Better healthcare

I am taking an interest in how the extra money for the NHS will  be spent. It is most important that NHS England comes up with a proper plan of what they are trying to achieve by way of expansion and service improvements, so they can then test out how many extra staff they may need and what new contracts they should sign to deliver the  better healthcare.

I understand that the Health Secretary is engaged on just such an exercise. I would be interested to hear from people, especially constituents, on what would be sensible requests for spending this additional cash. My priorities include wanting a well staffed GP service locally so that patients can get appointments that are timely and GPs feel they have manageable workloads so they can provide the best possible service. I think we do need some more hospital capacity for the most common procedures to reduce waiting times and provide some  choice and flexibility for patients over when and where they receive treatment.

Local services need to  be expanded to reflect the additional homes and increase in population. I share the government’s wish to see better mental health provision where there are proven protocols and treatments that can make a difference to people in need of help.

The government is considering the role of technology in future medical services and care. How far do patients want to go with digital booking, or even  remote consultations? I am keen that this should  be based on patient preference rather than a mandatory conversion, as healthcare is a private and individual matter where  the patient needs to feel happy with the system. Patients need to  trust the doctor and the way he or she works for it stand most chance of being a success.


  1. Lifelogic
    January 29, 2019

    We need freedom and choice, we need to start charging the patients who can afford to pay something. If people can pay for a hair cut why not for the GP. We need to change the tax system so that people are not penalised for using private medical care so as to lighten the load on the NHS. The NHS is a dire virtual state monopoly, with rationing, delays, general incompetence and some of the worst heath outcomes for a developed nation.

    Gosport, Mid Staffs, Bristol Royal Infirmary, Morecambe Bay, Furness General ….. are just the tip on an iceberg. But “Conservatives” like May and Hammond love dire state monopolies.

    1. James
      January 31, 2019

      We need to get back to “the patient will see you now doctor”. Unquestionably, the NHS has become a black hole for taxpayers money. Putting in further vast sums is tinkering round the edges, and will change nothing. The NHS may have been the envy of the world seventy years ago. No longer. The health systems of many other countries have surpassed us, with clearly better patient outcomes. The solution is to foster a completely free market in healthcare, with the medical equivalents of Aldi, Tesco and Sainsbury’s running things rather than bureaucrats. You need only to think of what would happen if bureaucrats were in charge of food distribution.

      1. Lifelogic
        January 31, 2019

        Exactly it is a dire state monopoly and real competition is largely killed by making it free (all be it delayed and rationed). The best way to spend money on it is tax breaks to encourage people to make private health provision, thus lightening the load on the NHS. It is the envy of no one. It is one of the worst systems of any developed nation based on outcomes. This is very clear from the statistics.

        1. Lifelogic
          January 31, 2019

          More lefty PC, anti-male, socialist, lunacy from the courts in deciding that working in a shop is of “equal value” to working in a warehouse. If the shop workers want to work in a warehouse then let them. It is not the same at all. How on earth can the courts make sensible decisions on what is of equal value. All jobs and differences advantages and disadvantages, let the market decided by supply and demand.

          Is being a top female footballer of equal value to being a male one? If so why does one get circa 1000 times more? It is just supply and demand get the courts out of it. It is hugely damaging.

      2. Javelin
        January 31, 2019

        Did you know all MPs and senior civil servants and their families get private health care?

        A dirty little secret MPs try to hide from you.

        When MPs get private health care they privately don’t care about health.

        Reply MPs get no such thing

        1. Iain Gill
          January 31, 2019

          I dont know about private healthcare, but it is public domain that MP’s are the only group entitled to a GP at home and a GP near their place or work, and able to get referred according to either the rules of their home CCG or London CCG. Everyone else who works in London but lives officially somewhere else gets no such access.

          It is also obvious that the NHS treats VIP’s differently, MP’s being a classic example, as much MP diabetic care, heart ops, and so on show, radically different to what they would get as ordinary members of the public.

        2. Chris
          January 31, 2019

          I understand civil servants get greatly reduced private health care rates, and similarly with travel insurance.

        3. Lifelogic
          January 31, 2019

          Employers and the public should all be encourage to arrange private health care (with tax breaks and abolition of Hammond’s 12% tax on medical insurance).

          Why should some people have to pay four times over to choose to go privately. Once for other people, then the tax and NI on the money they need to earn to pay for their own cover then Hammonds 12% on top of the insurance. Hammond is an appalling economic menace.

          Freedom of Choice please. Let us use our own money as we choose, get the government out of the way.

          1. Iain Gill
            February 1, 2019

            when you have to go private because the NHS fails to deliver then you should get a refund of the cost as a tax rebate.

            often its not that we want to go private its that the alternative is dying.

      3. jerry
        January 31, 2019

        @James; “The health systems of many other countries have surpassed [ours]”

        Yes, those with an even more regulated bureaucrat systems than our own health service, such as in Germany or France for instance. In Germany tier one health insurance is compulsory, thus a tax in all but name, and set annually by statutory regulation.

        “what would happen if bureaucrats were in charge of food distribution.”

        Like it was were during and after WW2 you mean? When everyone got what they needed, not what they could afford or wanted on the whim, what is more the nation was never in such good (nutritional) health, before or since!…

        1. Mark B
          January 31, 2019

          You could buy more if you had the money and the items you wanted were in stock. There was also the black market.

          1. jerry
            February 1, 2019

            @Mark B; Yes, unfortunately there will always be the selfish and criminal minds…

        2. Dame Rita Webb
          February 1, 2019

          Jerry in theory you are correct about food rationing, however in reality read any of the social histories of WW2 and they will tell you a different story. There was a thriving black market in food, rampant corruption with the forgery of ration books etc and most people today would not think Lord Woolton’s ideas on food to be very nutritional. Its delusional to think the rich and influential did not go without their luxuries. Winston did not go short of whisky and cigars and did not seem to lose any weight during the period either.

      4. Iain Gill
        January 31, 2019

        correct, you can ring a GP in Italy and they will come round to your house within a few hours, for a very modest charge. and you pick your own GP none of this catchment area nonsense.

        in Italian A & E you walk straight in and see a doc straight away

        in New Zealand you walk into a GP (and many consultant) waiting room and get seen within an hour, just like walking into a barbers shop here, and you can pick any GP you like near work, near home, absolutely anywhere. the towns and cities have walk in clinics where you can walk in and see a doc 24/7, they would never palm you off with a nurse pretending to be a doc.

        in Belgium get taken to A & E and need a heart stent you will reliably get one within an hour or two, here its very unusual for that to happen and many are just left to die for want of simple cheap treatment.

        and so on. people have become so dulled by constant exposure to the NHS poor service that they think its somehow acceptable.

        1. Chris
          January 31, 2019

          Agree, I G, and woe betide anyone who complains about the nHS.

        2. Lifelogic
          January 31, 2019

          Well, the only way the NHS has of deterring people going to A&E or their GP is to make them wait for three hours or put them off as best they can by making it a fairly appalling experience. So they do all of these things. They have your money already and so patients are just a liability (not a customer) and are treated as such at every turn.

          If an A&E or GP had a reputation for no queues and excellent service they would drown in patients – so where is the incentive to perform? Such is the nature of dire state monopolies.

    2. Al
      January 31, 2019

      Billing overseas and other patients without national insurance should be a priority, and the postcode lottery issue desperately needs to be resolved. The bureaucracy behind the whole system needs an overhaul to stop money vanishing into black holes and paperwork.

      A system where private GPs or treatment can be used alongside or to complement the NHS would make sense. e.g. with increasing numbers of large firms either demanding doctor’s notes before the three day mark, or relying on the NHS for day-to-day reasons/drugtests, there’s no reason those services should not be provided by walk-ins and take the load off the NHS – or at least charge the companies for it.

      1. Lifelogic
        January 31, 2019

        When families leave the UK (and they report this to HMRC as they are supposed to do) it is still very common for GPs to continue being paid for many years, This for caring for these many non existent patients – so appallingly inefficient is the system and the payment system for GPs.

        Not their money after all that the government is wasting it is the tax payers – so what do they care.

        1. Al
          February 1, 2019

          ” This for caring for these many non existent patients – so appallingly inefficient is the system and the payment system for GPs. ”

          And yet when I first moved house I ended up remaining with my old GP for five years because none of the doctors where I now lived had space on their registers, and it was the only way to stay registered at all. The system is completely broken.

    3. Richard1
      January 31, 2019

      Yes all sensible but there won’t be support in Parliament for that approach and nor will Mrs May sponsor that line of policy so its academic.

      meanwhile I suggest we all hold our horses on extra money for the NHS, apparently Mrs May has agreed to hand over much the £39bn to the EU whether there’s a deal or not! Mr Robbins has allowed the fact that he thinks the govt’s plan to re-negotiate the WA is “madness” to enter the public domain. We really don’t have a chance. with inadequates like this negotiating maybe the best thing is just to kow-tow and stay in the EU and tell people ‘sorry you might have voted for it but its just impossible to leave. suck it up’.

    4. Adam
      January 31, 2019


      Govt used to support private medical care with tax relief.
      Now it pays for the cost of operations others would have paid for at full expense.

    5. jerry
      January 31, 2019

      @LL; “We need freedom and choice, we need to start charging the patients who can afford to pay something.”

      We already have choice, we already pay, there is no law that prevents people from taking out extra private but limited medical cover and many already do so, almost all pay for the NHS now, either via income tax, NI or other taxes. The NHS is not free, although it is free at the point of need (for UK nationals) as it should be.

      “We need to change the tax system so that people are not penalised for using private medical care so as to lighten the load on the NHS.”

      Except your beloved private care system is not universal, get run down by that No.7 bus and it will almost certainly be the NHS who picks you up, mends your bones etc, otherwise do tell me which of the many private medical scheme available in the UK run their own nation wide emergency response ambulances, A&E departments etc. comparable to that provided by the NHS?

      Also the NHS is cradle to grave for any one treatment, not time limited like so many private schemes are, which then dumps onward care back to the NHS or expect additional payments for pre-existing/continued treatments.

      “Gosport, Mid Staffs, Bristol Royal Infirmary, Morecambe Bay, Furness General ….. are just the tip on an iceberg.”

      You should check the figures for medical malpractice claims in the USA [1] before trying to tarnish the NHS with such a broad bush, most of whose scandals are due to miss management, brought about by the sort of deregulation and market forces you appear to approve of!

      [1] yes I know there are other health care systems and countries besides the UK and USA but Mr Lifeillogical wants to pay less tax, not more

    6. agricola74
      January 31, 2019

      Yes LL there have been quite unforgivable black spots historically , many of which could have been dealt with in the courts.
      Yes tax breaks for private health policies. Same for education as both lift the burden on the nation.
      Front line medicine is not in a dire state. Certain areas need better funding and more medical personnel. My main contribution omitted mental health which for too long has been a Cinderella. Something I find illogical.
      I have no hang ups about some choosing private health but I still have a firm belief that the NHS should be free at the point of need for any British national. I would also not quibble were a level of personal responsibility built into our demands of the NHS.

      1. Lifelogic
        January 31, 2019

        No one should be turned away at A&E due to an inability to pay, but what is wrong with charging those who can afford to pay the cost of their care? This encourages innovation, real competition and personal responsibility. Further more make people who do often dangerous sports insure themselves fully. People who drink or take drugs should pay to less money for the drink or drugs next weekend that way.

    7. BR
      January 31, 2019

      Everyone should pay. Did you get lost on your way to the Socialist Utopia forum?

      The idea is to deter needless visits and many of those are from poor life choices (smoking, drinking and eating bad food). Many of the people who do that would easily qualify for the free visits you suggest, whereas the working schmuck doesn’t have time to pester doctors with their self-inflicted grief.

  2. Mark B
    January 29, 2019

    Good morning.

    If there is to be new money for the English NHS I do not want non-English MP’s debating it in the House. Why ? Because they will do all they can to frustrate it so they can get more money for themselves.

    But it is not more money the NHS in general needs, it is massive reform and, a change in the law to prevent those who have not, and never will, contribute to it. ie Health Tourism.

    1. Mark B
      January 31, 2019

      Good morning.

      How did a comment from the 29th get here ?

