NHS costs and revenues

I hear the cost of the NHS and how to pay for it is back on some people’s agendas. Let’s make it clear once more. We Conservatives fought the last election on a pledge to keep NHS treatment free (other than the cross party prescription charges and charges for eye and teeth treatments already introduced). I do not expect the new government to deviate from that promise. Labour, the SNP and the Lib Dems still also support this approach.

I heard an interesting interview with the Labour Shadow Health Secretary where she made a number of good suggestions. She recommended buying out some of the very expensive PFI schemes the NHS is struggling to pay for. Labour should know about them, as they negotiated many of them. Now could be a good time, given low interest rates, to buy out future obligations. She wanted less use of agency staff. That’s a policy she shares with the Health Secretary. All governments have found it difficult to deliver, but that’s no reason not to try again. She proposed more use of generic pharmacueticals, with lower medicine prices. That too is cross party commonsense, but it is always worthwhile having another push.

I think a Conservative government can add to that list of helpful ideas. I will relaunch my proposal that the NHS should get better at collecting equipment when people  no longer need it, and recycling it for future use. It may need maintaining or checking, but it should be cheaper if the former patient or their family drops the item back after use. The NHS should get better at charging visitors from overseas for all non urgent treatments, as they are meant to do. I am quite prepared to give them my NI number or some other support of identity for treatment if they need to make more checks on access. Easier still is to require all non urgent referrals to come through a GP, and for GP Registration to be the point at which you either register as a UK citizen with free entitlement, or a foreign user who has to pay one way or another. You should provide proof of nationality when first registering.  EU visitors from the continent would qualify for free treatment  but the NHS should demand payment from their sponsor states.

The NHS has hospitals and surgeries that I have seen outside my constituency that could benefit from better quality management systems. More getting things right first time, proper controls over use of expensive supplies, and working well as a team with good use of employee time are all important features of quality working that also cut costs.

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50 Comments

  1. Mark B
    Posted August 27, 2016 at 5:18 am | Permalink

    Good morning.

    Make it a legal requirement that all non-EU visitors to the UK must have their own private medical cover. No medical cover, no entry !

    Any people who claim asylum in this country should declare their nationality and, where the UK is giving monies to said country via the Department for Overseas Development, we deduct it from their aid and give it to those departments, such as the NHS, whose services they are using.

    It is time for a bit of tough love.

    • Mark B
      Posted August 27, 2016 at 5:20 am | Permalink

      Oh, and cap all those CEO’s salaries, expenses and other perks. If they claim that they will not be able to hire or keep such people all the better. Most of them are Labour lackies anyway.

      • Lifelogic
        Posted August 27, 2016 at 6:47 am | Permalink

        There is certainly a lot of over payment in the admin department. One of my companies a while back had a fairly second rate admin employee who managed to get a job in NHS admin with a huge jump in salary. We were delighted she had gone.

    • Antisthenes
      Posted August 27, 2016 at 10:24 am | Permalink

      A system can be devised relatively easily to stop abuse to and to direct how a service is used. The NHS has registers that customers must apply to be on to be treated and treaties with other countries on the level of services and who pays that are provided to their respective citizens. However a system is only as good as the people who operate it and that is why any system devised for the NHS including the current one which is very flawed is bound to fail.

      The provision and funding is not set up in a way that motivates staff to act competently and responsibly. It lacks competition, reward and punishment. Level of service and income is not reliant on customer satisfaction or in being competent except in rare cases(perhaps becoming less rare as more customers are being compensated for bad service which does not address the problem as it is not the staff who are paying that compensation) as customers are captive and income is guaranteed by enforced tax receipts.

    • rose
      Posted August 27, 2016 at 10:32 am | Permalink

      A lot of people from other continents now come here on EU passports, having milked the other EU welfare states. Presumably they are now “Danes”, “Dutch”, “Swedes”, “Finns” etc. They may have been asylum seekers originally but they are now European nationals. That is not to say there aren’t ever increasing numbers of other people claiming to be asylum seekers as well.

      We need to come out of the Geneva Convention and the ECHR, as well as the EU. They were set up for Europeans, not the whole world. And in those days the right to a family life meant the right not to have the secret police knocking on your door in the night. Anyway, if the right to a family life, as defined today, were taken to its logical conclusion, you wouldn’t be able to send anyone to prison. Why don’t the irresponsible judges notice that?

    • Concerned
      Posted August 28, 2016 at 11:00 am | Permalink

      #john redwood. And ask GPs to stop prescribing odd quantities so that pharmacies do not have to split packets… Even more waste?

  2. Lifelogic
    Posted August 27, 2016 at 6:10 am | Permalink

    The main problem with the NHS is that it is free at the point of rationing, delay and non treatment.

