugely under his time in office.

        Free at the point or rationing, death, negligence and general non delivery.

        1. Iain Gill
          July 31, 2016

          Its a nonsense for severe ear ache to be handled the way the NHS does it. The rest of the developed world allows patients to self refer to ENT consultant, and serious
          problems get nipped in the bud. It doesnt even cost any more than a GP appointment if setup correctly. Anyone who has lived abroad will know women go to see their favourite gynecologist like they go to see the hairdresser for regular checkups, and much more
          successful than our poor GP led equivalent that approach is at preventing issues early. Please dont just keep reinforcing the rubbish NHS practises.

  3. Richard Preston
    July 30, 2016

    Well done. Another complex issue reduced to platitudes, wishful thinking, and which Brexit will do precisely nothing to resolve.

    Reply So what is your proposal?

    1. forthurst
      July 30, 2016

      We have just got lost a ruling clique that was so misguided and depraved that they applauded Bliar in the HoC on his departure and the CMD years would have fooled most into believing he was still de facto PM, just like Mandelson, the eminence grise of the Bliar years, was advising Osborne. Good riddance.

      Leaving the EU opens up opportunities for beneficial selfgovernance including controlling the flood of aliens into our country which had not existed with the likes of the EU loving CMD, Juncker and Merkel forging our destinies.

      1. sjb
        July 30, 2016

        The key word in your sentence and indeed the promoters of Brexit is ‘controlling’ [immigration]. But it does not necessarily follow that we will see a significant reduction in aliens, which I suspect is what many Leavers expect and is perhaps why – after the referendum – Hannan and Johnson appeared to make this point.

        The proposed points-based system may work against our interests. For example, say UK companies cannot find UK workers with the specific skills they urgently need. As things stand, they may well find them in other member states and the workers start in days. But if a lot of official paperwork has to be completed + state approval is required then it might take weeks before workers could start.

    2. Lifelogic
      July 30, 2016

      Brexit give the UK freedom to act in its own interests and not to have to treat all comers from the EU. We will (given a sensible government regime) become far wealthier as a result to. It is a huge advantage in putting a democratic UK into a position to sort out the NHS and much else that is totally wrong with the UK.

      In a short article you have to reduce complex issues. It is rather like the silly expression endlessly wheeled out usually by lefties “You cannot generalise” of course you can generalise (and indeed you have to generalise or could never say anything much on any subject) without speaking for months on end.

    3. acorn
      July 30, 2016

      NHS England costs about £98 billion a year to operate. You could give the infamous £10 billion to it, that would raise the 8.5% of UK GDP we spend on health care, circa £2,000 each; nearer to the 10 – 11% our near EU neighbours pay.

  4. Lifelogic
    July 30, 2016

    The money needs to follow that patient far more. The best way to do this is to start charging the patients (who can afford to pay) and treating them like patients (rather than a nuisance to be deterred as much as possible). Even getting an appointment at a GP’s or registering can be difficulty and then you are lucky to get more than a minute or two with them.

    Currently the UK health system is fairly appalling. People are told their condition is not sufficiently serious to need an operation when in reality it clearly does (often when the patient could happily pay for it were they actually told the truth). Lots of elderly people who need cataract, knee or hip operations or scans and test are not being given them and are left to struggle on. Perhaps injuring themselves further as a result. Loads of conditions are misdiagnosed, scans that are needed are not done or they are endlessly delayed.

    Another sensible approach would be to give some tax relief to people who take private insurance to lighten the loan on the NHS.

    An instruction should go out to all NHS staff that patients should be told the truth if they would benefit an operation or test they should be told the medical truth. You need this or that operation/test/scan but the NHS will probably never get round to doing it, so you had better go privately if you can.

    I know of at least three cases where just telling the truth to patients in this way would have saved a lot of harm at no cost to the NHS at all. The three people could easily have paid anyway rather than suffer one developing further serious complications as a result of the misinformation & delay.

    There is a huge problem of bed blocking and pushing from pillar to post. Trying to push the patient liability back to a different department, area or budget.

    1. Lifelogic
      July 30, 2016

      Addenbrooke’s hospital in Cambridge says on its web site:

      Our message to the public is not to come to A&E unless it is an emergency or their condition is life-threatening.

      If you come to A&E and it is not an emergency then you will wait a long time. We have to prioritise treating the sickest patients first, those with life-threatening injuries or need emergency attention.

      But people do not know what is an emergency (nor often do the doctors). Abdominal pain for example can be trivial or prove fatal within hours if not treated promptly. Appendicitis for example used to be the second commonest cause to premature death in men. Meningitis and many other serious conditions can be difficult to diagnose. Anyway if they cannot get a GP appointment what is there alternative?

      1. Tad Davison
        July 30, 2016


        I had a scan on my chest back in February. I hadn’t heard a thing from Addenbrookes up to a couple of weeks ago and the situation is getting a bit desperate, so I visited my GP to try to find out what is holding things up. He told me the cardiology department had ‘imploded’ and not even GPs were receiving any information about patient’s results.

        Yet each Friday and Saturday night especially, the local A and E department is full of people who are suffering from self-induced ‘problems’ through the excessive consumption of drink or drugs. It seems they get priority over everyone else, and receive expensive treatment that wouldn’t have been necessary had they not chosen to binge themselves stupid. That cannot be right.