      1. jerry
        January 31, 2019

        “Better healthcare
        By johnredwood | Published: January 31, 2019

        Mark B
        Posted January 31, 2019 at 5:48 am

        How did a comment [made by Mark B] from the 29th get here ?

        Two possibilities; 1/. Our host published this article in error on the 29th and you have forgotten replying to it; or more worryingly 2/. comments are getting spoofed some how in the names of others – perhaps time for a secure login system, using a public user name and a private password?

        Reply Yes published on wrong time trigger

      2. Stephen Priest
        January 31, 2019

        “How did a comment from the 29th get here ?”

        I have just checked with the BBC and apparently it due to the uncertainties caused by a no deal Brexit.

        In other news the Met Office has announce that their will be heavy snow tonight due to Brexit despite Global Warming.

        1. Stephen Priest
          January 31, 2019

          In other news the Met Office has announced that there will be heavy snow tonight due to Brexit despite Global Warming.

          1. Lifelogic
            January 31, 2019

            Also the climate alarmists everywhere in the world report that very cold weather in the Mid West (or hot weather, wet weather, dry weather, windy weather, calm weather or indeed normal weather anywhere on earth at all) is very clear proof that their alarmist warming religion is true and their Co2 devil gas – we are all doomed, doomed religion is accurate.

            100 months to save the world as Prince Charles put nearly 120 months ago – “less than 100 months to act” to save the planet from irreversible damage due to climate change.

            “Fewer surely your R.H.! Perhaps he not is more Tesco that Waitrose despite all that over priced organic stuff they sell!

        2. Chris
          January 31, 2019

          Yes, they go for the global warming option every time!

      3. Lifelogic
        January 31, 2019

        I am just good at predicting the future:- So next I predict that Brexit means sweat F.A. May will cave in, extend the leaving date, deliver a dire fake Brexit (with help of some Labour votes) and bury the Tory party perhaps for ever.

        Actually I think it appeared briefly the other day then went away again!

        1. Lifelogic
          January 31, 2019

          No sooner predicted that we get:-

          Brexit: ‘Extra time’ may be needed, says Jeremy Hunt.

          This the (PPE again) man who was so good at endlessly apologising the the very, very many appalling NHS disasters and pointless deaths they cause.

          Yet he never did any of the very obvious and easy remedies that the NHS required – why? Ones assumes because he is another remainer socialist dope like May.

          1. Stephen Priest
            January 31, 2019

            Most Cabinet and Shadow Cabinet member are freelancers these days. An idea pops into their heads one minute and it comes out of their mouths the next.

            No Extra time is need for Brexit.
            No Penalties (such as £39 billion or Irish Backstop)
            And certainly no replays (People/losers vote).

            The referendum was clearly won by Leave despite very biased referees and linesmen.

    2. JoolsB
      January 31, 2019

      No chance of that Mark. Insultingly they even have an SNP MP in the Health (English) Select Committee. After all for every pound of English taxpayers’ money spent in England, the Scots, Welsh & NI get Barnett consequentials – their reasoning for poking their noses into English only matters (which all those MPs squatting in English seats obviously have no problem with). Of course it doesn’t work the other way round when Hammond is dishing out billions of extra money in his budgets to the devolved nations whilst continuing to cut English services to the bone.

      1. jerry
        January 31, 2019

        @JoolsB; Forgive me, what are you implying, when I next travel to Scotland, because the NHS is devolved into four regions, being a UK passport holder resident of England I will need to take out health travel insurance?!

        There is no such “Health (English) Select Committee”, nice rant…

        1. JoolsB
          February 1, 2019

          Sorry Jerry,
          Afraid it’s you who does not know what you are talking about. Of course there is House of Commons Health Select Committee which is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health. Although the word England isn’t mentioned, it only applies to the NHS in England yet MPs from across the whole UK sit on it. The same with education. There is an Education Select Committee.

          Yes there are now four separate NHS’s in the UK. The Scottish NHS is run by the Scottish SNP Government and the Welsh NHS run by the Labour Welsh Government. Of course the English NHS is run by the UK Government.

          I suggest before any visits back to the UK you inform yourself of the facts. But don’t worry about health insurance, the good old International Health Service will look after you free of charge, all four of them.

          1. jerry
            February 1, 2019

            @JoolsB; No, it is you who is wrong, and do have the good manners to actually read what others say before making a further fool of yourself, just what did you not understand when I said “being a UK passport holder resident of England”…

            Not all DoH matters as they affect Scotland, Wales and NI are devolved, meaning the Health Select Committee deals with a UK DoH (not NHS) wide brief, so why shouldn’t the SNP [1] be represented on such a UK wide select committee?!

            [1] who, looking at the make up of the current committee, almost certainly also represents the interests of the other devolved govts. given the absence of either a Welsh or Northern Irish MP.

    3. fedupsoutherner
      January 31, 2019

      Well said Mark B. I am fed up with Scotland poking their nose into our affairs. It’s about time England was recognised as a country in its own right. Other devolved nations must have no say in what goes on in England. We are second rate citizens.

      1. jerry
        January 31, 2019

        @fedupsoutherner; If it is legitimately a purely English issue surely EVEL is the answer?

        1. Mark B
          February 1, 2019

          No ! Only equality of outcome. ie An English parliament.

          1. jerry
            February 1, 2019

            @MarkB; You want to waste £m’s on an English-only parliament when EVEL legislation does the job for little or no cost?!

            I though you wanted lower taxes, not a tax hike, talk about cutting ones own nose off to spite someone else.

  3. Dominic
    January 29, 2019

    The NHS is a vested interest. It is also a State employee vested interest. It now exists to promote its own interests and the interests of those it employs. The interests of the patient enjoy tertiary consideration. I can see this very assertion take form in my own GP practice. You can’t see a GP any-more unless it’s by Skype or maybe you’ll receive a call-back. This is of course the GP surgery constructing the delivery of its services around the needs of its employees

    And so they expect more funding for less work. Welcome to the British public sector.

    Throwing money at the NHS is a complete waste of scarce resources

    The Tories have become New Labour. They’ve embraced the concept of virtue signalling using taxpayers money.

    Reform of backward provision under this socialist PM is never a consideration. Such a strategy is politically awkward and causing negative headlines. The strategy now is simple, throw cash at it as you would meat to a lion in a cage

    I can’t imagine what it must be like to be a Tory MP under this PM. You must each day sacrifice ever more of your principles to support a bankrupt leader

    To conclude. Spending taxpayers money is not an achievement. Abusing the private sector to finance State spending for political advantage is not an achievement.

    1. Lifelogic
      January 31, 2019

      Exactly May is just a daft, misguided socialist. She is not much different than Mr Magic Money Tree Corbyn in essence, just degree.

    2. agricola74
      January 31, 2019

      Whatever you private health policy allows, wait until you really need and experience the NHS before deriding it.

      1. Lifelogic
        January 31, 2019

        Lots of people really need the NHS and find it fails to deliver or is rationed and delayed. They have paid in for year and then if fails them. It is one of the worse systems in the developed world as the statistic show clearly. It kills thousands through gross incompetence (and often worse).

        1. Lifelogic
          January 31, 2019

          It is I suppose better than no health care at all! I will give you that. But without the NHS there would be far better health care not worse.

  4. Mark B
    January 31, 2019

    Good morning.

    Notwithstanding the above, I would like to publish a comment for today.

    Local services need to be expanded to reflect the additional homes and increase in population.

    Our, now you mention the main problem – Population increase.

    Solution: Make them pay for private medical care and not have access to the NHS. The NHS should be for UK citizens ONLY !!

    1. Dame Rita Webb
      January 31, 2019

      Yep works that way in our beloved EU. When I have used the German and Dutch health services I have found the EH11 card to be a waste of time. You get into see the doctor after you have coughed up and its a trivial sum regardless. Unlike their British counterparts and their excuses, Euro medics have the resources to collect the fee and have no moral objections to charging foreigners for care either.

    2. Richard
      January 31, 2019

      I assume your referring to those pesky johnny foreigners using our services. Only those ‘ordinarily resident’ are entitled to free healthcare. Excluding A&E.
      This is reciprocated in EU (at the moment…..) and other countries.

      1. Jagman84
        January 31, 2019

        You better tell the NHS staff of this fact. It appears to be wantonly ignored on a daily basis and this has been the case for some considerable time. Non-EU nationals especially. Why pay for treatment, in your own country, when you can pop on a plane and get it free in the UK? Open borders and a welfare system are incompatible and is the road to financial ruin.

      2. Mark B
        January 31, 2019

        The Healthcare is not FREE, no matter who uses it. ‘Johnny Foreigner’ or not.

        It is only FREE to those who do not pay in. And that is the problem, too many taking out and not enough going in. And what does go in gets either wasted or, eaten up in salaries, benefits and outside fees.

        1. fedupsoutherner
          January 31, 2019

          Quite right Mark B. We pay and foreigners get it for nothing after a short while. Pregnant women ‘on holiday’ is a prime example. Why are they allowed to travel when they are due to give birth?

      3. John Hatfield
        January 31, 2019


        1. Mark B
          January 31, 2019

          Yes, thank you.

          Less haste and all that.


    3. Narrow Shoulders
      January 31, 2019

      By paying for the care the increased population would jump the queue. This will not decrease waiting times without increased capacity.

      The additional monies from the payments could be used to add medical staff but most likely will lead to more accountants and admin staff. So while the new arrivals will at least pay for the service UK citizens are unlikely to benefit from improved services and timings.

    4. Lynn Atkinson
      January 31, 2019

      Absolutely! And the ‘money’ must be with the patients –

    5. bigneil
      January 31, 2019

      The govt won’t make the NHS for UK citizens only. The Human Rights lawyers would have a field day carrying on their fight to get the rest of the planet free treatment on our taxes. What it probably will do however, is rename it to the International Health Service, free to everyone ( but only paid for by us, who won’t be able to get an appointment, because it will be full of foreigners needing translators and taking multiple time-slots ).

    6. Den
      January 31, 2019

      Nye Bevan must turn in his grave seeing his baby morph into the International Health Service. Free for ALL except the British Taxpayers.

      1. Mark B
        January 31, 2019

        This is it. If you are old, kept yourself fit for most if your life and end up due to old age in a NHS hospital, your chances are very thin. And I speak from someone with some past experience on how elderly patients are treated.

    7. Iain Gill
      January 31, 2019

      if you are a foreign national with indefinite leave to remain, often married to a Brit, with British children, of course you should be entitled to full access. you are in any case only one expensive form away from being a British citizen.

      on the other hand we offer indefinite leave to remain to far too many people, for far too many reasons.

  5. Everhopeful
    January 31, 2019

    Agree entirely..been saying it for years.
    Why shouldn’t GPS and dentists be treated like hairdressers?
    Horrible Marxist monopoly! Strangely imbued with a sort of quasi religion.
    Always terrified of it and at every juncture let down by it.
    Might help if those who entered medicine were kind people. Robots might be preferable?
    ( Oh and this directive re getting rid of “ghost patients” is being used by that new breed of terror ..the practice manager…to bully and threaten. Not good.)

    1. Dame Rita Webb
      January 31, 2019

      Not a marxist monopoly but a horrible example of crony capitalism. Look a bit closer and you will probably find your care being provided by an organisation headed by a Caribbean tax exile.

    2. Anonymous
      January 31, 2019

      Why shouldn’t GPs and dentists be treated like hairdressers ? Because after 8 years of highly competitive selection and hundreds of thousands of pounds worth of training GPs and dentists can name their price around the globe ???

      1. Lifelogic
        January 31, 2019

        About 50% of the doctors (trained in the UK at public expense) leave the UK or take up other work (as NHS pay and work conditions for junior doctors rather poor). They are capable people who can earn rather more elsewhere and are treated better too.

    3. Stred
      January 31, 2019

      The NHS is still sending letters to a French young lady who was a tenant of mine in 1994, returned to France and is now almost 50. They want her to make an appointment for a test at my GP s surgery, where she must have been s ghost patient for the past 24 years. The doctors are paid for preventive medicine. I did try returning the letters, which are posted but he regional authority, one of very many. They don’t seem to be interested. Perhaps the management is so well paid that they have done some complicated analysis and think it is worth the bother, rather like the decision to refuse to clean and re-use expensive crutches, surgical boots and wheelchairs.

      1. Stred
        January 31, 2019

        Sorry about smart alterations… by the and not worth. I can’t see the script while doing captcha.