    Labour, the LibDims, the SNP and the Conservatives are all totally wrong. It can never work efficiently as it is currently structured. It certainly cannot provide health care to people from all around the World as it tries to do now often without even bothering to invoice them.

    Thousands are dying or waiting month and years for proper treatment at huge costs to the public. The NHS far from being the envy or the world as the BBC and lefties like think is a disaster. This despite the fact that many working in it are hugely dedicated and capable. It is the organisation, funding & structure of it that does not work at all well and never will do with the current structure and funding system.

    • Lifelogic
      Posted August 27, 2016 at 6:19 am | Permalink

      We should introduce some tax relief for private cover to lighten the load on the NHS.
      Also some charges for seeing a GP and hospital for all except the few who really cannot afford them. If you can pay for a hair cut or your car you can pay to see the GP or casualty or the ambulance.

      The NHS should also tell patient the truth. If someone need an operation they should say so and tell them the NHS is unlikely to be able to do it for X months or years (which can even lead to complications or inability to work for months). Telling they they might be better off paying for it. Very often patients are being totally deceived or given trivial treatment when a full operation is needed. This is dishonest and a total outrage.

      • anon
        Posted August 28, 2016 at 5:11 pm | Permalink

        Tax relief may remove the pressure on the NHS to reform its bloated management and “me first” as evidenced by salaries and benefits at the top.

        Any progress on the “off-payroll” rorts?

        Perhaps NI should be made the same between employees and contractors? or merged with income tax.

  3. Cheshire Girl
    Posted August 27, 2016 at 6:20 am | Permalink

    Despite all the rhetoric, I believe that there will have to be some charges to use the NHS, say, a modest charge for GP appointment. And stop writing a prescription for things like paracetamol, toothpaste and mouthwash. Apparently, it costs the NHS £8 for a prescription for paracetamol, when I can buy a packet from my local supermarket for 35 pence.
    I recently picked up a newsletter from my local surgery, warning that appointments would have to be cut back because of the shortage of GPs, and the pressure on those already there. It is not surprising that with an ageing population and nearly a million people coming in from overseas in the last three years, that the NHS is struggling. Its about time the Government ‘bit the bullet’ and did something about it!

    • Anonymous
      Posted August 28, 2016 at 8:35 am | Permalink

      There is also the issue of GPs job sharing, working part-time and retiring early long before they have completed a full length of service.

      The shortage of GPs can be blamed – in part – on the number of women GPs who are selected and would not give the same commitment as men.

      We don’t see many old GPs nowadays.

      Sorry to say it but it’s the same in many other jobs too.

      • Anonymous
        Posted August 28, 2016 at 8:39 am | Permalink

        If it’s true that millions coming from overseas are good for the economy then the NHS should be booming – not collapsing under its own weight.

        If there is anything which proves the lie “immigrants make a massive contribution to the economy” it is this.

        The parlous state of the NHS proves that the net contribution is not nearly enough.

        • anon
          Posted August 28, 2016 at 5:31 pm | Permalink

          Interesting analysis at market oracle ” article 54205″

          UK Out of Control Immigration Crisis Continues, Tax Credits, EU Referendum and BrExit

  4. eeyore
    Posted August 27, 2016 at 6:23 am | Permalink

    Will there never be any good news about the NHS for those of us who think the whole thing is madness? What business is it of the State to look after people’s health? Health is important but food is more so, yet even Comrade Corbyn is not so lost to reason as to call for a National Food Service.

    Now everyone’s health is everyone else’s business millions are encouraged to hand responsibility for themselves to the taxpayer, live grossly and expect that others will pick up the bill.

    Again and again under a welfare state fecklessness becomes wisdom and prudence folly. What sort of public policy is this? It debauches the citizen as inevitably as QE debauches the economy. Is there not one single politician who dare call an end to it?

  5. alan jutson
    Posted August 27, 2016 at 7:01 am | Permalink

    I agree with the points you make John as it is simply common sense, but I am afraid Common sense is little used in many of our State run Departments.

    As I understand it a new report is about to be released on how a better and more efficient NHS should reduce costs, which on the face of it sounds an excellent idea, until that is you hear that it contains suggestions of Ward closures, A&E Closures, and even Hospital closures, because that will save money.

    With a growing population, and with a growing elderly population, cutting bed numbers when most hospitals run at a reported 98% occupancy rate is simply ludicrous.

    We already have patients sent home too early on many occasions, who then have to return again due to complications and infections.
    We already have over one million full time family carers who look after family members 24/7 with not enough support from the so called professionals, with those family carers often needing respite care themselves eventually because their own health then suffers under the strain.