        This is perhaps where other ministries need to play their part. The NHS can try to treat the consequences of deteriorating social responsibility, but not tackle it at source. In Britain, we should not need to import people from abroad with a good work ethic and decent moral values. Instead, we need to produce responsible people to meet this nation’s future needs, not the dross I watched on YouTube a few nights ago etc ed


        1. Lifelogic
          July 30, 2016

          Indeed get copies of the x rays off them (if you can) and get someone to look at them privately. That is what I would do. I find many private specialist are actually very reasonable in price anyway for a consultation.

          Often rather better value than plumbers and the likes (and their systems for scans, test and the likes are prompt and usually work well and quickly). A few days rather than six months for the NHS to deliver (if they ever do deliver).

    2. Lifelogic
      July 30, 2016

      The way the NHS is organised is appallingly inefficient. It is more of a queueing, delaying and rationing system, rather than an efficient system for diagnosis and treatment.

      The system is designed not to serve patients but to meet or often not meet artificial & arbitrary government “targets”.

      GP’s too are absurdly organised, the best patient for them is one who never comes and they get paid for anyway. Putting patients off it there best approach financially.

      One GP I know had a policy of allowing you to only discuss one condition per (far too short) appointment. So you perhaps had to make three or four separate appointments (hardly efficient for either for patient or doctor). Anyway the conditions might well be linked.

      Many others use the “no appointments today is it urgent, ring back tomorrow between 9.00 and 9.30” (to listen to an engaged tone) approach.

      Fortunately myself and my family did not need the NHS very much, but whenever we did I was amazed by how very poorly it was organised and how inefficient it was. This despite the fact that so many of the staff are hugely dedicated and hard working.
      It is the system that stinks.

      Endless operations and procedures cancelled at the very last minute too, when people have many all sort of personal care and other arrangements for them.

      The NHS is of course not helped by trying offering free treatment for lots of people who have never paid anything into the system at all from all over the World.

  5. Mark B
    July 30, 2016

    Good morning.

    Throwing money at the NHS is great for PR but does little to solve the problems of this most sacred cow of Socialism. It needs root and branch reform.

    I have witnessed some of this reform whilst the NHS was under Labour. Under them they opened up the NHS, by stealth, to private enterprise. This was in the form of ambulance services which, whilst still free at the point of service, was privately run.

    For those who disagree with competition for services, let me remind my fellow contributors that GP’s practices are private concerns, and no one seems to object to that arrangement.

    But again, I did not vote to leave the EU to take money from one large bureaucratic leviathan in order to give to another, no matter how well meaning. To me, leaving the EU was a about political and administrative reform.

  6. Anonymous
    July 30, 2016

    With aged ‘bed blockers’ … where are the families ???

    The State can’t be expected to do everything, can it ?

    1. alan jutson
      July 30, 2016


      “Where are the families”

      Whilst I would agree some can perhaps do more, I would suggest a good many of them are working to earn enough to pay their own bills as well as perhaps raising children.

      We already have millions of carers looking after family members in the UK who are in desperate respite care need themselves, because their partners really need 24 hour care.
      When these carers also breakdown, usually physically exhausted or mentally drained, the state then had two people to look after instead of one !

      1. sjb
        July 30, 2016

        Yes, it is surprising that the growing army of family carers and the problems they face have not moved up the political agenda. A new factor is where the pt’s children have had to move away because of rising property prices so will no longer be able to pop in each day to check on Mum and/or Dad. Plus, if we leave the EU, how soon (if at all) will the shortfall in care workers & clinicians be met?

    2. Lifelogic
      July 30, 2016

      Well they might well be at the other end of the country, or even in Australia or something. Perhaps after paying such a huge proportion of their wages in taxes, plus 40 % of their stolen wealth on death they think that the state should actually provide something back for a change!

    3. Kevin Lohse
      July 30, 2016

      “Where are the families?” my family is in Perth, WA. My son finds it a little difficult to drop in once a day to see how I am.
      I’ve just had personal experience of the NHS, after an episode of heart failure. The medical staff are generally magnificent. The system stinks. My gatekeeping GP gave me Subutemol for 6 months and put the symptoms down to being overweight. Finally, after a sleepless night trying to breathe I went to A&E, described my symptoms and 5 minutes later was in the Cardiac Care ward. My feet literally did not touch the ground. Now that GP gives good advice in 99 cases out of 100. The human condition means that everybody gets it wrong sometimes. I can accept that. What I cannot accept is that no apology has been offered and that I’m now seen by a junior in the practice.

      1. Lifelogic
        July 30, 2016

        “The medical staff are generally magnificent. The system stinks”

        That is exactly my impression (well most of the medical staff anyway).

  7. Ian Wragg
    July 30, 2016

    My opinion of the NHS is if they had 100% of the government spending and everyone in the country worked for them they would need more resources.
    This Soviet inspired entity needs breaking up and rethinking.
    Control by rationing.

