The Health White Paper

This week the government published “Working together to improve health and social care”, a White Paper sketching proposals for reorganisation of the NHS and the wider care sector.

It set out three aims.

1, Better health and wellbeing for all

2. Better quality health service for all individuals

3. A sustainable use of NHS resources.

I have  no problems with these very general aims. 2 and 3 should be the main drivers of NHS care, whilst 1 of course will entail individuals and the private sector to continue to apply  our energies to the task which is so wide ranging.

The main reorganisation entails creating two new bodies in each local government area. The first will be an Integrated Care System  ( ICS )  NHS body to control, procure  and direct local NHS services and to supervise capital budgets of the local NHS Trusts. The second will be an Integrated Care System Partnership to work with local government and presumably with private sector care providers to ensure good services and relevant procurement.

The White Paper envisages removing some of the competition provisions in current health regulations, to take away powers to control trust mergers, and to limit competitive tendering. They wish to go over to a more collaborative model. NHS England will be merged with Monitor and the NHS Trust Development Authority. The Clinical Commissioning groups are absorbed by the new ICS bodies.

I need to know more about how joint working will take place between Councils and the NHS under these arrangements. I also want more detail over what additional powers the NHS will have over private sector care providers, and how if at all the relationship between  care homes and the NHS will alter.

As I consider my response more fully I would  be interested in any comments.


  1. SM
    February 13, 2021

    Aims 1 & 2: statements of the b***ding obvious.

    Aim 3: Yes, we all know that ‘sustainable’ is the signalling word ‘de nos jours’ to show how selfless and thoughtful an organisation is.

    My suggestion is that the overarching need is to first come to a decision about what the NHS should be doing and what it should NOT be doing, then work out how much it would all cost, then decide what the State can afford. All that requires some very hard thinking on the part of Health experts, economists and politicians – and, dare I say it, on the part of the general public.

    1. MiC
      February 13, 2021

      The overarching consideration for the Tories will be to pretend that the other hundreds of countries of the world do not exist, and that they therefore have nothing whatsoever to learn from those who do health for their people very well.

      The BBC will maintain that pretence too, as ever, as it does over occupational pensions, education, and rail.

      1. Ian Wragg
        February 13, 2021

        The envy of the world(not).
        A beast which is incapable of taming.
        When will the NHS have been saved and we can resume life.

        1. Hope
          February 13, 2021

          Criminals who have entered the country illegally are put up in four star hotels in London for free and given free vaccinations ahead of U.K. Taxpaying population!

          Handcock rejoiced in announcing ten year prison sentences for those UK citizens not being truthful where they have been on holiday! What about illegal immigrants JR? Will they get ten years straight away for not saying where they come from? Why are they not paying like U.K. Citizens for quarantine or put in detention centers to stop evading justice and deportation?

          Why are illegal criminals given health care free when they passed through several safe countries? Is this part of the FREE World Health Service without public mandate? Hunt was going to stop it before quietly dropping. What is your gutless Govt position now?

          Scandalous absolutely scandalous.

        2. NigelE
          February 13, 2021

          The UK health sector has shown it can be world beating. It developed and/or acquired the vaccines for Covid, and has delivered those vaccines in a timely and highly organised manner.

          This is the benchmark it has set itself. We now expect the same performance for all of the areas that the NHS provides treatment.

      2. Fred.H
        February 13, 2021

        The difference Martin is that the BBC already proves the pretence, whereas you simply predict the Tories will in future.

      3. No Longer Anonymous
        February 13, 2021

        Personal responsibility, MiC.

        Most of our ill health is caused by being overweight. It was the #1 concern of the NHS before CV-19. Indeed we were already in an epidemic.

        We are told that obesity is due to poverty but a good percentage of weight gain is because poor people choose to drink fizzy pop over tap water. A good percentage of the calories are through poor (and expensive) choice in hydration.

        1. Iain Gill
          February 13, 2021

          the sugar tax has already forced all the supermarkets to turn almost all of their fizzy pop over to sugar free kind. I dont see any reduction in the national average waistline. so blaming the pop is rather far fetched non scientific nonsense, but then thats what the politicians listen to.

          1. No Longer Anonymous
            February 14, 2021

            Then something other than tap water is doing it.