    Time for us to have a real and proper grown up discussion about what we really do expect from our health service and how much we are prepared to spend to improve it not cut it.

    • alan jutson
      Posted August 27, 2016 at 7:13 am | Permalink

      Fully appreciate that with modern technology and advances in new surgery techniques, recovery from many operations now is less than it was many years ago, but very often aftercare has not moved forward with it.

      In addition the range of operations completed is also growing, tattoo removal, breast enlargement, IVF for single people, etc etc, should these really be done at the expense of the taxpayer ?
      Likewise should self inflicted injury in the form of drunks and drug abusers also take up expensive hospital beds ?

      Perhaps in the future the NHS cannot be all things to all people, for all conditions, and still remain free at the point of use for everything.

    • fedupsoutherner
      Posted August 27, 2016 at 9:34 pm | Permalink

      I have friends in Worthing where I used to live. Not only is the area going to be saturated with new housing, the roads are not going to be improved and the NHS is closing numerous wards and cutting beds. How can this work when the population of the town is obviously going to escalate rapidly?

  6. Doreen Dickinson
    Posted August 27, 2016 at 7:11 am | Permalink

    If you have more than 1 item on repeat prescription & you run out of 1 you can’t just apply for that 1 you have to have the whole prescription, hence people stock piling or throwing it away. Stop giving prescriptions for paracetamol & ibrufen to people that don’t pay. Cost over the counter 30p- 80p

    • sm
      Posted August 27, 2016 at 9:30 pm | Permalink

      Your first assertion is incorrect. When I have over-accumulated medication, I simply speak to the pharmacist and none is supplied for a month.

    • hefner
      Posted August 28, 2016 at 2:34 pm | Permalink

      Doreen,
      My GP has not given a prescription to any in my family for paracetamol or ibuprofen for more than 6, 7, 8 years? These medicines have to be bought full price (indeed around a pound) from a pharmacy or better a supermarket.
      You are indeed very lucky to still get a prescription for those.

  7. fedupsoutherner
    Posted August 27, 2016 at 7:21 am | Permalink

    Only give out prescriptions for a short time to begin with unless the patient has had them before. There are far too many prescriptions given for a long period where the patient is allergic and has to take them back. These cannot be used again. A waste of NHS money. Also start cracking down on people who come over here purely for free treatment and to give birth.

  8. agricola
    Posted August 27, 2016 at 7:28 am | Permalink

    You are correct in everything you highlight. Add to it a much more agressive and professional NHS purchasing body for capital equipment and consumables and we are on the way to getting it right.

  9. Iain Gill
    Posted August 27, 2016 at 7:50 am | Permalink

    Plenty of foreign nationals with indefinite leave to remain are entitled to treatment, as are those from countries offering reciprocal treatment to Brits in their home country. It is the long list of other foreign nationals entitled to free care which upsets people, as do those getting treatment with no entitlement.

  10. Antisthenes
    Posted August 27, 2016 at 7:59 am | Permalink

    There is a tailor made system that delivers all of that wish list bar two “NHS treatment free” and “PFI”. However it virtually does deliver free treatment for the least well off and it does not have a PFI problem or would ever cause one. I am of course referring to French health care which works considerably better than the NHS because it’s provision and funding is provided by the private sector. This has the added bonus that as the cost of the health care increases more of the burden can be moved to the private sector and therefore not the taxpayer. The taxpayer will always have some input to ensure that healthcare is available to all regardless of their circumstance.

    The NHS will never be able to to do any of the things on your wish list adequately because being a monopoly and being solely funded by the public purse it has no incentive to do so. If the customer does not have any responsibility for payment then demand will always be greater than need. If the NHS does not have to compete for customers then the service does not have to improved as it is a take it or leave it situation. What it does motivate is for NHS employees to use the funding not for the customers benefit but for their own. That can be seen by the overlarge administrations in hospitals and GP surgeries levels not seen in French ones, bad work practices, attitude problems and accumulation of privileges and rewards that are not earned or reasonable.

    It is time politicians especially on the left and the people stopped living in La La land and contemplate a completely different healthcare system than the NHS provides. Either adopt the French system or at least learn from it. Unless that happens the NHS will never be fit for purpose or financially sustainable and it’s dysfunction will continue to increase. There are many good people who work in the NHS but they are being corrupted by the way the system is constructed and not motivated to give of their best. It is not the employees who are at fault but the environment in which they have to work.

    • Antisthenes
      Posted August 27, 2016 at 8:02 am | Permalink

      “because it’s provision and funding is provided by the private sector”

      I wish to correct an error the above should read because it’s provision and funding is “partly” provided by the private sector.