    1. Lifelogic
      July 30, 2016

      Spot on, and this is despite the fact that many of the staff are actually very dedicated and excellent, some are even underpaid for what they do too. It is the system, the organisational structure and the funding method that stinks. It can never work efficiently as currently structured.

      Thousands are dying as a result. In terms of unnecessary deaths it must be about 50,000 times worse than those caused by terrorism in the UK. The government need to get its priorities right, look at the numbers and do something sensible for a change. It was Cameron’s priority in three letters he claimed, but it has deteriorated hugely under his dire period of office.

    2. Cheshire Girl
      July 31, 2016

      I don’t care what Politicians say, but I believe at some point, the NHS is going to have to start charging patients for some things. Maybe a small charge for visiting a GP, and for appointments not cancelled by the patient ( these alone cost a lot of money). Also, stop prescribing medicines that can be bought cheaply over the counter. I hear that mouthwash and toothpaste are often prescribed. This is ridiculous!

      Dont get me started on the cost to us of all the drunks that clog up A & E on weekend nights, and those from abroad who are taking advantage of our free health service, to which they are not entitled. This has been going on for years, and there has been endless talk from Governments, but very little is ever done about it.

  8. alan jutson
    July 30, 2016

    All good stuff John but we still hear stories reported that a consultant has earn’t (well been paid) over £375,000 for overtime on top of his £90,000 salary.

    Then we have the latest reported overpaid contracts for training fiasco in the Southern Health Region.

    Aware that these may be isolated incidents, but when coupled with the PFI fiasco’s it all adds up to gross financial mismanagement by somebody.

    Time we really also did do all we could to try and train all of our personnel in house, to save us having to rob them from overseas.

    Do we really need all nurses to be graduates ?

    Fully agree we need to charge overseas visitors for emergency treatment, but you need a change of mindset of those in hospitals who seem to refuse to co-operate in doing so, but then in the same breath moan about a shortage of money in their budgets.

    Recent a reported cataract fiasco where overseas visitors have been treated ahead of our own citizens who often wait until almost blind, a close friend of ours recently had a cataract operation cancelled as it was deemed not bad enough yet !.
    I myself am awaiting a hand operation (restricted finger movement) after funding clearance has been gained.

    Both of us have paid into the system for 50 years !.

    1. Lifelogic
      July 30, 2016

      Old people are very often wrongly told their cataract is not serious enough to justify an operation yet. Then they fall over and break their hip or something costing far more.

    2. Lifelogic
      July 30, 2016

      Do all nurses need to be graduates clearly not. Indeed do all surgeons need such long training in every area of medicine, or do they perhaps just need to know how to do a cataract operation well for example, perhaps needing just six months of specialist training? Is the medical profession just a trade union that is rather too powerful?

  9. Denis Cooper
    July 30, 2016

    Daniel Hannan has quite a nice article today about “Remoaners”:

    “Remoaners are determined to find bad news”

    While there’s a letter from one of them – surprise, surprise, a LibDem – which ignores the fact that Parliament decided that people would be asked a simple question about whether the UK should Remain in the EU or Leave the EU, nothing on the ballot paper about what alternative arrangement they might prefer if the answer to that question was Leave, or indeed how they would like the EU to be rearranged if the answer was Remain:

    “An early election”

    Oddly enough, it was the LibDems who demanded the Fixed Term Parliaments Act to remove the right of the Prime Minister to call an early general election at a time which suited them, for example when the Opposition was falling apart.

    1. Lifelogic
      July 30, 2016

      Indeed good point from Hannan.

      I see that Hinkley Point C, in the picture you link to, is rather close to the beach. Can we safely assume that tsunami waves will never happen in England? I think not, They have in the past and will doubless do so again. Albeit perhaps less frequently than in Japan.

      Anyway it is the wrong nuclear project. The price is way to high, at more than double the current on demand cost of electricity from Gas. Nuclear is not as flexible at meeting demand as gas either. Cheaper just to build a large stock pile of coal and
      gas. Then get fracking.

      1. stred
        July 30, 2016

        Re tsunamis. There is a theory that a very large tsunami could occur if an unstable part of the Canaries slipped into the sea. Geologists think it has happened before. The wave could flood south coast seaside cities. If it went up the Bristol Channel it would be amplified, as the tides are, leading to the Severn Bore.

        Perhaps another good reason for re-assessment.

        1. Lifelogic
          July 30, 2016

          The best approach is to use up the cheap gas, fracking, oil and coal and lots of research into better nuclear but delay it. The longer we delay the best and safest nuclear plants we will get.

          Forget about the global warming (exaggeration of) religion pushed by the “expert” high priests of greenery (who were clearly wrong for the last 18 years) and cut all the grants for green crap lagoons, wind, wave, PV….

          Cheap energy

        2. Jagman84
          July 30, 2016

          It is geologically possible but the Eastern coast of the US would be the most in danger, along with the West Indies.

      2. Tad Davison
        July 30, 2016

        Interesting too, that the Bristol Channel has one of the highest tidal ranges in the world estimated at some 40 feet, and the Servern Bore is renowned for it’s strength.