    4. jerry
      January 31, 2019

      @Everhopeful; “Why shouldn’t GPS and dentists be treated like hairdressers?

      Because hairdressers, whilst privy to much local gossip, do not have to deal with sensitive personal medical information about their customers, and until recently their paper records (and even now, whilst digitised, not accessible to all other health care professionals).

      “Horrible Marxist monopoly! Strangely imbued with a sort of quasi religion.”

      GPs were actually a result if there not being the “Horrible Marxist monopoly” you suggest, simply because back in 1945/7 GPs demanded they remained aloof from the rest of the new NHS, that is why they have traditionally managed their own surgeries. That quasi religion you speak of, indeed, but it’s not Marxist nor NHS, but of the BMA (as was in 1945/7…

      1. Everhopeful
        February 1, 2019

        NHS was born out of the class war via Marxist influenced policies.
        Treated like hairdressers…in as much as you can go to which ever hairdresser you choose…and try another one if that one does not suit.
        Yes..many doctors were against the NHS seeing it as an undermining of their professionalism. In fact once it was imposed they tried to sabotage it by oversupplying free stuff…didn’t work!

        1. jerry
          February 1, 2019

          @Everhopeful; Your entire comment is a hard right wing nonsense on stilts, a pitiful case of “Make-it-up”. 🙁

    5. Everhopeful
      January 31, 2019

      The above was a reply to Lifelogic.

    6. agricola74
      January 31, 2019

      Because lovable Marlene wafting her scissors is not required to achieve A,s at school or spend seven years plus at medical school before being allowed to remove your appendix.

      1. eeyore
        January 31, 2019

        Is that a reason for appendectomies to be a state monopoly? Everhopeful suggests monopolies tend to be inefficient and self-serving, and who can seriously disagree?

        The recipe our host seeks for better healthcare, therefore, is more competition. Whether that is politically acceptable is another matter entirely.

      2. JoolsB
        January 31, 2019

        I do not begrudge the doctors starting on a salary way below £30K after 6 years in medical school but what I do find outrageous is the salaries and perks of those in the back offices on salaries many times that of a Junior doctor. My nephew and his wife are such people and are on salaries and pensions the rest of us can only dream of. Always seem to be off on holiday and after just having a baby he is now on 6 weeks paternal leave after she has had her full year off and have both now decided to work some days from home each week to fit in with baby.

        The country would be a basket case if this happened in the private sector but then we don’t have unions bullying our supine politicians too craven to make the necessary changes.

        1. Lifelogic
          February 1, 2019

          Exactly, loads of people in the state sector are living off the backs of others while doing very little of any value at all and often doing far more harm than good. Lots of people in the private sector too doing largely pointless jobs too mainly due to idiotic employment laws, over complex taxation, the green crap religion, HS2, misguided bank regulations and endless idiotic red tape.

          So what proportion of work time in the UK is actually useful and productive I wonder, 50% maybe and perhaps even less.

    7. Brigham
      January 31, 2019

      If you treat dentists and doctors like hairdressers then many more of them will desert the NHS and we will be much worse off. The thing that needs to be done immediately is to get rid of the bureaucracy and committees that are weighing down the whole of the NHS. I know because I was a medical rep for a pharmaceutical company, and recently the patient participation group at my local surgery. I left that because I got a look at the the management structure in Kent, and was completely disgusted at all the people that are employed who are non medical. Despite what many people think, doctors are just ordinary people who are being crapped on by the patients from below and by the bureaucracy from above. It doesn’t surprise me that there is a lack of them.

      1. Iain Gill
        February 1, 2019

        Nope British GP’s move abroad to countries where the public access is like barber shops here. They universally like that system better than the UK approach.

  6. Dame Rita Webb
    January 31, 2019

    The NHS does not need more money it would only waste it. Why does a ‘national’ service need to be split up? Apart from the Scots and Welsh versions, why does NHS England need to be split between North and South too? Why does each trust need its own HR and payroll function, why is this not done centrally without the duplication? If there was a central function they would not need to spend so much on locum staff, as they would know which neighbouring trust had staff that could be seconded over. If the management of the NHS is up to scratch, why does it need to spend millions management consultants? Why do they resort to gagging clauses when they dismiss a medic that has fallen foul of them?

    1. Lifelogic
      February 1, 2019

      Why do they resort to gagging clauses . Not just staff they lose, they gag all their staff I understand in employment contracts.

      Why, because if they did not the full horrors of the appalling, thousands of deaths causing NHS would be even more obvious to all. They do it so they can continue pretending that the NHS is “the envy of the World” despite the abundant evidence.

  7. Baz Lloyd
    January 31, 2019

    The government has already committed more than £20 Billion extra that it doesn’t have, with no proper plan, on the NHS

    John Redwood has been arguing for months for yet more from the £39 Billion he thought he was going to have.

    At no point in these proceedings did he tell us on what or according to what ‘plan’.

    More spending is pointless. We want better productivity.

    The problem with the socialist National Health Service lies in socialists like John Redwood themselves. It’s spend first then have think about on what, and how.

    John Redwood thinks that if you spend more money, things you want come. THEY DO NOT.

    The NHS is already the fifth biggest employer in the world and could, in years to come become the third. It’s productivity rates are disgusting.

    The sick leave amongst its’ staff is appalling and it perfectly usual for its staff to take sick leave as if it’s holiday entitlement, but to keep in touch with their mates at work and stage a miraculous recovery if there’s any overtime going.

    The NHS spends 30% of its’ wages budget that we give it to care for us, on pensions for people who no longer work there!!

    Reply No need to lie about my views. I wrote about the need to raise productivity and quality and to first define why you need to spend more.

    1. Iain Gill
      February 2, 2019

      first give money to the people most obviously let down by the NHS, to take anywhere they want for treatment, and competition and private provision will emerge and people will take the money to other areas and so on

      start simply, the 2% of people who have been on operation waiting lists the longest

      or the diabetics in those CCG areas which give hardly any insulin pumps

      and so on

  8. Dominic
    January 31, 2019

    Someone tell May to stop spending taxpayers money to finance political objectives.

    We all know that this money will be wasted. This is the NHS. Wasting scarce resources is what they do. Why do they waste? Because they can and because it isn’t their money so they couldn’t care less.

    In effect NHS spending is rising but access to GP and hospital services is now streamlined. So, the NHS is getting more cash for doing less. Unbelievable

    It is very simple. This Tory government is desperate to create the veneer of a caring, compassionate political party as May pander’s to the left’s agenda. But, she’s using the taxpayer to do it. Why is that acceptable?

    It’s bad enough having to finance Labour’s socialist client state but now we have to finance the political gamesmanship of Theresa May and the Tory party

    I don’t want to see more cash wasted on the NHS. I want to see REFORM of the NHS. Yes, that will involve industrial conflict but that’s not a reason to avoid tough decisions

    May is a socialist. She enjoys spending our money to achieve a political outcome. Taxpayers don’t pay tax to finance political spending and they don’t pay tax that allows politicians in government to avoid taking tough decisions.

    Extra NHS spending will no doubt create nice, warm cosy headlines in the press but we all know that in 5 years time the NHS will still be whining, moaning, scaremongering and campaigning for more cash to waste

    stop pandering to Labour’s client state. What we need is massive reform and then destruction of Labour’s client state

  9. Anonymous
    January 31, 2019

    Mum has no dentist and now, it seems, no GP. A week long wait for an appointment only to be seen by a nurse who said “This is the preliminary to your real appointment – to come in the next two weeks.”

    Where are all the doctors that we were told open borders would bring ? Why are our own going ?

  10. Dave Andrews
    January 31, 2019

    Better Healthcare = less patients
    The real problem with public health is lifestyle diseases. Rather than increasing the supply of healthcare we need to reduce the demand.
    Can we relieve the NHS of responsibility for smoking related illnesses, over-eating disorders, excess alcohol problems, drug abuse and conditions caused by lack of exercise? Then the NHS can concentrate on those who are genuinely sick, who shouldn’t have to wait in line behind those who having been well have made themselves sick.
    Only a proportion of the population are suitable to be trained to become doctors and nurses. You don’t want to waste time training people not fitted for healthcare because the suitable people can’t meet the demand.

  11. Richard
    January 31, 2019

    When the Economy shrinks after brexit there won’t be any extra money.
    The real problem is an aging and more obese population.
    You need to tax sugar and fast food outlets, and use the revenue to subsidise fresh veg.
    We need more immigrants to reduce the average population age and to fill nursing and doctors vacancies but your turning them away with your little Englander policies.

  12. L Jones
    January 31, 2019

    Bring back ‘minor injuries clinics’, to take the pressure off A&E – pressure created by actually closing A&Es just at a time when our towns and villages are being hugely expanded. Our village has grown, with no corresponding expansion in services – schools, surgeries, etc.
    Our city is inundated with new housing estates, yet the hospital remains the same. A&E, I understand, is often overwhelmed. How can this go on?
    NHS crisis = population crisis

    As Mark B says, our health service should be for UK citizens ONLY, and health tourism must be stopped – spend money on the admin to make sure it is. Other countries manage it.

  13. Caterpillar
    January 31, 2019

    1. There are plenty of options around the world that are not fully private and not fully state. Look at them, publish and stop the privatise non-privatise argument.
    2. Accelerate hip and knee operations for the elderly, delaying them as non-life threatening slows recovery and prolongs immobility putting strain on other services and relatives (hence knocking on to their productivity). (I don’t understand why these ops aren’t mass produced).
    3. Allow voluntary euthanasia.
    4. Quasi paternalism for prevention – if you are overweight you contribute more for your healthcare
    5. Population target.
    6. Only two childbirths on the state.
    7. Allow donors to specify who they would allow organs to go to.

  14. Andy
    January 31, 2019

    A more interesting question is where does the extra money for the NHS come from?

    We know Vote Leave promised it – but then we know it was a lie.

    So which budgets are you cutting instead?

    We know Penny Mordaunt wants to axe foreign aid. Another Tory incompetent who doesn’t get the basics. But where does the rest of the cash come from?

    Is there a magic money tree somewhere?

  15. Nigl
    January 31, 2019

    Digital services, indeed but it is tinkering at the edges and when recently hospitals had to be ordered to stop using fax machines it sums up the almost futile nature of trying to change the culture. One of the challenges of the new BT C E O is to get away from the dead hand of civil service culture still pervading it after many years of privatisation.

    Nonetheless in the spirit of your request, increase GP provision. Both in SW and SE London I know getting appointments is a nightmare. We hear that the government’s Blairite attacks on middle class wealth in particular pension pots, is resulting in Doctors retiring rather than paying exorbitant amounts of tax leading to the Minister seeking exemptions and nowcyou are seeking more money to solve a problem of your own making. You couldn’t make it up.

    Spending priorities: the public dental service is a disgrace forcing people to,pay vast amounts or risk having their teeth butchered.

    Ambulance services are often inadequate. Alzheimer’s is an illness, the government’s forcing its care on to family is shocking. Treatment of elderly people in hospital despite best efforts of staff again we should be ashamed of. More nurses, investment in hospice care with bespoke buildings in hospital grounds also to take bed blockers.

    Truly compete in the private care arena. It should be a valuable source of income.

    And then there are all the efficiency savings and approaches as suggested by Lifelogic etc but I won’t hold my breath.

    However whilst the NHS undoubtedly has some excellent parts, until the Government from the PM down stops the BS that it is the best in the world and that is really the culture that is the problem we will be having this debate again in 20 years time as another vast tranche of taxpayers money disappears into its money pit.

  16. Mev
    January 31, 2019

    The challenge with the NHS is that it is not a single organisation, single employer and nor is it a state-led employer as some would suggest.

    The NHS has:
    7,454 GP practices
    853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations
    135 acute non-specialist trusts (including 84 foundation trusts)
    54 mental health trusts (including 42 foundation trusts)
    35 community providers (11 NHS trusts, 6 foundation
    17 acute specialist trusts (including 16 foundation trusts)
    trusts, 17 social enterprises and 1 limited company)
    10 ambulance trusts (including 5 foundation trusts)
    and commissioned by 207 clinical commissioning groups that report to NHS England who is ultimately accountable to the Secretary State for Health.

    The amount of providers isn’t necessarily a problem and merely reflects the amount and type of work their is to do, geography, and population factors.