  11. Anonymous
    Posted August 27, 2016 at 8:01 am | Permalink

    If we are to believe that mass immigration is great for the economy and crucial for revenues to pay for pensions, the NHS and general welfare then the NHS should be swimming in money and skilled staff by now.

    That we are having to cut the NHS at the very time the population is booming tells us the truth.

    And can we please dispense with the Labour expression “…investing in the NHS”. Investment involves monies which can be recovered and which accrues interest and dividends. Once money is spent on the NHS it is spent – it is not ‘invested’.

    We do not sell NHS services and make money out of them, rather we give them away to whomsoever turns up.

    The other truth is that the rest of the world have got to hear about our largesse and this is evidenced not just by the words of refugees – but the fact that refugees are battling their way (literally at Calais) to get to Britain in particular.

    Off topic. I hear from an extremely reliable and knowledgeable source that there will be power cuts this winter. This has been long predicted but will be blamed on Brexit.

    In actuality most of our crises has some connection with our membership EU – especially our population, housing and energy crises.

    • rose
      Posted August 27, 2016 at 11:45 pm | Permalink

      “Immigration has been a fiscal cost to the UK Exchequer. Between 1995 and 2011 migrants in the UK were a fiscal cost totalling £160 billion, or over £9 billion a year.”

      From Migration Watch and House of Lords report on economic impact of migration.

  12. CHRISTOPHER HOUSTON
    Posted August 27, 2016 at 8:01 am | Permalink

    The Labour Party is like the affable guy in the pub, the golf club or in gatherings of the Tiddlywinks Appreciation Society. No matter what the subject of conversation, women, space research, nuclear power, football, he will turn it all round onto his hobby-horse, perhaps lepidoptery and how he thoroughly enjoys pin-sticking. In the case of Labour, a discussion of women is immediately turned into ” We don’t have enough nurses in the NHS “; on Space Research: “Just think how many hospitals we could build if we didn’t send that rocket to the asteroid “; on Nuclear Power: ” We could employ another one hundred NHS doctors if instead of nuclear power we simply whistled in the wind “; with Football “Just think how many NHS baby units we could finance if we didn’t pay footballers so much.” Yes , yes, yes. But repetition of NHS, NHS, NHS, given that we’ve had hospitals since the Norman invasion in 1066 and modern research suggests much before that, that if we haven’t got our health service right in over one thousand years of activity then its pointless banging on about it when most people wish to continue with their Tiddlywinks or Pint.

    The Labout Party claims to have created the NHS in 1947. So, 70 years, and Labour on its own admission has failed to get it working properly. Perhaps it should try doing something it is good at.

  13. Colin Watson
    Posted August 27, 2016 at 8:07 am | Permalink

    Totally agree John and in particular about efficiencies in systems. Over the past two years my family have seen the NHS at close quarters and although we think it is a fabulous service, but not perfect of course, there are considerable efficiencies that can be made. Cutting overpayments on agency staff and improve systems. One prime example being all those who have an eMail address can have there hospital correspondence via that channel. I had a NHS procedure at the Circle Hospital in Reading and they sent paperwork by eMail.

    Poor communication among departments also increases costs, creates delays.

    It’s not a task that I would like but I am sure that lots of efficiencies throughout the NHS would add up quickly and allow funds to be more effectively spent.

  14. Nig l
    Posted August 27, 2016 at 8:26 am | Permalink

    As usual some good suggestions but they are tactical, the real issue is cultural, the culture of poor management with a very expensive, but important element, the consultants, acting like seigneurs.

    If they had a total quality management approach, we would not be continually having these discussions.

  15. Iain Gill
    Posted August 27, 2016 at 8:34 am | Permalink

    And national insurance number proves nothing, plenty with one not entitled to treatment, and plenty without are entitled to treatment.

    Remember large numbers of foreign students get them when they arrive as they are allowed to work 20 hours a week, and stay after their visa expires etc.

  16. sm
    Posted August 27, 2016 at 8:41 am | Permalink

    John – in the early 1980’s, when I and my contemporaries were in our prime, a very close friend was an NHS consultant at one of London’s major teaching hospitals. Time and again he would tell us, in huge frustration, that funding just disappeared down a black hole generated by incompetent management.

    Nowadays, I and my contemporaries are OAPs and are inevitably using NHS services far more. What we experience is frequent examples of miraculous modern medical techniques and utterly appalling and unforgivably incompetent day-to-day management.

    Plus ca change, plus c’est la meme chose.

  17. JoolsB
    Posted August 27, 2016 at 8:56 am | Permalink

    ” Labour, the SNP and the Lib Dems still also support this approach.”