        It is said by some that a combination of exceptionally high tides, a storm surge, flood water from the land, and a natural catastrophe somewhere at sea ‘could’ render the proposed defences at Hinkley Point vulnerable to a breach. That scenario might be improbable, but I would feel better were it absolutely impossible. And let’s not forget that the defences at Fukushima were supposed to be impregnable, and the worst case scenario had been evaluated and factored into its design before building commenced.

        Dungeness is also said to be at risk.

        In the case of Hinkley Point especially, you rightly say that costs are too high, but the cost of building the thing, and the drain upon the consumer and tax-payer, will be as nothing if something were to go wrong with it when it comes online.

        If on the other hand, we made better use of the dependable free power of the tidal surges in that area, the exceptional potential danger of a nuclear power station could be cancelled out altogether.


        1. Lifelogic
          July 30, 2016

          Sizewell too?

          1. Tad Davison
            July 31, 2016

            We could go on LL, there’s a long list.

            Bradwell in Essex saw a lot of flooding in 1953, and I am told it wouldn’t take much to bring about an even higher flood surge. The Thames barrier is used far more often now than was anticipated even a short while ago, which suggests to me the chances of inundation have been increased.


    2. Anonymous
      July 30, 2016

      Of course indications are that we won’t actually be leaving the EU. So Mr Hannan’s claim that things aren’t as bad as predicted since the referendum could be because of this.

      I am concerned that broadcasters and journalists could talk us into a downturn. The BBC’s opinion is clear simply by the way the news is expressed, with foreboding.

  10. Lifelogic
    July 30, 2016

    You say:- “At present too many people go straight to hospital instead of going through the process of GP evaluation”

    I am not at all convinced by this. Surely a GP evaluation/triage could be done at a casualty department for the same or even lower costs than it can be at the GP’s. Lower as they would have more through put and “could” (with proper organisation) be more efficient at it. Often the reason the patients are only at Casualty as they simply cannot get a rapid GP appointment.

    GP’s so often are unable to do much anyway other than refer on anyway, this as they do not have direct access to rapid scans and many tests that might be needed.

    Free at the point of use (or delay, rationing and non treatment) that is the problem just start to charge. With exceptions for those who really cannot pay. Use the money to make the system actually work for a change.

  11. Brexit
    July 30, 2016

    Yet more constructive and positive comments in your piece this morning.

    What a shame that these messages aren’t being received by the majority of the British public who get their news via the BBC, Sky and ITV. The broadcast media continue to give the impression that the NHS will not benefit at all from Brexit.

    A large proportion of the public still believe that no thought went into the country’s post-Brexit finances. Whilst this appears to be true of the Government, it certainly isn’t the case that the Leave campaign didn’t address the economy in the event of a Leave result.

    Is there no hope that you could yet have input into the Government’s Brexit deliberations?

    If your readers are interested, we have 3 new pieces this morning including good news on the post-Brexit economy regarding GDP growth, mortgages, and other things.

    Best wishes, the team

    1. bratwurst
      July 30, 2016

      The Leave campaign had no coherent plan for post-Brexit ( and had no mandate to produce one). The referendum was remain / stay. Once the result was determined it was then up to the government of the day on how to implement the decision.

  12. agricola
    July 30, 2016

    Your budget aspirations are a move in the right direction. In your desire to reduce demand there is far more that can be done than to reduce the number of migrants, many of whom may well be providing the services we are using.

    Stand in a supermarket checkout queue behind one of many obese citizens, and there are plenty. Look at what is on the belt, chances are it is a good indication of a totally unhealthy diet. If they have children with them observe the trans generational signs of obesity. Size shape and gait are a surefire way of spotting a UK person on holiday here in Spain. A brave government of good intent would take steps to control what was available for the UK population to swallow.

    Then check out the level of sport and physical activity in UK schools. Speculate why many of our olympic level athletes derive from public schools. All school children should be subjected to a much higher level of physical activity. The above are preventative measures that in time will reduce the need for medical services.

    Seriously increase the level of home and community services available post hospital and for the infirm. If run by degree level nurses the actual operatives do not need an excessive level of education, just sound common sense.

    The UK population was possibly at it’s fittest during WW2 when even essential food was in short supply, and sailors were dying in the Atlantic to get it to us. If you really want to rectify matters you need the courage to bear down on the food industry and supermarkets to eliminate or change the nature of products that lead to obesity. You have the power, it is just a matter of will, and closing your ears to the lobbying food industry.

    1. fedupsoutherner
      July 30, 2016

      Agricola. Agree entirely about sport and physical education in school. Little wonder teenagers in some areas don’t participate in sport because of lack of facilities going through school. Many playing fields have been taken away and in some schools swimming lessons are not offered anymore. A love of sport starts when young and with encouragement often goes on into teenage years. My son was lucky enough to attend a private school where every sport imaginable was offered and he excelled and loved it. It helps with physical well being and mental too. A good diet is also important and often sport and physical activity reflects this. Even if it is only training in the gym, what you eat is highlighted.

  13. Caterpillar
    July 30, 2016

    I hope that as the economy is rebalanced away from London* that poverty in some areas will reduce and allow people’s life decisions to improve (less poverty, higher available IQ, better health), though this would be speeded up by a guaranteed basic income (neither a left nor right policy, the basic income would lead to individuals being able to make more individually responsible choices). I’ll repeat it – rebalance the economy, move to a guaranteed basic income, as poverty reduces a lot of strain on the NHS will melt away.