    A single provider organisation would not work. It would still be the same people working in their roles (there is not another 2m+ workforce out their with nothing to do, relevant skills and able to step in!)

    Nor is there any sense in expecting Clinicians to see more patients. For example, GPs will consult face to face with with 30 patients, carry out telephone consultations, do home visits, process hospital letters, action test results, support other staff members, and sign and issue prescriptions all day. There is a limit to the human ability to think clearly and safely and is one of the reasons why bus drivers and pilots are limited to the number of hours a day they are allowed to work and with mandatory rest periods. After the demands of the day as described above, I would not want my child or family member to be the last action of a GP day, especially where consulting, diagnosing, treatment, referral and prescribing decisions are made (many are life or death /early prevention).

    And that is just one part of the sector. So what to do.

    1. No getting away from the fact that there is not enough bread and butter appointments that no amount of technology will resolve. More appointments means more Doctors and Nurses, not working unsafe conditions. That means more money and more training.
    2. Standardisation. 207 commissioning groups have 207 procurement methodologies, 207 localised processes for reviewing clinical guidelines and best evidence that are then articulated into pathways and trigger points. I am sure it is the same in provider spheres. There is huge scope to remove duplication and avoid reinventing wheels 207+ times.
    3. Simplifying contracting. GP practices now have many different NHS contracts with different organisations with different reporting methodologies and with different payment systems, which now results in each Practice requiring an industry to manage that. It is too complicated and needs to be unified into a single contract. Not only that, but when 1/3rd of Practice income is delayed by 1/2/3/6/12months, it is impossible to employ staff without a means to pay them. Do we expect hospitals to take out business loans and multi-million pound overdrafts? This creates inherent instability.
    4. Invest in social care. Reductions have meant that hospitals cannot discharge patients as early as they used to meaning that these beds are being used up. Commissioners spend tens of millions of pounds on this problem but root cause is investment in social care.
    5. Planned care. Growing population, more potential patients, more potential presentations of problems, more clinicians needed, and more money needed to fund clinicians.
    6. Urgent care. Same as above, except we also make it complicated: A&E, ambulance, 999, 111, Walk-in centres, urgent care centres, minor injuries unit, pharmacy first schemes, and then of Course GP Practice. Too complicated, too fussy, and avoids the core problem: not enough capacity in GP surgeries and in hospitals.
    7. Self-help for real. Not just leaflets and videos. But actually enabling patients and volunteers to set up support groups. These are super successful with thousands of groups such as Breathe Easy for COPD, Singing for the Brain for Dementia and carers etc (see
    8. And there is more for sure.

    Calling for patient charges is simply another way to address the current underfunding but risks creating inequality – healthcare for those who can afford it rather than healthcare for all.

    Asking existing clinicians to cram more into the day risks patient lives through raising the likelihood of unsafe decisions.

    Adding even more (new) tiers of services will make the NHS even more difficult to navigate.

    There is probably benefit in merging GP practices to reduce duplication and increase specialisms in the non-clinical workforce, whilst enabling new clinical roles through economies of scale. But even mergers when they get to a certain size starts requiring their own industry for governance and assurance.

    Maybe it is simple after-all: if there is not enough appointments to meet genuine demand (and how de we know it is genuine demand unless they are consulted with?), then we need more clinicians, which requires more money. Sure, opportunities to redesign etc, but in truth, an appointment is an appointment and an operation is an operation. You can create new routes and methodologies, but still requires appointments, clinicians and money.

    More investment.
    More clinical staff
    Affordable drugs

  17. Rien Huizer
    January 31, 2019

    Mr Redwood,

    Of course the NHS should be made more efficient (although it is not expensive yet, but it will become much more expensive as health technology offeres better care for much more money) but one could also say that the NHS should limit itself to only basic services that guarantee reasonable care (but not the most advanced) for free. In essence, a government handout. And as with handouts, beggars cannot be choosers.

  18. GilesB
    January 31, 2019

    NHS needs to either:
    – Bring back Matron! i.e. Sack all the administrators. Give the medics a finite amount of money and let them get on with it, or
    – Manage the GPs and Consultants. Stop expensive unnecessary prescriptions. Don’t have operating theatres empty on Friday afternoon while the surgeons are on the golf course. Focus more on preventative care

    Currently the governance structure is ridiculous directly causing empire-building, wasted resources, and poor service. And NO ACCOUNTABILITY. The managers blame the medics. The medics blame the managers.

  19. Alan Jutson
    January 31, 2019

    As one of your constituents, to give a comprehensive answer would involve a lengthy post, so I will be as brief as I can from past experience.

    GP Practice:
    Appointment system employed means lengthy phone call waiting times (on hold) for wanting appointments which would be a real problem for those working, and lengthy waiting times for perceived non urgent problems.
    The recent introduction of turn up and wait helps, but can lead to waiting times of up to two hours.
    Referral to a consultant for a debilitating problem seems to take forever (6 months not uncommon)

    Clinical treatment is usually good when you eventually get it.
    Follow up physio is usually poor to non existent, most people we know, and indeed ourselves have gone private because of such poor service and lengthy waiting times.
    Administration is almost inevitably poor to disgraceful, with appointments often
    being scheduled for periods when you have previously advised the hospital you will be
    Waiting times are lengthy, unless your GP thinks you have a Cancer risk.
    Why does the surgeon/consultant need to apply for funding for certain operations which they themselves believe are essential, which causes delay in the system, whilst the patient becomes even more ill and incapacitated.
    Much delay between clinical and local service provision of aftercare after leading to bed blocking.
    Simply not enough beds available in many hospitals given the population increases of late.

    Urgent/Emergency cases.
    In our area it seems to work reasonably well to good once the problem has been diagnosed, although why so many tests required cannot be completed on the same day, instead of on multiple days seems inefficient and frustrating for all at times (administration problems again)

    Social and Home care:
    Always seems to be financially/cost driven, rather than patient health care requirements.
    Often total confusion/argument over how the system works, who pays, who has what responsibility and for how long.
    Visits often too short for proper care, and often too many different careers attending, so patient knowledge and requirements are often rather vague (what would you like me to do being the question often asked of the patient)
    Is there a case for convalescent type centres as in past times, where specialist physio and recovery treatment programmes were run after initial hospital care.

    General points:
    Management of staff time and facilities seems generally to be poor, leading to frustration of all, and inefficient working by many.
    Hospitals appear to work in what appears to be some sort of semi orderly chaos, is this a management problem, or is this just the way it will be, given the huge numbers of people passing through the system.
    How do we best tackle the problem of fail to turn up appointments, which wastes everyone time and money ?

    Is the cost of the very generous and excellent Pension fund to staff included within the NHS budget, and is this a reason why the NHS appears to be starved of money ?
    Is there a case for separating the pension funds from actual operational budgets for all of our Public Services, HNS, Police, Fire Service, etc. so that we get a real cost factor for each sector

  20. Peter Richmond
    January 31, 2019

    On occasion I have been seen at our local surgery by a nurse rather than a GP which was perfectly fine given the problem I had. So I have no problem with our local surgery bringing in other clinics managed by professionals allied to medicine, such as physio and occupational therapists. Indeed I would advocate decentralising a large section of services currently located in the large hospitals. The price of technology is falling, even small x-ray machines for example can be located at the GP surgery or even the pharmacy in some instances which would allow diagnosis of numerous fractures and treatment provided on the spot. Diagnostic kits also allow many diseases to be immediately avoiding long wait times to attend crowded clinics at the main hospital.

  21. Stred
    January 31, 2019

    The NHS is still sending letters to a French young lady who was a tenant of mine in 1994, returned to France and is now almost 50. They want her to make an appointment for a test at my GP s surgery, where she must have been a ghost patient for the past 24 years. The doctors are paid for preventive medicine. I did try returning the letters, which are posted by the regional authority, one of very many. They don’t seem to be interested. Perhaps the management is so well paid that they have done some complicated analysis and think it is not worth the bother, rather like the decision to refuse to clean and re-use expensive crutches, surgical boots and wheelchairs

  22. sm
    January 31, 2019

    1. To relieve pressure on both hospitals and GP practices, there should be an increase in the number of Minor Injury Units, which should also be far better publicised than the existing ones are now.

    2. To relieve pressure on acute hospital beds, there should be an increase in the number of Rehabilitation Units, which would also help to prevent costly re-admissions and give Social Services time to sort out patients’ domiciliary needs. These Rehab Units must NOT be in the acute hospitals themselves, since in my experience they inevitably end up being used for acute cases.

    3. If GPs wish to continue primarily serving NHS patients, they should be NHS employees in bricks and mortar owned by the NHS.

    1. Iain Gill
      January 31, 2019

      “Minor Injury Units” dont work in the UK because they dont have X-Ray machines and are often staffed with only nurses and not docs.

      They work abroad because they can X-Ray that ankle and tell whether the patient has broken a bone or has a sprain, and because they have docs that can do proper diagnosis.

      1. sm
        January 31, 2019

        The SE English town I lived in until 2 years ago had an MIU that did have an Xray unit, which relieved pressure on the DGH some 12 miles away. Skilled and experienced nursing staff are just as competent at dealing with the usual flow of problems at an MIU as any doctor, and would know when it is appropriate to refer a patient to a more specialised unit.

        1. Iain Gill
          January 31, 2019

          nurses have made many spectacular failures when looking at X-Rays, see my other post that mentions that if John gets time to allow it through moderation

      2. L Jones
        January 31, 2019

        Not every injury requires X-ray. Just cuts and other sundry minor mishaps which need immediate attention, but are obviously not life-threatening, can be handled by MI clinics. That alone would take a lot of pressure off A&Es. Our local one was staffed by nurses and a duty doctor. Sadly it’s gone now and our hospital is struggling.

    2. fedupsoutherner
      January 31, 2019

      Sm. They closed alot of rehabiliation unit years ago. The hospitals now bear the brunt of it all.

      1. sm
        January 31, 2019

        ‘The hospitals bear the brunt of it’ ….which is precisely my point! It’s no good hospital management moaning about bed-blocking when the powers-that-be will not take the obvious action.

  23. a-tracy
    January 31, 2019

    “Local services need to be expanded to reflect the additional homes and increase in population.”

    Local services also need to reflect the age breakdown of the doctor’s patients.

    As planners like to put all the social housing in one town and not a fair share in others the medical care also needs to reflect socioeconomic factors because patients in manual jobs can’t take half a day off or a full day off work (working at home) to take medical appointments at 11am or 2pm, lots of single mothers in a GPs panel results in more free services and more help having to be provided in the clinic. We were told we lost our evening clinic because it was abused and misused by people who could have come in for a day time appointment but just went as emergency appointments for minor needs after work.

    Until you start to balance each school, doctors area with housing shared out more fairly there will be big imbalances, start to get that right and the rest will follow. Look at your own Councils first any area with less than 15% social housing ask why? Any area with more than 20% social housing again ask why all social needs are put in the one town in the Borough.

    Wealthy people like Lifelogic just don’t see the people that I know that don’t visit the dentist anymore because the appointments price them out (came in with the Labour government before the lefties start banging their drum), some of them aren’t even sending their children because they’ve stopped going themselves, some are choosing just to have teeth pulled out because they can’t afford treatment – do you really want this in doctors surgeries people going back to only accessing medical care when they’re on deaths door.

  24. Bryan Harris
    January 31, 2019

    The NHS is planning, already, to provide more money to local services, while not giving quite so much to hospitals. Yes to more community related activities, and yes to expanding the services offered by GP’s.
    It should also be a requirement for GP surgeries to offer a greater range of treatments, from massage and first aid, to alternative treatments. All too often the NHS relies on drugs as a quick fix, and it really is time we had a greater range of treatments, if for no other reason than the huge costs involved in using drugs.

    This leads onto my major concern – Who wants a country full of young people high on psychotic drugs?
    The NHS plan to increase mental care – on the surface a great idea… We all know growing up can be stressful, but most of us survive it OK. Now they will be vetting young people for any one of a million alleged psychiatric conditions … and we all know what that means – an over-subscribed use of psychotic drugs….
    We only have to look across to America to see how these drugs can affect young people. How many school shootings have they had in 2018? I’ve lost count. It’s very odd that the media rarely mention now that the kids were on psychotic drugs, and that they were quite harmless until they were prescribed these drugs. Perhaps they get tired of repeating the same old lines, but nobody has bothered to fully investigate the link between psychiatric drugs and killings.
    We need some safeguards built into the NHS plan to prevent abusive prescription of psychotic drugs, and additionally it should be a requirement, hacked out in stone, that the NHS stops it’s reliance on psychotic drugs, and uses some of that £20Billion to research safe alternative treatments. Otherwise we will see a country full of zombies and a drugs bill that continually goes through the roof.