    Very kind of the SNP to support this approach when it is only the NHS in England you are talking about John, although of course like every other politician, you always fail to mention that fact when talking about the NHS.
    If you really want a fairer deal for England you could start by insisting all those England only departments the UK Government is responsible for are given their full title, e.g. the Department of Health for England or the Department of Education for England.
    You and your colleagues could also ask what right the SNP have to approve or disapprove of any policy which only applies to the NHS in ENGLAND especially when all the things mentioned above, prescriptions, dental checks and eye checks are absolutely free in Scotland, unlike England.

  18. Newmania
    Posted August 27, 2016 at 9:21 am | Permalink

    The problem cost of a failure to confront our debts, and the difficulties we will have realigning to our poorer future is not one the working population can sustain. Current Brexit crowing about the absence of an Armageddon few thought likely in the first place does not mean that zero interest rates increased borrowing and a lower currency has no cost. The real break in trading arrangements will have a considerable cost especially as Brexit seem oblivious to the threat to our largest export , financial services
    Even the kindest predictions see a slow down in growth and that will mean our already considerable deficit difficulties will have to be tackled more urgently. The very last thing the country could afford to contemplate are increases in taxes so the question is not , whether we cut but what we cut . How the NHS avopids this is hatd to see given iuts sheer scale .
    A few good ( ish) ideas are entirely irrelevant . The only thing that matters to the forces of Brexit are to defer any such pain until after the country is irrevocably committed to a future of isolation form Europe which , in effect means we have no government . We cannot afford this endless rhetoric at the expense of decision. Theresa May must set out a credible future for the country ,as yet she has not . Fudge soon becomes sickly .

    One of the costs of Brexit , was always going to be competence .I gather that the question of passporting alone is occupying tribes of state officials not even up to knowing the information tghey should gather ( Mr Redwoods claim to have solved the problem is beyond parody !).
    The mountainous task or reknitting every single one of our International arrangements will be chaotic of course and as with every state enterprise we can expect a meandering effort to avoid blame .
    So we will see no decision about the NHS , we will see no plan prospectus . Instead we will retrunto the muddle of Post war Britain where no-one was to blame , no-one k new why but buildings crumbled maintenance was deferred and when every issue is set in the Brexit/ Remain culture war just as it was between Marxism and Free enterprise before .
    Like any war it will excite those in it but everyone else will chiefly notice the lack of roads food jobs rational government and working services.

    Absurd slur on Brexit removed ed

  19. English Pensioner
    Posted August 27, 2016 at 10:23 am | Permalink

    Yesterday I read that the NHS was proposing to close more wards to cut expenditure; if this is the best that management can think of we urgently need new management.
    A few months back, my wife was due for an operation which would mean a couple of nights in hospital. On the first scheduled date it was cancelled after she was prepared for surgery because some tests hadn’t been carried out (or as my wife believes lost by the hospital). The second time it was cancelled because there were no beds available. The third time she was told to come in, although “we haven’t got a bed”. They did the op and somehow found a bed.
    But look at the money that was wasted. Presumably each time the surgeon and theatre staff were available, but on two occasions just sat around doing nothing. What a waste! Even an unused theatre costs money and, in the real world, any business wants to keep its facilities running for the maximum number of hours possible; but not the NHS.
    How many more times has something like this happened at this one hospital? And how much waste is there if the cost is added up for the NHS as a whole?

  20. Roy Grainger
    Posted August 27, 2016 at 10:36 am | Permalink

    Yes the Shadow Health Secretaries comments were surprisingly constructive.

  21. Nick White
    Posted August 27, 2016 at 10:38 am | Permalink

    A charge for not attending an appointment unless there are mitigating circumstances would focus minds that the NHS is not “free” but paid for via taxes. There were 63 missed appointments at my GP last week. Is it really too much trouble in this day and age of mobile phones for someone not to phone and cancel? It would allow the appointment to go to someone that needs to see a GP.

  22. graham1946
    Posted August 27, 2016 at 10:40 am | Permalink

    What the top-down re-organisation at the cost of 3 billion achieved I don’t see. Even the architect of it all has disappeared. It was monumental cock-up and resulted in even more paperwork than ever, which uses up far too much clinicians time and longer queues again. It’s about time the NHS had proper computer systems that actually work and embraced the new millennium.

    For instance, a couple of years ago I had a major operation in an Australian owned private hospital on the NHS with the consultant I saw in the NHS hospital where I had all my tests.

    I developed an infection and the Consultant’s secretary phoned to say that a prescription would be left at the hospital pharmacy. As the hospital is a 40 minute drive away and I was in great pain I asked if the prescription could be faxed or electronically sent to my local pharmacy who could make it up and deliver to my home. They said it was not allowed and I had to attend personally to collect the drugs, which I did by getting someone to drive me. This kind of idiocy is, apparently quite common and wastes everyones’ time and patience.