    * Do an Australia – move parliament, the civil service, museums, galleries etc to Birmingham (c.f. Canberra) and get HS2 built to Manchester (Melbourne) and London (Sydney). Rebalance, rebalance, rebalance.

    1. backofanenvelope
      July 30, 2016

      I understand that the Palace of Westminster needs a complete rebuild. Now would be an ideal time to move the whole thing to Birmingham – the NEC would be handy. We could also move the MoD to somewhere like Caterick – where the civil servants could actually see some military. It would be a good time to slim the whole thing down. While we are at it – why not rebase the SLBM subs to Falmouth and Plymouth.

    2. Anonymous
      July 30, 2016

      Remove poverty and IQ and health improves ?

      Or is it the case that low IQ results in poverty and poor health !

      1. Anonymous
        July 30, 2016

        Even the poorest of us have more choices in activity, foodstuff, more security and warmer accommodation than our WW2 ancestors when food was rationed and the nation at its fittest.

        Our hardest workers live 31 to a house on well below minimum wage. I don’t see any fat men washing cars at the local handwash.

      2. Caterpillar
        July 30, 2016

        Anonymous, when people are wondering how to meet the next decision (where does the meal come from, how to pay the rent) full attention is given to that and other decisions are poorly made – the effect is similar to about a drop of 15 IQ points. A bad decision in poverty (for example short term loan) then has knock on effects. If you are not in poverty you don’t sleep for a couple of nights and you might have similar reduced level of decision making, but if you make a poor decision under this situation (e.g. buy something you don’t need) and you are not in poverty the knock on effect is minimal to zero.

        Removal of the absolute focus on one thing and the de ion making for others then improves. One point of a basic guaranteed income for all is to remove / reduce the worries so that they are able to make more responsible decisions. Benefits don’t tend to work in the same way, as people worry about losing them. I guess IDS understood some of this, but it is only the Greens that have so far suggested the policy in the UK, though in other countries it is under consideration.

  14. bigneil
    July 30, 2016

    The bosses of the NHS seemingly want the NHS to fold. They know it is funded by our taxes, but as more and more people pile in by the hundreds of thousands, having contributed nothing, but getting thousands of pounds of instant treatment, the hospitals do nothing about “who is paying for it”?. By continually increasing the financial pressure on the decreasing %age of population whose taxes are paying for it, there can only be one result. I assume some of the top bosses want it to fold, hoping they will start up their own, very highly salaried, healthcare business after the NHS collapse.
    The world is piling in for the never ending supply of freebies from the UK. NHS, housing and money, all on the taxpayer. It cannot continue forever.

  15. Antisthenes
    July 30, 2016

    The NHS because of it’s structure will suck in large amounts of money without delivering the same amount of benefit. Simply because it is a monopoly and so has no incentive to use the money it receives sensibly or to operate efficiently. Certainly the objectives you list are desirable but the numbers are based on the NHS as it currently operates. Apart from which what happens when the the saved EU money is no longer enough as it most certainly will not be.

    Privatise some of the provision and funding of the NHS and abetter understanding of the true needs of the NHS would be established. Apart from which medical practitioners will start working more for their customers than themselves. They and many of us of course believe that they are dedicated people. However that dedication is more illusionary than fact as they build systems that are purported to make patient care better but in fact designed to make their working lives easier.

    This comes about not out of personal interest although when it comes to employer employee bargaining it is(because it is a monopoly the employees generally win) but because of the inefficiencies of the NHS and lack of motivation to do better it fosters.

    As it stands the NHS will over time fail. It is not far away from that happening it is already dysfunctional and not fit for service. Wales and Scotland will be the first casualties as they are not even attempting to reform the NHS. England is but in the end it will be to no avail.

    France does practice aspect of the things I suggest that the NHS should do and their healthcare is by my reckoning many times better than ours. And because it does it can more quickly adapt to changing circumstances. When it is considered that France is not a country that likes competition for it to introduce it into it’s health service is significant.

  16. graham1946
    July 30, 2016

    ‘The NHS needs to be encouraged to be better at determining who needs hospital treatment’

    I’m pretty sure the doctors and nurse know who these people are and would love to get on with treating the sick, rather than warehousing people who are not in medical need. I see four big problems in the NHS, all of which the government has full control over:-

    1) It is underfunded – always has been, but much worse since 2010. Our politicians are very ready to ‘lead the world’ as they see it in giving away money to overseas countries so that leaders can strut the world stage in vanity, whilst our own people go without the healthcare commensurate with being the one of the largest economies in the world. The funding should be put in regardless of the Brexit savings, which in any event will not follow for years, probably. We underfund by at least 2 percent of GDP compared to similar first world countries.