  25. jerry
    January 31, 2019

    How about just admitting the error and undoing the management changes of the last 40 years?! There is probably no need for any more money, just a lot less top and middle tier (miss-)management, all having to feed ever greater amounts of data to the DHSC and its agencies etc.

    1. KZB
      January 31, 2019

      At least 20% of the budget is spent on messing about with the NHS internal market. There was a Spectator article about this a few months back.
      Under the last Labour government the budget increased by a factor of about 2.5. During this funding increase, A&Es were closed and hospital beds declined to just over half what we used to have back in the 1970’s. Much of the population were unable to access NHS dentists and GP waiting times went through the roof. So I agree that throwing money at it is not the answer, but then neither is more marketization.

    2. Peter
      January 31, 2019

      Quite. Also the disgusting merry-go-round with failed chief executives on enormous salaries moving from one health authority to another.

      Meanwhile, money also gushes down the drain on useless IT systems for the NHS.

    3. sm
      January 31, 2019

      The need is for a complete rethink for the NHS, Jerry.

      Think about it: a truly massive system to provide healthcare for 66 million people and counting, whether it’s dealing with an ingrowing toenail, a multiple car accident, childbirth or a lethal cancer in ways that were unthinkable in 1948.

    4. Mark B
      January 31, 2019

      Some of these ‘Managers’ earn more than the PM who, supposedly, runs the country.

  26. Lynn Atkinson
    January 31, 2019

    My daughter works in managing change in the NHS. She says nobody can get the Consultants to play ball, else they ‘leave your hospital’ – so there is vicious competition in the NHS between hospitals and trusts, ungovernable by the market (patients) who can’t ‘leave your hospital’!
    Because consultants will not do their rounds earlier, nobody knows how many discharges there will be that day – and beds available. So they fly blind. Any bed is used so a heart patient can end up in a cancer ward – can’t be moved when a bed in heart is available because the medications are thrown away not moved with the patient! Heart specialist then needs to visit various other words – wasting more time, etc etc etc what a MESS!

  27. Adam
    January 31, 2019

    Stop the suffering, chaotic work & expense of preventable conditions by promoting better health early.

    The fittest healthiest nation on earth would thrive with the least health expenditure.

    1. Mark B
      January 31, 2019

      We were never fitter or healthier than in the Second World War under rationing. Not that I am proposing that but, if some want to try, they can be my guest – not literally of course 😉

  28. Man of Kent
    January 31, 2019

    Our health system has responsibilities back to front .

    We each should be responsible for our own health .
    We do not need nannying .
    Singapore has an excellent system that pays a set amount each month into each persons NI Health account for him or her to spend as they see fit .

    When the account reaches a ceiling figure the state takes the responsibility for old age care using first the personal account balance .

    This method costs the country some 3% of GDP , ours costs some 10% and the US 15%.

    The standards of health care are very high in Singapore .
    Gosh even Comrade Mugabe goes there !

  29. Bob
    January 31, 2019

    Why is it a problem when a patient doesn’t turn up for an appointment?
    NHS waiting rooms are crammed and the staff are always behind schedule, so if a patient doesn’t turn up, happy days, move straight to the next patient in line.
    The BBC never explain why it would cause a problem.

    The also never back up the project fear stories about trucks queuing to get goods into Britain after 29th March. Who would be delaying the trucks and why? They never ask or answer this obvious question.

  30. bigneil
    January 31, 2019

    What happened to the scheme where people from abroad coming and getting free treatment were going to be charged? – -Presumably quietly dropped? If it had been used/working then there would have been fanfares. just keep putting the bill onto us – – and the foreign patient then flies back home, laughing all the way.

  31. Narrow Shoulders
    January 31, 2019

    Interestingly I am sat in a walk in x ray clinic as I write and have come from the walk in blood test clinic.

    Both operation are run highly efficiently with swift throughput and no loss from missed appointments and expectation for wait times well managed.

    However there is a large volume of traffic, the results will need a lots of people to scrutinise and then treat. That requires massive overhead and represents a small part of the whole operation.

    It is too big and is trying to do too much for too many. A review of where scale benefits and where it hinders would be my first move.

  32. Captain Peacock
    January 31, 2019

    When the Tories had a great leader I see you get a mention John.
    Everything she said was true.

  33. The PrangWizard
    January 31, 2019

    Doctors are considered by many remote enough already with stories of long waits for appointments; we don’t want to make them even more so by turning them into an extension of the machine, like trying to get home insurance or the like, – press 1 if you think you have a cold, 2 if you think you’ve broken your neck. That won’t save time in any event, and correct diagnosing will not be possible. There will be much misuse and duplication.

    It is stating the obvious of course, but people should be able to get to see a doctor or nurse quickly if they feel able to get there, or the doctor or a nurse needs to be able to get to a patient if they can’t, some more so than others. And to help enable all that, if the patient is a time waster or complaints are trivial the doctor or nurse ought to be able to say so without the fear of retribution.

    To end on a positive, our surgery introduced new systems towards the end of last year after the building’s interior arrangement was altered and enlarged a little and I was able to get a same day appointment with a physiotherapist recently after trying to heal myself for a month. The surgery also says that it can usually offer next day appointments to see a doctor or nurse, although thankfully I haven’t had the need to put it to the test. Maybe we have been a test-bed for the recent announcement of system improvements.

  34. Man of Kent
    January 31, 2019

    BTW following on from yesterday’s post , I was intrigued by your statement Sir JR that while you could vote for the Brady amendment you would not vote for the motion that if the backstop were taken out of the WA you would then support it .

    Was there a recorded vote so we can see the measure of support for this in the HOC ?

    I found the Sky poll , result shown in a banner at the bottom of the screen , very instructive.
    They were
    Accept May’s deal 23%

    Accept May’s deal if the backstop is removed. 34%

    NO Deal. 39%

    I do hope that by supporting the Brady amendment too much has not been given away to the Remainers.
    What is encouraging is that there are so many Leavers supporting No Deal
    And that many once they see what is involved in the deal with the backstop removers will support NO deal .

    Reply I did not vote for the Brady amendment because it did say could vote for WA minus backstop.

    1. Chris
      January 31, 2019

      Reply to Mr Redwood: yes, and that is the crux. Why did your fellow Brexiteers vote for it when there is so much wrong with the WA? It needs to be binned forthwith and the plan by David Davis resurrected. Perhaps it is because they wanted to save May and the Party rather than save the country.

      At the moment, the EU is stating that the WA is signed by May, it can’t be reopened, and that is that. It acknowledges that the WA with an amendment to the backstop what the UK wants and in practical terms that means vassal status UK. How can Boris, Rees-Mogg et al have supported that? At least you have been honourable, and consistently so, Mr Redwood.

      Interesting and not at all surprising that May has apparently reneged on promises to reform her negotiating team to bring in individuals with real experience of the WTO and Free Trade arrangements. Robbins reigns supreme, it seems, with yet again the Brexiteers being led up the garden path. At least it meant that she secured their votes in time. Truth seems what is expedient at the time – a policy frequently used by one Tony Blair apparently and now accepted as normal behaviour in the H of C?

    2. Man of Kent
      January 31, 2019

      l Reply to reply

      Thank you .
      I have now seen the voting record and that you did not vote .
      Congratulations .

      I just hope that JRM and the ERG know what they are doing and that they will not vote for May’s deal without widescale legal amendment to the dreadful WA .
      A wishy washy codicil of best intentions on the backstop should simply not be enough to support the PM .

  35. oldwulf
    January 31, 2019

    The Register of Members’ Interests shows those MPs who employ family members, presumably at a cost to the taxpayer ?

    Is there a similar Register for GPs ?

    1. Jiminyjim
      January 31, 2019

      We need to look at the system available through French ‘pharmacies’ and funded by their government. It covers a vast range of minor ailments and wounds and protects the front line services.
      In addition, we need to do whatever is needed (probably some kind of payment) firstly to ensure that the NHS views patients as customers (currently no NHS employee does) and secondly to ensure that the customers do not abuse the service just because it’s free.

  36. Mockbeggar
    January 31, 2019

    The single most important thing that must be done is to have a common administration between hospitals and what we used to call convalescent homes where, particularly elderly, patients can be sent rather than clogging up hospital beds that are extremely expensive even compared with 3 star + hotels.

    Another thing is to recognise that since well over 50% of GPs are now female, they often have no desire to work full time; they need to look after children and so on. I say this with no disrespect to female GPs, simply to point out the facts of life. This means expanding the number of places at medical schools and, as you say, Sir, increasing the number of paramedics, physios and nurses available in GP surgeries.

    We also need to start insisting that everyone entitled to treatment by the NHS should be registered with a GP practice. This should be everyone’s first port of call. As it is, A&E departments are obliged to waste time treating people who are neither accidents nor emergencies.

    1. Chris
      January 31, 2019

      We need to have convalescent homes/cottage hospitals brought back pronto, Mockbeggar.

  37. Tom Rogers
    January 31, 2019

    Healthcare is certainly important, but there again, we all have to die some time, don’t we. It also occurs to me that pouring money into healthcare is, if you’ll forgive the medical analogy, a bit like using cough medicine as a palliative for cancer.

    What about ending immigration first? All of these domestic policy issues – healthcare and others – you discuss on your blog (and not a few of the overseas problems too) are caused by having too many people in the country and, instead of doing something about it, you seem to be attached to this unreal, and I would say irrational, dogma that we should import more. Why?

    The onus is on you to justify this, so please do so. We’re keen to learn why these pre-questions are not being asked, why you people at Westminster keep jumping into policy discussions that involve putting a sticking plaster on the manifestation of the irrational, enforced mass imposition of Third World people on Western societies. Is it because your party is funded by greedy employers who want cheap, pliant Third World and eastern European labour?

    Controlled borders and ending immigration is not just a hobby-horse for boorish right-wingers. It’s also the basis for looking after your own people. So instead of continually throwing money at healthcare and building more and more ugly, cookie-cutter housing to line the pockets of the builders, why not do the following:

    – end mass immigration, and as a starting-point, reduce net migration to less than 5,000 per annum within five years, and a negligible or negative value within 10 years;
    – control entry to the country, restricting it to tourism and business visits, and in the rare cases, visas for academics and scientists and people from north-western European countries who have skills that we’re short of;
    – control the border: set up a national border policy, abrogate from the ECHR (establish a margin of appreciation in the applicability of the Convention to protect the British way of life and ensure social solidarity), and expel and deport everybody found to be here illegally, no exceptions; allow out-of-country appeals;
    – give notice that we withdraw from the ECHR, then repeal the Human Rights Act and replace it with a Bill of Rights based on liberties (negative rights) rather than codified rights;
    – sort out education by restoring the tripartite system and selection, requiring that the ‘new’ universities convert back to polytechnic status and stop offering academic courses and restrict university entry to the intellectual elite;
    – put in place a ten-year plan to replace all immigrant NHS staff with native-born staff, including setting-up new medical and nursing courses, etc., and imposing a new contractual condition on all NHS staff that if they take their skills to other countries, they have to refund the cost of their training;
    – tell the business community that they need to invest in combination of technology and people (i.e. skills, working conditions, wages), and if they don’t like that, that’s fine by us, they can move elsewhere and we’ll tariff their goods in return so they can’t sell anything here;
    – turn prisons into work camps and require that nobody can be released unless and until they have gained a Level 2 NVQ in a trade, or they have credible other plans for earning a legitimate living; and, if they don’t have a job or business to go to, they must accept a three-month work placement organised by probation;
    – abolish the statutory minimum wage.

    I can think of a few others things, but you probably catch my drift. We need a bit of testosterone in government.

    Sorry if, figuratively, I sound like a broken record, but maybe that’s not such a bad thing. The message needs ramming down your throats – No More Immigration. Take that on board, and problems like healthcare will begin to be resolved.