    I have suggested the PFI contracts be bought out many times over the last few years on this blog so it is not new, just that the politicians are slow to see such an obvious remedy and then think it is revolutionary when one of them suggests it.

    Get the NHS out of the clutches of the politicians and fund it properly according to the demand on it and we will see an improvement. Every year another third of a million swell our population, but does the money keep up? As even the base load money is not correct, I would doubt it. W underfund by 2 percent of GDP against first world averages and have the most densely populated advanced country. We let in all sorts of diseases without checks. Money can always be found for the banks and vanity, but the most vital service we have is done on the cheap. The entire cost of the NHS is about one eighth of the money the banks were bailed out with.

  23. behindthefrogs
    Posted August 27, 2016 at 11:21 am | Permalink

    If the government is serious about reducing NHS costs it must implement solutions to some of its overloads like the sugar tax and minimum alcohol pricing. These taxes should not be directed to nice causes but used to cover the cost of the NHS.

  24. ian
    Posted August 27, 2016 at 12:51 pm | Permalink

    So now after years we are to get debate on health care.
    As i said the other week PFI is big problem, how anyone could leverage up the health service by 7 to 1 that means you borrow 1 billion and the banks and companies want 7 billion back over 30th years, looking at that, how can you expand the health service with more people coming in all the time with 7 to 1 leverage for new hospitals, they shut down old hospitals which have no debt to pay for the new hospitals which are loaded with debt, This new plan they are talking about is just the old plan which is make sure the bankers get their money so cut service to the bone.

    Then the problem with trusts ministration, one manager for 2.9 staff, must be one of the highest ratios in the country, yes that 92.500 staff to 34.000 managers and the message is, us in the building next door are doing alright so do not look at us for any saving. that the way it is set up by parliament, like two separate companies fighting for resources in side the one company, one fighting for bankers and companies with pay rises for it staff with bigger pensions and the other one fighting for more beds, equipment, drugs and staff and a pay rise to attract more people to be nurses, well you all know who wins as set out by parliament.

    Now my question is, can a hospital run itself without a building full of ministration staff next door because without the doctor and nurses telling the ministration staff by computer or phone what is happening they could not do their job and when the information goes into the computer that it, everybody know all over the hospitals to the GPs, a hospitals is quit capable of taking care of itself because as soon as something is taken to be used it is recorded by computer and reordered like the beds and appointments drugs, food and so on.
    The only thing i can think of is that it parliament that has made it like this, with their full employment ideas, all BS and GDP must go up so they can have there say at international meeting as being number 5 in the world for GDP.

    The new hospitals are built with fewer beds because of key hole surgery and you go home same day or your stay is no more than three days which is great but a lot bed are taken by older people who cannot go home so the hospital cannot do the mount of surgery the hospital was designed for, so i think if the staff in the building next door move out the elderly can be put into their building to free up the hospital so it can get on with it job as they were designed for.

    Is it time to call in new PMs in parliament and rid of the rubbish one to get the job done.

  25. Martyn G
    Posted August 27, 2016 at 1:17 pm | Permalink

    The elephant in the room that no politician seems willing to speak on, is the sheer additional numbers of people now resident, legally or illegally, in the UK – and largely, it seems, in England.
    The NHS we are told is approaching breaking point because of numbers wanting treatment. Wards and hospitals are being closed and dire emergency arrangements being made to hopefully cope this Winter and if the numbers of immigrants continues at the current rate – and there are no signs or possibilities of reducing those numbers. Without seriously firm political action being taken – and soon – it is difficult to conceive how the NHS can stand up to the burden of ever-increasing numbers for very much longer.

  26. Jack
    Posted August 27, 2016 at 1:38 pm | Permalink

    Any cost savings made by the NHS should be passed on in the form of lower taxes. Otherwise the budget deficit will get too small to support the economy.

  27. Bryan Harris
    Posted August 27, 2016 at 1:42 pm | Permalink

    Hi John – Agree with your comments

    BTW – nice to hear your ideas for leaving the EU are amongst those being considered by the government.

    NHS – It is very hard to get a grip on the costs without a rational breakdown. Is there such a thing? EG xx was spent on support staff over xx hospitals – xx was spent on drugs – xx was spent on management salaries..ETC ETC.

    Using that data, the old 80-20 rule comes into play where the highest category would be attacked first.

    Additionally, the NHS needs to look at cheaper/better ways of doing things. For too long alternative medicines have been ignored through outright prejudice.
    We want an effective NHS, so let’s start looking at all possible solutions to the problems of patients.