    2) Inadequate social care. Cuts by the government and a lack of realisation of real world costs amongst politicians mean Care homes are closing in large numbers and firms are going bust. Local Authorities are unable to give the proper funding due to cuts in their income. They are offering something like £12 per hour for home carer visits, yet the government are implementing wages levels that are clearly not possible under this level of payment. My garage charges 5 times as much to service my car as carers are offered to look after the vulnerable.
    3) We are not training enough nurses and doctors and are under valuing many that we have. Junior doctors are not paid highly like GP’s, and yet not many want to be GP’s. Why? The level of Whitehall interference and paperwork pressure is a lot to do with it.
    4) There was a totally unnecessary re-organisation after 2010 which no-one really understood, was incompetently done and cost 3 billion to do. All that has been achieved is longer waiting times for treatment, rationing of drugs, shortage of staff, and poorer service.

    Until all these things and many more are rectified and the NHS taken away from being the plaything of politicians, nothing will change, even if you do give the Brexit money, which I doubt. There will probably be more ‘urgent’ stuff to do with the money, like Hinckley and HS2 which of course result in the politicians delight of an opening ceremony and a few days of headlines in the news.

    The future is in the hands of government, which unfortunately does not instill confidence.

  17. Brigham
    July 30, 2016

    I joined a patient participation group. I thought it was to find ways to improve things for the patients and doctors. “Watta mistaka to make” The ladies of the PPG in the practice genuinely tried to find ways to improve things, but a woman from the “District committee” who attended one of our meetings, produced a piece of paper with all the committees that were, as far as I could ascertain, nothing to do with anything pertaining to medicine. I asked how many of these people were paid. No answer. Huge empires have been built, which, in my opinion, should be dismantled. The NHS needs an “ombudsman” to root out all the power hungry leeches.

  18. Colin Hart
    July 30, 2016

    For decades we have confused the principle of free at the point of delivery with the idea that health services can and must be provided by a state organisation funded solely by the taxpayer.

    Until we are prepared to seriously question the latter, we will have a health system that is increasingly unsustainable.

    Your proposals are well meant but they amount to little more than tinkering.

  19. Bert Young
    July 30, 2016

    Getting back control of our cash as soon as possible is the first step ; it should not take the months / years indicated . The NHS is in dire need of structural reform ; it is far too big an organisation as it stands directed from a central HQ . Certainly more regional influence is necessary – there are far too many differences of standards across the the UK at the moment .

    The training and availability of more medics is an essential aspect of our financial planning and , as John has indicated , ought to feature strongly in the way the money redeemed from Brussels is allocated . I wish his ideas were at the core of present Government thinking ; we need to get back to some grassroots thinking .

  20. Dave Andrrews
    July 30, 2016

    With so many needing health care through obesity, smoking, alcohol and numerous other self-inflicted conditions, the main problem in the NHS is the numbers who having been well have made themselves sick.
    If we could relieve the NHS of the burden of the results of human folly, less doctors and nurses would be needed, and these could be selected from the most suitable candidates, rather than numbers being made up of the less suitable.
    The NHS is not so much under-funded but oversubscribed.

  21. sm
    July 30, 2016

    One of the admirable original purposes of the NHS was to redistribute hospital provision, which was appallingly irregular by 1945. Unfortunately the general concept appears to have been financially constructed on the mistaken thesis that by providing ‘free’ treatment, the population’s health would be so improved that demand would significantly reduce. The plans did not take into account rapid developments of treatments, and also that by preventing death in middle age there would be an increasing population of the elderly, with all the cost implications.

    There are restrictions on the numbers of doctors/nurses to be trained, partly encouraged by the profession to increase wages because of scarcity of provision. Why is the UK draining 2nd and 3rd world countries of their medical professionals?

    The management of Trusts is generally appalling, with a few exceptions, but there is no country-wide standard imposed, and no legal requirement apparently that the bad Trusts should learn from the efficient ones.

    And one final point: there would be little problem with bed-blocking in expensive hospitals if convalescent homes were re-instated, where sensible rehabilitation could take place, plus giving time for arrangements to be worked out with Social Services and families. Despite spending years on Patient Relation panels, no authority or senior doctor has ever responded to my questions on this.

  22. The PrangWizard
    July 30, 2016

    The NHS is a money pit. It eats our wealth. If it were as good as it is claimed and so superior to any other system why are we in the UK not the healthiest and happiest people in the world?

    Thousands of people have been killed in its ‘care’, by neglect and incompetence, how can this simply be glossed over? It needs major reform to end waste and abuse.

    As for GPs they are overwhelmed with people who in many cases have nothing wrong with them and foreigners who take advantage and should be made to pay first. Consequently have little time for the people who are really in need of investigation and treatment.

    Spending the savings made on Brexit will not make the slightest difference and is one of the ways the benefits will simply be frittered away. No-one will notice.

    People will still complain, people will still be mistreated. I won’t bore readers with examples of callous disinterest so frequently displayed by those who have forgotten what nursing is; I’m sure everyone has had experience or knowledge of same.

  23. Roy Grainger
    July 30, 2016

    Extra spending on NHS tends to go to paying existing staff more over time. Our GPs are vastly overpaid compared with those in several other EU countries.

    1. graham1946
      July 30, 2016

      And yet we have a shortage of GP’s and overtime should not be necessary. What’s going on? Poor management is the answer and a wish to run it down ready for privatisation. Reducing their emolument won’t bring in more. Getting the government out of the way might.
      Internal market is not needed and is wasteful. We don’t need managers on high salaries telling doctors they can’t prescribe certain drugs and each CCG doing their own buying. Without the administrative drag organised since 2010, we’d get far better value than setting one off against another. It is a public service not a ‘market’ for making money. Run the way it is it will never improve, but maybe that’s the point. Certainly services are worse than pre 2010 whatever failings there were then.