    2. Hope
      February 13, 2021

      Surely you have the public inquiry first for catastrophic health policy failing then consider changes! More wasted money even considering it at this time.

    3. MiC
      February 13, 2021

      The timing of this disruption for conscientious NHS staff could not be more calculated and cynical.

      They are stretched to breaking point because of covid19.

      Their sense of responsibility means that they cannot fight any degradation to their pay, conditions, pension terms or prospects in any meaningful way.

      But that is what Tory rule means.

      And any consequences for the public are no problem for them either, I deduce.

    4. Mary McDougall
      February 13, 2021

      The main problem with the NHS as you will find many saying, is the certainty that there is too much duplication in paperwork and too many administration roles. Streamlining is required so that one removes flotsam/deadwood.

  2. Mark B
    February 13, 2021

    Good morning.

    It is a matter of interpretation. For example :

    1. I interpret this as a means to interfere more in our lives. That is, what we eat and what we do. If we do not live our lives according to State personal health rules, then we may have access denied to us ? (see point 3.)

    2. This is relative and cannot be judged on its own. Who decides what constitutes as ‘better’ and ‘quality’ ? Well the people responsible for the same. Hardly comforting that, is it ?

    3. Rationing. (see item 1.)

    What concerns me is that the State now has taken control of private business. ie A supposedly ‘Conservative’ government has just nationalised the care industry. That means the government / taxpayer will have to pay and, where service is poor, no one will have much of a choice.

    So we are to be owned by the State from the cradle to the grave. Throughout our lives the State will be able to control, coerce and indoctrinate us. No wonder people have been so compliant over the recent non-pandemic.

    1. DennisA
      February 13, 2021

      I am afraid you are right. Micro-management of our lives is well under way and the Covid situation shows how much people have embraced it. In a statement about the changes, Matt Hancock said, “Medical matters are for Ministers”. “NHS England will have a clinical and day-to-day operational independence, but the secretary of state will be empowered to set direction for the NHS and intervene where necessary.”

      There is an iconic photo of Mr Hancock, accompanying the article.

      1. Mark B
        February 14, 2021

        Big Brother.

  3. BW
    February 13, 2021

    Can we not insist that as part of a visitors visa that individuals have health insurance.

    1. Dave Andrews
      February 13, 2021

      Can we also insist anyone who is reckless with their health has health insurance?

      1. turboterrier
        February 13, 2021

        Totally correct. Too many abusing their and their children’s bodies and until they have to take full responsibility for their actions, the NHS will continue to to pour good money after bad and not address the problem.

      2. graham1946
        February 14, 2021

        They won’t get it. Health Insurance becomes more and more expensive as you get older, just like life insurance reduces as they get nearer to payout. Insurance companies do not like taking risks, just premiums.

    2. Andy
      February 13, 2021

      ‘Visitors’ – as you call them – already pay for health care here.

      1. MWB
        February 13, 2021

        No they don’t.

      2. Fred.H
        February 13, 2021

        nonsense you know full well hardly any people are challenged nor payments are collected by the NHS.

        1. Timaction
          February 13, 2021

          The former Conservative Party promised action on this (health tourism) and immigration. Latest figures show over 5 million, yes 5 million, have registered to live here from the EU. The ons reports 12 million foreign nationals living here. Ever wonder why you cant get a Doctors appointment, our roads contested, our children cant get into our local schools, building on our greenbelt? Yet they dont increase our carbon footprint and Boris is going to nick our cars and boilers with no infrastructure or thought of where the raw materials for batteries are coming from or how they’re mined. Truly shocking Government! No excuses after 10.5 years in office. Has Gove resolved the fish or Northern Ireland trade or taken reciprocal action? Thought not.

  4. Lifelogic
    February 13, 2021

    Sounds like another top down NHS reorganisation disaster in the making. What is needed is more power and choice for paying “customers” of the NHS & healthcare in general. Healthcare that responds to patients not politicians and bureaucrats. Start by cutting taxes and charging for it for all who can afford to pay. Encourage real competition in healthcare, encourage people to go privately with tax breaks to “protect the NHS” and company schemes and thus shorten the appalling waiting lists. Getting more money overall into healthcare.