  28. ian
    Posted August 27, 2016 at 2:53 pm | Permalink

    With the BOE starting to buy corporate bonds and now the fed want to change the law in the usa so it can buy corporate bonds and companies shares with QE, how long will it be before theses private banks own everything on the markets on behalf of their countries, Japan is already doing all this and still going down the pan, what is QE, is it the state buying it own bonds by way of a private bank called BOE which can print money at will of any amount with no assets behind it and now corporate bonds and shares to be added to what it can buy, the idea behind buying government bonds is that the treasury orders the BOE which is a private bank to print the money to buy the bonds and the interest go to the treasury if the country is not in negative interest rates because if that happens the treasury might have to pay the private bank but it will never come to that but buying companies bond and shares was never in the book, this is a add on, when they buy government bonds they will never sell them, they are to be rolled over forever till inflation has eaten them away, might takeover a hundred years erode there value but buying companies and their bonds is another thing, the BOE can print 50 trillion pounds in seconds and go to the markets and buy everything in sight that week, now why would a parliament want to do that, is it to make sure the elite lose no money or to become more like china or is it that BOE can run companies better or is it that parliament just want to buy everything up because they have made mistakes in running the economy and all companies will be going broke in the future or is it just parliament wanting communism so they do not have to explain themselves any more to the people, it has not happen yet but they are getting ready for it. with usa leading the way by putting interest rates up with the fed standing by with it new laws to buy the markets up, what about private companies and small business are they going to buy them to or just let them go to the wall.

  29. Bert Young
    Posted August 27, 2016 at 4:26 pm | Permalink

    It’s time for a complete re-think on the NHS from the top down . Allowing foreigners access is merely the tip of the iceberg . The expansion of our population has put an enormous strain on our infrastructure and this simply just has to stop ; the NHS is one of the first casualties of this .

    Nitpicking the way around the NHS problem is not the way to go ; successive Governments have all shied away from making drastic change for fear of upsetting the voters ; the future has to be different otherwise electorate support will disappear .

  30. acorn
    Posted August 27, 2016 at 4:59 pm | Permalink

    Privatise it JR, you know you want to. Privatising the NHS would be the Conservative party finding the Holy Grail. Along with Education that is; privatisation of which is covertly proceeding quite well.

    There is nothing wrong with moving the post Brexit UK economy, nearer to a Pay-As-You-Go model. Free at the point of use leads to abuse. It is far better that the proletariat understand what things cost to supply. Making six trips a year to a free GP service is now considered the norm. In my youth, going twice a year was considered excessive!

    A debit card, state funded, could be issued to each UK citizen, covering the first £2,000 a year of health services. The same card could be loaded with £6,000 a year for education services up to the age of 22 years; including a gap year for voluntary service overseas. That is what the state is currently spending on such services.

    Naturally, this would put a stop to “health tourists” looking for free elective surgery, arriving from overseas. No health debit card would mean just free basic life support care, and a phone call to a charitable organisation for financing anything further. The citizens of the UK would decide how much they would wish to support such health Charities.

    Reply No. We are pledged to free at the point of need.

  31. David Kemball-Cook
    Posted August 28, 2016 at 10:48 am | Permalink

    John, do you have any idea why the govt could not tell the BoE to do ‘NHS QE’? The NHS issues bonds for all its PFI debts, the BoE buys them all up.

    The PFI debt would be eliminated, or at least transformed into low or zero interest bonds.
    Nobody expects, seriously, that all the existing QE debt would be unwound, so all this PFI debt could also be quietly consigned to history

    Thinking about it, what was actually wrong with ‘Peoples QE’ anyway?
    Apart from that the idea came from John McDonnell?
    Seems a better use of printing money than giving it to banks

  32. Dunedin
    Posted August 28, 2016 at 11:26 am | Permalink

    Recently I was involved in returning NHS equipment for an elderly relative – unfortunately it is not as simple as dropping it off somewhere.

    Paperwork has to be generated – one list for equipment issued to the lady and another for equipment issued to her late husband. Separate drivers were despatched with the separate lists on different days to the same address. The first one left a card having turned up on a day when they had been advised the house would be empty, and the second chap was not entirely happy about collecting stuff not on his list. This is mindless wastage of taxpayers’ money. Also, as another reader has mentioned, it is impossible to return supplies of medication which have not been opened and could be prescribed to someone else. The NHS are always telling us they need more money, but taxpayers want to see commitment to tackling waste.

    It is encouraging to see there is crossparty interest in buying out expensive NHS PFI schemes – how far do you think the government would be willing to go in buying out PFI schemes overall?