  24. Ken Moore
    July 30, 2016

    All pie in the sky stuff..may or may not has no intention of getting us out of the Eu.
    The Conservative party wanted a Remainer as leader VERY BADLY…we are about to find out why….

  25. Ken Moore
    July 30, 2016

    Uncle Redwood,
    Why can’t Mrs May get a bloody move on and repeal the 1972 European Community act immediately. Even if article 50 was triggered tomorrow we would still have to pay another 2 years subscriptions. For nothing.

    1. bratwurst
      July 30, 2016

      Because that would make all the ‘Project Fear’ prophesies come true.

  26. Peter Wood
    July 30, 2016

    I’m looking for a set of objectives to define ‘Brexit’, apart from not being in the EU political project. I’m hoping Ms May will define such a set, to which we can work toward.

    If Ms May can do this, then a plan can be produced to achieve it. A plan that will succeed best will first reduce the legitimacy of the EU Commission. We should not fight un-productive battles; ignore Mr. Junker and his coterie as much as possible and deal with the ‘organ grinder’. (And we all know who that lady is)

    We should not be under any illusion here, Brexit should cause real change and possible a rethink in the European project; the EU commission knows this and will fight to retain their relevance. We are best served by working around them; fight on our terms not theirs.

    July 30, 2016

    There are certain words and phrases and acronyms which have become…..mooreeffoc…
    …Words which could have deep meaning but make Mr. John Shockhorrornews instantly switch off both figuratively and in the case of his TV, actually.
    Here are my own top-ten in no particular order:-

    hardworking families
    Another referendum
    172 Labour MPs

    July 30, 2016

    Some of the stickinesses with our health care system(s) are the fallout from Labour Party electoral practices of:- ” if it gets them to vote for us then say it, implement it.”

    The UK Labour Party has done much harm particularly in its sticky rock solid Labour heartlands in sustaining and creating the lacklustre prize of”Hand-me-out” with “For what we about to receive” being their only prayer. Well it keeps their own voters on their knees whilst 172 Labour MPs play musical benches in Parliament. But does nothing to deal with three quarters of a million migrants flowing in and out each year in diverse locations without plan and having a third of a million of them, again with no demographic plan or whether their is sufficient heathcare in the particular location, deciding to settle for a while at least. Toss a coin or stick a pin on a lottery ticket whether any of them are nurses or would be acceptable here as such.

    It is significant for Corbynistas ( I shall not insult the Labour Party by referring to the 172 PLP as Labourites ) that only nationalisation, for them, a completely controlled economy and country could possibly have any meaningful plan for the human millions settling in the UK. But they should take note that every country in the recent past and before that, with socialistic or planned nationalisation-look-a-likes have had to impose strict to murderous immigration and emigration controls up to and including building a wall to stop people getting in but importantly stopping them leave. And, with the exception perhaps of Cuba, in some regards, their health care system was not as good as they would have wished….or planned for.

    1. Anonymous
      July 30, 2016

      The health service becomes the industrial wing of leftism after industry has failed – owing to leftism.

      It is very hard to fight against so that even conservatism ends up fighting for it on – so called – middle ground politics.

  29. Adam
    July 30, 2016

    The medical profession is too strong. They look after themselves first others second.

    GPs are the worst end of this. It would be nice to see them regulated one day. We should make sure they are trying hard and giving out correct advice regularly. I don’t believe it’s the case right now.

  30. Edward2ff
    July 30, 2016

    Only a Government would design a service which becomes financially worse off the more customers it treats.
    Until this alters the NHS will be unlikely to improve.

  31. Jack
    July 30, 2016

    No longer paying EU contributions will reduce the current account deficit, ceteris paribus, as we won’t have to sell Pound to buy Euro in order to pay them. But it won’t mean more money is available “to spend”.

    As the monopoly issuer of its currency, the UK government has always had the ability to spend whatever it wants; with the real resources available (inflation) as the only constraint.

    True, the EU Stability and Growth Pact limits government deficits to 3% of GDP, but that was a political constraint rather than an economic constraint.

  32. turboterrier
    July 30, 2016

    The state of the NHS is another reason for tighter border controls.

    Years ago my parents could not get into Australia because my mother had shadows on her lungs. Both of them were in the trades wanted list, nursing and telecommunications but it made no difference to the outcome.

    Everybody should be vetted for health problems before they get here, regardless of skills and ability.

  33. stred
    July 30, 2016

    Off subject. This looks worrying. The Vienna Convention on Treaty Law appears to prevent us from having control of our borders and we can only hope that some sort of Norway option will go halfway. I find it hard to accept that as a people, we have to accept what a load of bloody lawyers wrote in the previous century. Are VW, BMW and the rest going to refuse to sell to us because they dare not trade with naughty boys who change treaties? Booker seems to have gone chicken. International law only seems to work when catching up with events. The US and Russia ignore it when it suits them. In the end it adapts to reality.