  38. Prigger
    January 31, 2019

    Better Mr Hunt and Downing Street come to a common decision ” leaving the EU on 29th March 2019 and leaving later. It avoids confusion not least in the Cabinet

  39. Prigger
    January 31, 2019

    It could be an idea if the medical authorities would as in the war determine the nutrients absolutely necessary for a human being to keep body and soul together.
    On Sky News this morning it showed a volunteer ( agency unknown) delivering food packages to those in debt and hungry. “Just some cereals ( cornflakes ), a few small toys, ( all in a cardboard box which could hold 12x 6-packs of beer). It seemed fairly light judging by the body language of the lady carrying it.
    Porridge, with salt not sugar, was the staple diet of an old Scots workmate when he was a kid, (I recall in England eating porridge alot and lots of bread, and rice.(with SUGAR , alot )..not in tins>> RICE in heavy packets pre-meal, and he says they were very poor.He survived.
    When I was poorer in my late teens, early twenties, I never bought things like cornflakes. Far too expensive and little nutrients compared to say bread, porridge and other basic foodstuffs.I survived.
    I read, teeth, hair, skin, general health, depend on food intake.
    We have the middle class determining survival and bringing non-survival attitudes into important health matters.
    Also make sure sugar is in every “survival pack”. A MUST!. No not sugary fruits. SUGAR!!!And SALT, no not sea salt or low-salt SALT!!!!
    The NHS would save much money and charity agencies could just STOP and find a nice middle-class job producing something worthwhile.
    Nettles for my Scots workmate for food sometimes and, for making light homemade beer in my N.England.With SUGAR in fermentation and SALT on chips. We need SALT and SUGAR

  40. Den
    January 31, 2019

    Certain Large Hospitals should become “Centres of Excellence”. Meaning they have a multitude of departments covering ALL the common ailments. Departments such as Anaesthetics, Audiology, Cardiology, ENT, Gastroenterology, Gynecology, Haematology, Neurology, Ophthalmology, Neurology, General surgery, Orthopaedics, Renal, Urology et al should be under one roof.
    In my family the experience has been that our one large local hospital did not have the departments required so we had to drive almost 50 miles to receive a consultation and treatment for a spinal problem and another 25 miles to recieve consultation for an ENT problem in another hospital.
    I am totally against centralised Government but all for centralised Medical Treatment.

    1. sm
      February 1, 2019

      Because of the huge developments in modern medicine, it has been DoH policy for many years to establish speciality depts in certain hospitals, and for good reasons.

      If, for example, you send all your neurology patients to one hospital in an area, they will get treated by staff who are highly skilled and experienced because of the high number of patients with similar problems that they will see every day; it is also then worth installing any costly diagnostic or therapeutic equipment that will not stand idle.

      1. Den
        February 1, 2019

        I still cannot see why a large hospital in a large town with tens of thousands in the catchment area cannot do the same job. Or is it a matter of poor staffing levels?

        1. sm
          February 2, 2019

          Den, without going into unreasonable details, your large District General Hospital quite possibly does have one Speciality Unit. However, take the example of a Burns Unit – having one in each DGH would mean a) staff and equipment sitting idle much of the time, and b) diminution of skills gained through the experience of multiple patients.

          If you were involved in a major car accident that had caused brain damage, would you prefer to be taken to your local DGH that sees perhaps 8 such cases each year, or the nearest Neurology Unit that will see perhaps 10 per month, so including caring for other brain-damaged patients, the unit will have the best equipment, drugs and staff immediately to hand?

  41. agricola74
    January 31, 2019

    Unexpectedly I am experiencing the NHS at first hand. Over three months of investigation they have been swift and impecable in the way in which my problem has been handled. This has been the reaction of professionals to a situation they deem to be urgent. Had I wanted a hip replacement or cataracts dealt with I would have been better to go private. No doubt due to lack of personnel and or facilities. The NHS lacks both in many areas of activity and has to prioritise. The answer is to provide those personnel and facilities or to use the facilities 24/7 when you have the personnel.

    Moving away from the front line I would look at purchasing of both consumables and capital equipment. I would employ professional buyers and do it on a national basis rather than on a trust basis. I would also conduct an audit of waste in use of much in terms of consumables. I know people with boxes of such,left over from a treatment regime, that could be returned or alternativdly sent to MSF in Africa or wherever needed. My comment also covers aids to walking.

    The NHS may be hanging on by a thread in some areas but on the front line of providing urgent service they deserve our praise.

    The great British public also have a responsibility to the NHS. Do not arrive in A&E drunk out of your brains, drugged up to your eyebrows from personal choice, marking it all with aggression towards those who are dealing with the cosequences of your idiocy.

  42. Foodie
    January 31, 2019

    Remoaners with their food and medical shortages Project Fear,seems an attempt or even an actual War of attrition by the EU. As for the older generation over 60s. Bring in on!!!!

  43. Ed Mahony
    January 31, 2019

    We need to look far, far, far more at preventing illness (mental + physical and how they are closely linked) not just to reduce the cost of the NHS by billions and billions but also to make the country more productive and to increase patriotism.

    There is very little government can do on its own. Very little for any particular group of people. But a HUGE amount could be done if Parliament worked closely with religious organisations, in particular traditional Christian organisations such as the C of E and the Catholic Church, as well as people in Business, Sport, The Arts, Charities, The Armed Forces, The Police, and Prison Service, Social Services and of course, Health. But government has to take a lead in organising this.

    Fundamentally, it’s not about spending money to resolve this but changing attitudes.

    1. Ed Mahony
      January 31, 2019

      Even if the government led a campaign that led to preventive healthcare being upped by 5% of what it could achieve in an ideal world, that would still save lots and lots of money (as well as increase productivity and patriotism).

      And achieve that without spending lots of extra money but by changing attitudes.

      1. Ed Mahony
        January 31, 2019

        Sir John,

        Thank you for publishing my comments.
        Going to stop commenting (at least for a good while – lot on).
        I will keep you in my prayers (as I have done before).
        And I pray that God will inspire me and give me the power to do something really patriotic for my country, even if only God knows what that is – in particular in the line of arts which I’m involved in.
        This website has really made me think hard and explore what Patriotism actually means. And I have a duty to, as Patriotism is one of the virtues of traditional Christianity and which people must think seriously about and act upon during their lifetime (as well as duties to Family, Friends, Work Colleagues, Neighbours, and the Vulnerable).

        People might think me bonkers, but people from the past, such as Dante, Shakespeare, and many more ordinary people from their time, would not!

  44. Alison
    January 31, 2019

    Seven-day diagnostics essential. So many times one sees people stuck in hospital beds for weeks because they haven’t had scans promptly, then their condition worsens, so longer in the bed. Tragically a good friend died at new year because scans weren’t done in time.

    However: I suspect the money will have to be pulled, ie the NHS won’t get it (a) a chunk will go to deprived Labour constituencies which voted leave (to persuade the MP to vote for Mrs May’s agreement), and (b) we’ll be paying those billions to the EU, and (c) Treasury receipts will shrink massively as our economy dives under EU regulations and ECJ rulings.

    And if we enter a customs union, the NHS is just as likely to see more privatisation.

  45. acorn
    January 31, 2019

    A post “no-deal” Brexit that leads to a Free Trade Agreement with the USA, will no doubt push for access by the US Health Insurance industry into the NHS. The Conservative Party would welcome that opportunity.

    The UK government covers 84% of the single payer universal healthcare system costs (£2,200 per person), the US government covers 47% of theirs (eq to £3,200 per person). US private health care insurance averages £3,600 per person per year on top. Then there are the “deductibles” and the “co-payments”, which mean you pay a portion of the costs up front.

    If we want to be like Singapore, the UK will have to go on a diet of pay-as-you-go for all public services and see who is prepared to pay for what. Sort of a giant means tested benefits exercise.

    1. a-tracy
      February 2, 2019

      Acorn, you talk as though this is something new. As more health problems are treated by our NHS other services have been rationed or provided with top up payments, opticians, dentists, podiatry, you didn’t provide what the British payment is from national health insurance per person, if the average wage is £27,000 and the British workers contribution is 25.8% above the lel that’s about £5500.