  33. Christine
    Posted August 28, 2016 at 11:01 pm | Permalink

    “the NHS should get better at collecting equipment when people no longer need it, and recycling it for future use” – I agree. I recently tried to return some crutches and a walking frame that had been issued to my Mother-In-Law and were no longer needed. It was an impossible task. I couldn’t believe the waste. Instead of just pumping more money into the NHS we should be looking at how savings can be made. Patients should provide a deposit when taking NHS equipment and be obliged to return it.

    More training courses for British nurses should be set up. At my local college they only take foreign students because they can easily fill the courses and they get more revenue from foreign students. There’s something wrong with this system.

    Using NI numbers to verify who should get NHS treatment wouldn’t work as these numbers are given out to anyone who applies for a DWP benefit as these can’t be processed without one. It needs to be a check on nationality and NI contributions. My GP practice wrote asking for me to present proof of nationality and when I turned up with the documents at the surgery they said they didn’t need to see them now.

    Another saving the NHS could look at is the way prescriptions are administered. In this day and age why are we still using paper prescription scripts? Why is the patient allowed to tick a box to receive free prescriptions? At my doctors the prescription is sent electronically to the chemist and then the chemist prints it out for me to sign. Why? Prescription exemptions are authorized by the doctor and the exemption card issued by the computer system in Newcastle. As it’s all held on computer why isn’t this information regarding exemption passed straight to the chemist thereby cutting down on fraud?

  34. Juliet
    Posted August 31, 2016 at 10:59 am | Permalink

    The NHS is a publicly funded healthcare that is slowly been diminished because its too freely accessible to the whole of Europe and rest of the world. I think the NHS should be for UK citizens only, we and our parents invested in it so it can be free and available for the next generation of citizens and so forth.

    If you have a bank account, you’re not going to allow everyone access to it and spend your money, so why would we think it is ok to do this with NHS

    What we should be saying
    If you plan to visit/live in UK, you need healthcare insurance
    If you plan to live & work in UK, you need savings £20k

    The NHS is not free
    EU EEA Nationals, non-EU Nationals visiting/working/living in UK should pay to use any of the NHS up-front, and claim the cost of healthcare under their country of origin insurance. Those who become UK citizens should be treated differently regarding contributions into the system.

    NHS has not evolved with growing population.
    NHS funding model needs to be reformed.

    Gone are the days when NHS investment and efficiency was easy to measure. We don’t even know how many people currently reside in the UK let alone who can access NHS.

    Two major issues …
    1. increased population from outside of UK
    2. reimburse model from overseas visitors not managed properly

    NHS fails to claim back costs from those who abuse the system …
    1. 10,000 Polish women came to UK for free NHS abortions £10m in 2008
    2. NHS counts deficit £900 million cost of treating EU visitors
    3. EU EEA nationals are charging the NHS for care in their OWN country*
    via EHIC they charge the full cost of medical treatment in their home
    countries to the UK, even if they have never paid a penny of tax in Britain

    *http://www.dailymail.co.uk/news/article-3191557/Foreigners-charge-NHS-care-country-Loophole-lets-thousands-migrants-free-treatment-card-GP.html

    “In Hungary, you have to pay 8.5 cent of your monthly salary for state healthcare. So you can see why people so desperately want to get hold of them.
    They are a goldmine”

    Hungarian journalist Ani Hovarth

    Other loophole EU EEA bypass employment 6 month loophole, get pregnant or come to UK pregnant to have a baby in UK and kickstart short-term stay to get housing, benefits, long-term stay slip through the system

    Health Tourists …
    1. ‘Deliberate’ use of the NHS specifically to receive free treatment
    £110 million and £280 million a year
    Acute urgent expensive surgery walk-in thru A&E: £60-80 million
    2. ‘Normal’ use of the NHS foreign visitors £1.8 billion a year
    £500 million is recoverable

    This impacts everyone who has contributed to NHS over the years, when you come to use the service it barely exist, its appalling to see what we have allowed to happen to NHS, and to see how the NHS used to be. I have family who worked in NHS in 50’s thru early 90’s and they are shocked, again this is down to people managing NHS Trusts not listening to patients about deteriorating services etc., and the problems not filtering up to people making decisions on how collectively they need to work together to change ‘NHS model’ and why they need to change. Doesn’t matter how you patch things the problem(s) still exist.

    Senior citizens are living with pain on a daily basis because they are put on waiting list for urgent treatment that has to take a back step because NHS is seriously overstretched, under-funded, archaic backward paper processing of patient intake/waiting & non-existent appointment system, and consistent abuse of NHS by growing intake of EEA & non-UK nationals who clearly don’t value the system because they see it as free

    Reason why the NHS is not moving forward, it has a flawed model, because it’s badly run, it needs to become proactive rather than reactive.

  • 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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