    Reply This is all unhelpful misdirection. I have explained how we can leave legally

    July 30, 2016

    Off Topic:
    Does anyone have the slightest clue why UK media seems to favour The House of Clinton to reign over the Americas ? Mr Trump is seen as absolutely spot-on if he is quoted correctly and in the wider context. Maybe that is in fact why our media dislike him so much.
    But again why Hilary Clinton? The US Democrats are warlike; are for sacking coalminers and steel workers; exporting US jobs abroad. Yet the British Labour Party too seems to prefer her to the Republicans and Trump who are supported by all working class groupings in the USA including the miners, steel workers and car workers.

    It was the same with The Rt Hon Mr Blair and the Blairites who just loved the House of Bush. He was a Democrat in Republican clothing, and his dad. The House of Bush started waging war in Afghanistan supplying arms (allegation left out ed)and possibly supplying satellite Intelligence Information. Well that certainly stopped ISIL being wiped out in its infancy.
    There are not enough BBC and Sky News correspondents being sent to the Middle East where they can continue reporting as they always have.

  35. ian
    July 30, 2016

    They have put 8 billion in this parliament and another 10 billion if we come out of the EU they say and you will be writing about it for another 5 year about what can be done.
    You either get good treatment or you do not, that all there is to it, money does not save people, people save people. the debt in the NHS does not matter it just a bill that has to be paid, it go by amount work that has to be done each year and by the amount of claims for bad treatment and mount pay offs and fraud and payment to private companies for the building of the hospital and maintenance them at very high interest rates arranged by parliament.

    Each new government comes in and spends 3 or 4 billion rearranging the NHS with the out come being always the same and it will still go on because if they do not pay them who will, bad for GDP and bad for sell goods in the shops.

    What it all about is GDP, full employment, inflation and government giving instruction to the BOE that there to be no loss of GDP or growth while we are in office, you can do what ever it takes, while they seat back and do nothing and just borrow money and plans for new social engineering and new laws against the people to keep them in line with amount of oversea people they wish to let in to keep the ship from sinking.

  36. Christopher Hudson
    July 30, 2016

    Modern Slavery: it’s an absolute tragedy that it exists in the modern world. But do we really need new prime ministers establishing “task forces” to tackle what seem to the outsider vanity projects and personal missions. When there are, to put it mildly, a billion more important things on the to-do list.

  37. Trevor Butler
    July 31, 2016

    Maybe the NHS needs to take a leaf out of the Hong Kong Health Authority’s book?
    I have just been through a process with them which went like clockwork from start to finish –
    I went to the GP at the end April (Appointment within 24 hours via a automated telephone system) and explained the problem to him and the following day had an appointment scheduled to see a consultant . The consultant assessed me and decided I was a high priority case and I was immediately taken to the surgical ward for assessment (BP, cardio vascular, underlying conditions etc) advised about changes that I had to make to my lifestyle and issued with a date for surgery.
    I had the surgery last Friday and was discharged on Saturday.
    Did I pay? Yes – The total cost from start to finish was HK$295-00 including prescription medications, all blood tests and all of the above – That is 29 pounds 50 pence in UK money.
    Having now experienced this and looking back at my experiences with the NHS – I am now a firm advocate of paying something to enable a better service.
    PS – There is no NI in Hong Kong so the HA is funded from tax receipts alone.

  38. a-tracy
    July 31, 2016

    Student loans have been set up as a graduate tax on English students only to repay for 30 years now. Are you suggesting we should train nurses for free for the rest of the world to poach or would you be tying them in to 30 years NHS service to get their training free? Then if the private sector want to poach them (not training their own workforce) they have to pay their student loan back and the same with other Countries like Australia that we keep being told is the destination choice of many of our taxpayer funded trained Doctors, nurses and Other Medics. If you train people for free they don’t personally value that training. I can live this student graduate taxes AS LONG as they apply to everyone in the UK! Why should Scottish students that work in England not pay the same graduate tax? If they stay in Scotland then the Scottish government through their income tax system can choose not to claim it but otherwise this is totally unfair.

  39. Rhys Jaggar
    July 31, 2016

    What’s actually required is someone putting 650 MPs in a room and threatening them with automatic fusillades of gunfire if they do not address one simple thing:

    ‘Why are you creating an economy and a country which makes everyone sick??’

    I’ll tell you why:
    1. Because you think that you can remain healthy living on the minimum wage in shoddy housing.
    2. You induce stress and illness in the middle class expecting them to work 70-80 hrs a week.
    3. You fill foods with oestregen-lke compounds thereby reducing male fertility generation upon generation.

    You are all like ‘gardeners’ who manically clear an overgrown field, then sow things, blithely assuming that the weeds won’t grow back straight away. They do, so you start working manically again to try and clear them.

    There are actually ways to clear overgrown spaces which stop the weeds coming back. There are ways of cultivating crops to high quality and high yield without having to do too much weeding.

    Now if you politicians started from a debate on ‘how can we create a healthy, sustainable society?’ you might get beyond these stupid mantras of ‘more money for the NHS’.

    Now I know you all think that Gadaaffi was a terrorist, but if you actually looked at what he did for his people, you might find a few answers…….not all of them, but some of them….

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