  46. Iain Gill
    January 31, 2019

    Thanks for asking.
    Patients need far more power at every stage of the treatment cycle, that’s the key to improving the system. More top down control, however well meaning is not going to work.
    Some examples of where the NHS is badly mistaken at the moment:
    1 NHS England stopped ALL haemorrhoid operations recently, this is completely counter the practise of the whole medical world in the rest of the developed world including Scotland. Not only that the NHS is forcing the consultants to lie to patients telling them that they don’t need any treatment, and no treatment is available, which is a straightforward lie as cheap simple treatment is readily available (granted not from the NHS in England) which can often completely cure their problem. Yet another example where the NHS preaches a “duty of candour” but fails at the first step as any patient without the knowledge to understand what is going on is going to assume the lies the consultant is telling them are true. Now let’s look at a number of follow on issues from this, for one reducing deaths from colon cancer depends on people reporting blood in their poo early, and getting it checked, this NHS England decision is leaving vastly increased numbers of people with significant blood in poo issues so that for those that do develop colon cancer it will be masked and not merit attention, not good. Another is in that in many cases people are being left to drip blood everywhere they go, staining their clothes, and potentially spreading diseases carried in the blood, so it’s a massive public health issue, and its also forcing a lot of people out of the workforce as its simply impossible to hold down a job when you are leaking significant amounts of blood every day and staining the chairs you sit on etc. This is NHS top down dictat at its worst, its probably not even saving the country money if these other factors were looked at in the round.
    2 NHS England stopped ALL trigger finger operations recently, completely counter the practise in the whole of the rest of the developed world including Scotland. Not only that the NHS is forcing consultants to lie to patients and tell them they need no treatment. When the reality is a cheap simple operation would mostly cure them. Once again, no real duty of candour, when they should own up and be honest that they have stopped treatment as a cost saving measure but treatment is available, often fairly cheaply, privately or elsewhere in the world. This is leaving people unable to move their fingers and hands, and again forcing large numbers of people out of the workforce who could and should be actively contributing to our tax base.
    3 Take something like Lyme disease, practise in the entire rest of the developed world is if you know you have been bitten by a tick, and especially if you have the classic mark, you should get the antibiotics on the same day the bite took place. Lyme disease is almost completely and utterly preventable if the patient gets the antibiotic on the day of the bite. In other countries this is publicised, and you can walk in to medical centres or pharmacies and get the antibiotic there and then, its an obvious decision. Here its impossible to go through the hoops needed to get an antibiotic in time to stop this disease straight away as happens in large proportions of patients elsewhere in the world. The length of time (days) needed to see a doc, to get a prescription, to wait for relevant antibiotic to be available at pharmacy. So, we end up with unnecessary serious cases admitted to hospital that just would not be happening in other countries. No, we need to fix all this overhead nonsense and make it easy to get the right antibiotic straight away if you are bitten by a tick etc, like the entire rest of the developed world. (and all the pressure to reduced anti-biotic use is also bad in cases like this, we need the reverse we need proper antibiotics dished out early in cases like this, the reality is anti-biotic resistance is largely a problem out of control due to practises in India and China and not something little old UK on its own can influence much).
    4 Take something like skin cancer. Other developed countries routinely remove far larger percentages of moles than we do. It’s a numbers game. Any individual mole is only going to have a very small chance of being, or turning into skin cancer, but if you remove sufficient moles from the population you have prevented a skin cancer death. In addition, in the entire rest of the developed world people with moles are routinely seen by a dermatologist every 12 months, who will take a detailed look through proper instruments, and will again tend to remove any with a small chance of turning nasty. Here that never happens and even if you force yourself on the GP every 12 months, they will only look casually, they will never refer to a dermatologist with the proper kit and experience. So, in short, we are pretty crap at the mass approach needed to reduce skin cancer deaths.
    5 Treatment for diabetics varies wildly in this country. The percentages of patients with insulin pumps varies wildly from one CCG to another, from very high percentages to hardly any. Also, the supply is routinely ageist, where they tend to offer far more to young people but hardly any to those in their 30’s or older. None of this is good. The routine ageism is in my view evil, where is the equality of care? Insulin pumps save lives, and reduce a lot of follow on costs, we should be having much larger roll outs! Look at other specifics, say you are a diabetic who has had ongoing problems with verruca’s, often for multiple years, some CCG’s although not all, have stopped all secondary care for verruca’s completely. Fair enough let the GP’s have a go a treatment initially, but when they cannot clear them up after more than a year really the patient should be going to a dermatologist. A dermatologist with the extra skills and techniques will mostly be able to resolve. But many diabetics are being left with verruca’s for years, GP’s playing at being a dermatologist trying to resolve but failing, and guess what we have significant numbers of amputations of legs amongst our diabetic community, a lot directly caused by this nonsense NHS approach. Dermatologists can and do resolve the more problematic verruca’s, and this is a far cheaper option for a diabetic than leaving problems to get worse become infections and lead to amputation.
    6 Let’s look at blood tests. Styles of provision vary wildly in different parts of the country. In some places the doc will take the blood there and then when they decide you need it, or get their nurse in the next room to do it there and then, saving the patient another day off work (which the NHS never accounts for) to go get a blood test. In other places people will be given a slip to take to a central “phlebotomy clinic”, forcing people to take another day of work, and getting all the sick people in town together to spread their germs amongst each other so being the worst possible approach for infection control, and worse than that some of these “phlebotomy clinics” are in the local general hospital so you have all the sick people in town walking around the hospital (with immunity compromised patients) queueing up to get a blood test. Completely and utter infection control and optimising days off work madness.
    7 Or take a patient who needs regular blood tests for multiple conditions, mostly the NHS systems sends them multiple times to “phlebotomy clinics” when actually all the blood tests could have been done together if they were synchronised.
    8 Or look at patients routinely seen “out of area”, for instance many patients (very properly) end up getting long term outpatient care from a London hospital, as their local hospitals are simply not up to the job in their case. Those patients often have to get multiple blood tests both in London and in their home area as the hospitals in both locations cannot access each other’s results. We should have far more “out of area” referrals, as its unrealistic for all local general hospitals to be good at everything, and indeed patients themselves should be choosing where to go, but blood test results should be visible on a web site from one hospital to another.
    9 Moving onto the dumbing down of access, we have already been palmed off with nurses instead of docs far too often, and GP’s instead of consultants far too often. I myself know first hand of a child sent home from A & E after hand X-rays that had only been looked at by a nurse, told it was just bruising, that turned out to be fractures of both wrists which the doc in another hospital said “would be obvious to any first-year medical student looking at these X-rays”. So, it’s simply not working, and massive numbers of failures are covered up, and the complaints system is a joke. And other equally serious cases. PCSO’s have in reality been a complete failure in policing, and this new attempt at dumbing down in healthcare will be equally bad.
    10 take something simple. If you have extreme high blood pressure you need to be admitted to hospital for investigation and diagnosis. This is accepted in the medical world. It is a real medical emergency. Now the blood pressure reading which on its own triggers hospital admission varies wildly from CCG to CCG, it’s a vastly different number in say Bristol, to Reading, to London, to Suffolk. It’s not determined by the doc, its dictated to them by the local CCG. There is no excuse for this. And mostly the patients are not even aware that they would be getting admitted in other parts of the country. Stuff like this is the basics, that the NHS gets away with randomly deciding what it feels like doing, with no proper scientific basis for rejecting access to care.
    11 The NHS Digital agenda, has a lot of highly paid people not really delivering, and what is delivered is more top down Stalinist nonsense. The ministers need to realise that they and the NHS managers can never optimise the detail, the only way that’s doing to happen is with real, sustained handing over of power to patients. Turn the NHS into a state backed insurance company, but give the patients power over where they spend their pay-outs.
    12 Ear ache is treated very differently in the NHS to the entire rest of the developed world. I have seen no scientific papers which suggests the NHS is correct. NHS patients end up with years of problems that would have been resolved quickly and easily in other countries. If you sit in the private ENT consultants waiting rooms in London you will find many of the other patients are NHS GP’s who themselves reject the NHS approach when it comes to their own healthcare and go get the dirty wax removed from their ear canal, as simply removing the dirt can mostly stop the infection. The NHS approach of drops and antibiotics is simply crazy when physically removing the dirt would be routine outside the NHS, its dumbed down substandard care.
    I have many more observations of stating the obvious. The hype and propaganda about the NHS is so obviously nonsense when seen through the eyes of someone who has lived in many other countries. The real people are cheesed off with the poor care, lack of access, rationing, and all the rest of it.
    Hope some of this will help.
    Good luck

    1. a-tracy
      February 2, 2019

      Iain, I agree with your list, the cases of self-treating vertigo patients is increasing too and it is never checked if this condition is a bacterial infection doing the rounds, go to the GP and you just get fobbed off with ear drops until you stop going.

      Expensive private medical insurance is often the only way to get treatments the NHS used to offer, I know people ignored with problem no1 too and you are quite correct with skin cancer, even when you’ve had malignant melinoma the most severe form you are not checked annually it is up to your partner to spot changes.

      I’m also worried about them stopping inoculating teenagers against TB from 2000, TB cases are rising 2500 possibly from immigrants coming in with the condition if we eradicated it in the UK. This is just one big insurance claim case against the UK NHS if this keeps up its onward path. The Australian aborigines population severely depleted due to imported illness we really do need to guard against these problems, especially in certain areas of the UK.

      1. Iain Gill
        February 3, 2019


        yes, hopefully john can use this information to get some action

  47. Phil Gilbert
    January 31, 2019

    The system of rewarding doctors for prescribing certain drugs (such as statins) should be ended. The doctor is in any case paid well to act in the patients interest and this sort of incentive undermines the patient’s trust in the doctor’s objectivity.

    1. Iain Gill
      February 1, 2019

      we are significantly under prescribing statins. the statistics show for large proportions of the over 40’s they improve your chances of not having a serious cardiovascular episode in the next 10 years by an average of something like 20 %. thats a massive number of heart attacks that can be prevented.

      real challenge is that deciding which statin to give which patient is properly done by a cardiologist, and GP’s playing at this without the proper skills can lead to all sorts of problem, but in the UK the NHS thinks GP’s are skilled enough (which they mostly are not). also in a lot of cases patients need to be tried on multiple statins to establish which one they tolerate best.

      but yes docs should not be incentivised to give any advice, and should importantly be free to say that significantly better treatment is available outside the NHS when this is true, or that they themselves would go to hospital X instead of hospital Y and so on. patients want the proper undiluted reality of the docs view, when mostly they get a NHS version where the doc is under a lot of pressure not to reveal options outside the NHS or in different parts of the NHS.

      1. sm
        February 2, 2019

        Actually, when you look at the statistics over a very lengthy period, you have to dose many thousands of people with statins to prevent a very small number of deaths by cardiac events – what isn’t generally pointed out however, is that having done such wide-spread dosing, the incidence of death from cancer among statin consumers rises, since cholesterol is one of the body’s defences against cancer.

        Most cancers are the consequence of old age, and cholesterol levels normally rise as we get older to help counteract this. It is in the interest of Big Pharma
        to continually lower the ‘acceptable’ cholesterol level in order to increase statin consumption. There have also been a couple of studies that have shown that post-menopausal women are very resistant to statins and the dosage has to be considerably increased to have any effect.

        1. Iain Gill
          February 2, 2019

          not as far as I understand it.

          and even if its true you can target the statins at the half of the population with the higher blood pressure and increase the % effectiveness significantly. problem is most people dont know their blood pressure, and the NHS rarely checks it unless patients present for something unrelated and then high blood pressure is often discounted as a symptom of the short term illness they are presenting with and not a longer term problem…

          big pharma is not making much money on most statins as most are out of copyright and can be made generically, so the NHS is buying them very cheaply

  48. Christine
    January 31, 2019

    1) When I first started work we had regular inspections by ‘Time & Motion’ teams. They would come into areas and monitor what the staff did and assess whether the grade of the staff was correct. It kept managers on their toes. I know of NHS staff working way below their pay grade.

    2) The levels of sick leave are very high with no incentive to improve them. This puts a huge strain on the dedicated hard working members of staff who have to cover. We have become a soft liberal society who is frightened to challenge the abuse that takes place in our public sector.

    3) Further improvements using technology can help. Why is it that my doctor does my prescription on-line, sends it electronically to the pharmacist who then prints it out and places it in a box? The patient is then allowed to tick a box on the back to receive the prescription free even if they are not entitled. All the information is already held on the computer system, so why not use it. This would stop one abuse of our system.

    4) Throwing more money at the NHS is all the Government seem to understand. Often bureaucrats waste it. We need to look at the system and work smarter. Staff suggestion schemes for the people at the sharp end to get improvements and efficiencies in their field of expertise are another beneficial practise that seems to have gone by the wayside.

  49. Tabulazero
    January 31, 2019

    “Investment in the UK’s car industry plunged by close to 50 per cent last year as Manufacturers “sat on their hands” ahead of the UK’s departure from the EU”

    Just in case you missed it.

    1. Edward2
      January 31, 2019

      Well thats not all they said Tab.
      You missed out the bit they said about the Chinese downturn and the EU’s sudden turnaround on the beauty of diesels and the rise of Korea and the increase in company car taxes and the increase in new vehicle excise duty and the forthcoming Low Emmission Zones with their high dialy charges for yet to be defined vehicles and the restrictions by the Banks on car finance.
      Yes Tab it is all due to Brexit…..

  50. Pragmatist
    January 31, 2019

    Test for the Chief Medical Officer of the NHS

    Ask her of the bio-chemical composition of Cleaver (Galium aparine) used purposely and accidentally combined in foreign food imports and herbs used in Asian and pan European foods and the medical implications
    Ask her why it makes your bones turn red, and if she knows that at all. Is it God’s way of making one look pretty inside, to the bone?
    Of course sack her immediately if she cannot answer correctly

  51. Ian
    January 31, 2019

    Totally agree with most of the above, we have all it seems been inside what is one of the biggest employers in the world.
    As for dealing with people from the rest of the planet, this amounts to a few billion a year,
    this I am told is because doctors do not want to be involved, there should be a specialist in every hospital to deal with anyone without a genuine NH number.
    No one should be seen coming into this country without Health insurance.
    If we have an accident abroad, your passport is taken untill you arrange payment ?
    Other Countries are able to do it , we should too

  52. Matt R
    January 31, 2019

    My uncle lives in France. He’s 81, lives in a village in the middle of nowhere, has no internet access, but regularly uses the medical services and finds them fantastic. These are some of the reasons why, and the contrasts to the NHS.

    If he goes to his local GP and they are busy he simply goes to another one in the next village – there is no booking, just turn up and wait.

    He needs regular blood tests. The nurse comes to his house. She takes his blood then drops the sample off at the pharmacy in the village. They in turn send it to one of many small laboratories that are all across France. The following day the results arrive in the post – there is joined up thinking in how each task is carried out.

    When he goes to the doctor and needs a follow-up the doctor completes the relevant details on his computer as they talk. On leaving he’s handed the details of his next appointment – they do not need different people in different locations all getting involved, or internet systems that the patient needs to decipher. Technology is employed by the medical professionals for the benefit of the patients.

    He had cancer 7-8 years ago. Identified from a routine blood test, he was in hospital two weeks later with follow-up radiotherapy and has been fine since – they tackle an issue as early as possible, not leave it until the last minute and probably too late.

    To summarise, the French health service uses a joined up approach that allows them to get to the root of a problem as early as possible. They believe in prevention in preference to cure. The system runs very smoothly, is efficient for both the medical professionals and the patients alike and consequently leads to a better quality of life for the patients too.

    To echo some of the other commentators the issue with improving the NHS is that it’s become a sacred cow. And for which the only answer a lot of people will listen to is to throw more money at it. Money alone is not the answer.

    1. Iain Gill
      February 2, 2019

      yes and patients get copies of all blood test and other results routinely, which never happens in the NHS

  53. Pragmatist
    January 31, 2019

    I went to hospital for a complaint some time ago. I found on a simple everyday complaint I knew more than the 30 year old doctor attending me. So much so, she tried not to scoff at my statement to her, which was entirely correct. She then went through asking me to grip her first and second fingers “as hard you can” in a typical everyday practice that a NHS doctor might use to determining heart and/or other problems. The procedure was explained on TV by a doctor too as it would be impossible to hurt the doctor or nurse due to a scientifically impossibility and physics. I warned her that I did not wish to hurt her. She said kindly:”Don’t worry it won’t” I warned her again and she reluctantly and with a smirk said “Well do it slowly then” I did. I then laid half, approx, into my grip and then inhaled for a final push, I just began to squeeze more and she shouted with pain in her face and stiffness in her body “Stop!!!””.
    I worry about our NHS, greatly
    # I am not a muscle-worker. I have worked in various labouring jobs and not thought overly stronger than others. I am not, less so in fact.
    There is much, I have found it so more than once, that the NHS knows nothing about.

  54. Everhopeful
    January 31, 2019

    Obviously far too late now but what really gets me is how the NHS, in its desperation to subsume and control all things medical..gradually destroyed a perfectly functioning private health system ( running in tandem with the NHS).No doubt this arose from some ghastly liberal/ Marxist class envy. Not to mention the money grabbing regulation of everything ( vis HPC).
    All GPS had private lists…and what was wrong with that?
    All hospitals had private beds ( ordered by Bevan to put an end to private hospitals).
    Up until at least the 1970s maternity homes and nursing homes were commonplace.
    And now,soon there will be no option but to allow a huge privatisation of medical services unless of course the govt wants to see us dying in the streets.

  55. Geoff Homer
    January 31, 2019

    Within the area of NHS expenditure Sir John is it possible to examine the overlap in administration, cost and time in the move of patients from NHS care to Local Authority care when moved from hospital to a care or nursing home.. Health trusts then decide whether they will cover some or all of the nursing cost whilst the patient is in a LA funded home but not before countless meetings and patient client conferences. At the end of the day it is all taxpayer money but the system seems to demand layer after layer of admin to decide how it is spent. There must be a better and more cost effective way.

  56. Denis Cooper
    January 31, 2019

    Off-topic, there is a cracking article headlined:

    “Britain has never understood the fervour for the EU project”

    on page 18 of today’s CityAM newspaper, here:

    “There appears to be a common misconception in British governing circles that this is a rational institution.”

    “At the heart of British delusions at the current time is the inability to recognise that the EU has always been a political project first, and an economic project second.”

    “,,, throughout it all, the political goal of “ever closer union” was always central to the EU’s ambitions.”

    “Anyone who believes that the EU has gone soft on this objective and is willing to prioritise economics over politics has not understood recent history.”


    “We may yet exit the EU on 29 March with a deal. But it will be on EU terms if so, not ours.”

    It was thinking along similar lines to the author – Alan Mendoza of the Henry Jackson Society – which led me to write on November 26th 2017:

    “So we should now say that rather than kowtow to the stupid destructive intransigence of the EU we will fall back on WTO trade rules and only seek agreements on the practical or technical aspects of continuing trade.”

    The question is whether Theresa May has now left it too late to sort out those practical or technical aspects before March 29th.

    1. BrianW
      January 31, 2019

      Yes I’m afraid it’s much too late now, but that was her aim all along, to run down the clock. So it’s better we leave on the 29th march now with no deal than a bad WA.
      After a suitable period of time outside we can involve ourselves in worldwide trade on WTO terms but we will need to reinvent a merchant navy and set up shipping agencies throughout the world. Money will have to be spent on reorganising our ports to suit and on building ships for the UK flag because the bulk of the ferry trade of ro-ro will inevitably be replaced by container trade through the Uk container ports to Rotterdam and Antwerp, in the medium to long term, but in the short term we should prepare for a certain amount of chaos.

    2. rose
      January 31, 2019

      It can’t be an economic project second or it wouldn’t have arranged things so that its youth are unemployed and there is no growth.

  57. Christine
    January 31, 2019

    With sanitation, good food, access to dental treatment and healthcare we should as a nation be healthier and in need of less not more medical care. While acknowledging the advances in medicine which mean that more conditions can be treated, one gets the distinct impression that we are not healthier. My GP surgery is always very busy, much more so that when I joined it in 1972 (and no, the population in my village has not increased significantly since then). At that time there were four maybe five full time GPs (male) who did home visits, antenatal clinics, minor procedures and home births and were available 24/7. They never complained that they were overworked and the family doctor was a highly valued member of the community. Now it is difficult to maintain continuity of care from the same GP, something which is so important in the care of patients.
    Also, for want of a better word, the ‘matron’ system in hospitals worked so much better than the current set up, nurses learned on the job and were supported with food and board, there were at a guess 70% fewer managers and possibly less government interference. There were school nurses who could effect early interventions for children who needed better care at home or dental care. People did not go to A & E with a sore throat or an upset stomach; they self treated and waited for 24/48 hours before bothering doctors.
    Can we please go back to those days?

    1. Iain Gill
      February 1, 2019

      In the UK where are you supposed to take a child screaming in agony from extreme ear ache on the first day of a long bank holiday? A & E although the wrong setting inevitably because there is nowhere else to go. They are not going to die but it’s inhumane to leave them. They are unlikely to be seen by an ENT specialist, they will be fobbed off with the NHS substandard approach to ear ache meaning many will represent as serious cases that are hard when they eventually see an ENT specialist. In A & E they will be seeing a doc or nurse juggling car crash victims and kids with ear ache it’s madness.

  58. Sue L
    January 31, 2019

    Dear John

    My experience from elderly parents suggests the following (all of which could reduce costs, improve wellness and reduce the commitment needed from carers):
    1. A more holistic approach to wellness so that illnesses which are connected are dealt with as one rather than as individual complaints.
    2. The side effect of medicines are flagged, identified and resolved rather than overlooked or simply displaced by additional treatment.
    3. More treatment from specialist nurses who are also able to make home visits.
    4. More guidance / monitoring on life style options.
    5. Consistency of wellness treatment in the home and in social care.
    6. Targeted and regular assessment of common complaints before they trigger serious illness.
    7. More information on patient records on-line so that authorised carers can see treatment and help monitor accordingly.

    All of the above can be under the direction of GPs.

  59. Lindsay McDougall
    January 31, 2019

    To offer the type of healthcare that Sir John Redwood wants requires flexibility, which in turn requires some slack in the system. As long as the current free-at-the-point-of-consumption die-on-the-waiting-list system persists, we are not going to get it. Demand will expand to fill the increased supply provided; there will be no end to bed blocking, wasting doctors’ and patients’ time, waiting lists and dissatisfaction.

    In order that increased resources deliver the improved service required, some form of demand management is essential. In the short term, this must take the form of modest charges. I suggest £20 per GP visit, £30 per non-emergency visit to A&E, and £150 per annum for any hospital treatment. Bed blockers would be charged a daily amount greater than the daily cost of home care. We are light years away from having an insurance based system. (Obamacare is not an insurance based system; it is a tax based system in disguise). These charges will be sufficient to deter old biddies, old codgers and hypochondriacs from wasting doctors’ time. It is estimated that one in five medical interventions are unnecessary; introducing charges will go some way to getting rid of these.

    Introducing charges does necessitate the overhead of introducing an accounting function but there would be one significant saving to offset this cost. It would be possible to charge foreigners the full cost of their treatment.

    At the moment, pharmaceutical companies are making more and more powerful drugs, often requiring additional medicines to counteract the side effects, in order to prolong the fag end of life. The medical profession, having taken the hypocratic oath, feel obliged to provide them. Thus, an unholy alliance of the pharmaceutical industry and doctors combine to increase health care costs, particularly the cost of geriatric medicine. It is investing in yesterday and it is madness. Taxpayers haven’t taken the doctors’ oath, nor has the Chancellor of the exchequer; there is no reason to demand open ended payments.

    Other advantages of introducing charges:
    (1) People will look after their health better.
    (2) Reducing spending on geriatric medicine will free up resources for mental health care.

    So let’s have a reformed NHS.

  60. forthurst
    January 31, 2019

    Inexorably, we are moving towards third world status in so many areas: crime, healthcare, education. That is not to say that politicians do not go through the motions of making provision, in fact they mess around with them all the time, but as a consequence of the generally low ability facilitated by the FPTP electoral system, too many decisions are taken by people whose responsibilities are well above their pay grade, not least of which are dealing with entrenched bureaucracies and navigating through a labyrinth of political correctness that they themselves legislated.

    In the bad old days, a doctor was someone who trained and graduated from British Institutions whose standards could be relied on, who was far more likely to be male; he attended a medical school because he was qualified to do so not despite some faceless civil servant deciding that entry to medical schools should be artificially constrained. As a consequence, patients did not need an appointment to visit their doctor’s surgery and the doctor himself performed domiciliary visits and night calls in emergencies.

    Nowadays, it is difficult see a doctor without waiting a fortnight. It is difficult to see the same doctor twice in a row, and when the appointed time arrived, a patient is most likely to be confronted by either a part-time female or a third world graduate; a domiciliary visit or a night call serviced by the doctors’ practice would be beyond expectation.

  61. lojolondon
    January 31, 2019

    Here is an easy action that will not cost a cent, in fact it will save a fortune – get rid of that stupid law that requires nurses to get a degree before working. It stops people from going into the career, and then the NHS steals trained individuals from poor countries – meanwhile putting local people are on the dole. Ridiculous law, worst of both worlds, worst for everybody.

  62. fedupsoutherner
    January 31, 2019

    Stop cosmetic surgery on the NHS unless its for severe disfigurement. Boob jobs and tattoo removal should be paid for. Start insisting people have healthier lifestyles before spending thousands on their care. We have to be more responsible for our own health too.

  63. Brit
    January 31, 2019

    Good ole traditional British food is best. We’re used to it. As my old father used to say. “Eat it up, it’ll put ginger hairs on your chest.” It didn’t . B. liar!

  64. Cerberus
    January 31, 2019


    The EU offered us a FTA, all sectors, no tariffs possibly in Feb 2018 (14:40 onwards).

    1. Roy Grainger
      January 31, 2019

      It excluded Northern Ireland though didn’t it ?

      1. rose
        January 31, 2019

        Herr Selmayr says Northern Ireland must be the price for Brexit.

  65. Norman
    January 31, 2019

    On a parallel note, wonderful to see the latest report of the Gurkha Welfare Trust. Here we see medical care at its most inspired – and most deserved and appreciated – up there in the mountains of Nepal. (This should cheer us all up – hope that’s OK with you, JR.)

  66. Iain Gill
    January 31, 2019

    Another bit of feedback on the NHS…

    The practise of many hospitals to force the patient to sign a form giving up any legal remedy if hospital negligence leads to their property being stolen really needs to be stopped.

    The legal remedies are there for a reason, and forcing everyone to sign away their rights before being seen is taking the mickey.

    As for property stolen in hospitals its fairly obvious a lot of it is done by insiders. Its also obvious the way the NHS organises things by constantly moving patients from room to room, instead of the way the rest of the world does it keeping the patient in one place and making all the different services come to them, is part of the problem. We really should have private rooms with lockable lockers in this day and age, the mixed sex wards with beds often only a few feet apart are a disgrace (and still there in the newest NHS hospitals).

    Oh and car parking charges, lets not forget those, in many cases it would be cheaper to go private and get the free parking than it is to pay the large sums for NHS parking. Oh and the security guard who screamed at me in an NHS car park because he thought I was staff using a public car park really is bad, he saw me going day after day and assumed I was staff, I nearly decked him I was there because my relative was in serious trouble on one of the wards… (mind if I had been staff it would have been an equally outrageous approach)

    Oh and Basildon hospital which does not even acknowledge complaint letters sent special delivery, thats one way to massage the complaints stats.

    Or how about the admin systems showing me as “no show” when it was actually the NHS that rang me and cancelled the appointment. Corrupt massage of the figures to make the management look better.

    And so much more.

  67. rose
    January 31, 2019

    My two priorities are:
    1 Patients should be able to get an appointment to see their doctor without being told there aren’t any for three weeks and no appointments are being made for beyond three weeks, so please ring again in a week.

    2 A and E should not be such a ghastly experience. Because people can’t see their doctors and the population has got so much bigger, one might very well be there all night; sometimes the patient is kept on a trolley in a freezing corridor all that time, with no blanket or pillow. The night may also be spent with a lot of drunks and casualties of drinking. All three factors need to be tackled: A and E should not be used as a surgery, so attention has to be given to the surgeries; something must be done about the reckless licensing policies, or lack of them, of local councils; and of course, as we are always saying, the population must stop growing artificially.

Comments are closed.