    Hancock want an NHS responsible to ministers (with perhaps a PPE degree miles from the coal face who know almost nothing), who are responsible to parliament and every five year are elected by voters. A level of control by voters that is totally worthless. Turning the NHS into a political disaster. Was it Ed Miliband who said we are going to weaponise the NHS?

    With Tesco or Amazon millions of people vote everyday with what they choose to buy or not to buy. That is what is needed with healthcare too. Freedom and choice as to how you spend your own money on what you want and need. Not the government deciding for you and getting it wrong. With a safely net just for the few who really cannot afford to pay.

    With the NHS you get a huge tax bill, they waste over half of it in admin and then you get a huge waiting list, non treatment, the wrong treatments or a hospital acquired Covid infection.

    1. Lifelogic
      February 13, 2021

      8000 lives could have been saved had the NHS been better at stopping Covid spread in hospitals – analysis published by SAGE today.

      Probably far more than that if you include all those infected when they dumped infected people (often untested) into nursing home or sent back home after they we infected to infect others. As they did with one of my relatives.

    2. Nig l
      February 13, 2021

      Indeed. With ageing populations and increasingly sophisticated so expensive interventions a universal free service is not sustainable yet political heads in the sand driven by Labour make necessary changes impossible so we will get rationing.

      Like public sector pensions unfunded yet kicked down the road. No one has the balls to say it as it us and deal with it.

      1. MiC
        February 13, 2021

        Yes, damn all those military, security, and emergency services workers’ pensions eh?

  5. Lifelogic
    February 13, 2021

    Hancock/JCVI are so inept that they are currently causing perhaps hundreds of unnecessary deaths by not prioritising men in the vaccination order (by using age adjustment to reflect their much higher Covid risk). They have been told but do not even bother to reply.

    I see that the BBC “thinkers” and Julia Guillard types have even decided Covid discriminates against women. This when it kills or severely affects nearly twice as many men as women. Well I suppose is does Julia but mainly by killing more of their male partners, fathers or grandfathers.

  6. secretaria
    February 13, 2021

    At the moment it is quango speak, meaningless, the devil will be in the detail, so lets have the detail. Then like you perhaps some of us can comment constructively.

  7. Everhopeful
    February 13, 2021

    We need GPS….ENOUGH GPS. Who work proper hours.
    And accessible, local hospitals.
    Stop selling off NHS ( ie the public’s) resources.
    Those proposals are just too vague.
    How are they going to provide “better health and well-being”?
    Lock us in our houses, deny us medical/dental care and test and jab us ( with an experimental substance)on a weekly basis?
    Personally I have had more than enough of this b*********** government’s attempts to “help”me!
    As providers of healthcare they make extremely good undertakers.

    1. Fred.H
      February 13, 2021

      Current GP ‘consultation’ done by telephone Q & A – involves much delay. We need to switch to remote computer diagnosis causing referral where necessary.

  8. dixie
    February 13, 2021

    My immediate reaction is that the proposal appears to be that the solution to a failure of NHS bureaucracy is to introduce yet more NHS bureaucracy.

    However, playing the game;
    Item 1 should read “1, Better health and wellbeing for UK citizens”
    Item 2 should read “2. Better quality health service for UK citizens”

    1. Robert McDonald
      February 13, 2021

      No one will ever disagree with your version of what the NHS needs to do.
      The problem is you do not suggest HOW to make these factors better. And that is the problem, socialist will say spend more, that’s easy, doing it better is more difficult.
      I do agree with earlier comments that suggest those who can afford to pay should pay at least some part of their care costs, and that the key is that our health system should move more towards a mixed private and public health service. The Australian and German Health care systems provides magnificent health services by this form of cover. AND all UK visitors should have health insurance to land here.

      1. John Hatfield
        February 13, 2021

        Last paragraph agreed, Robert.

      2. dixie
        February 13, 2021

        Just in case you were replying to me rather than our host – I was trying to limit the cost a bit by restricting the NHS to addressing the needs of UK citizens rather than everyone on the planet – NHS executives and politicians clearly need clear boundaries specified.
        I agree we must learn from the best approaches though I do feel money isn’t the sole issue, a better attitude to food and fitness would probably be more effective as would banning all elective cosmetic and adjustment procedures. But there will still be people who ignore advice so do you adopt the Hancock dictatorial approach and bar them from health services, charge them extra?
        In terms of wellbeing I wonder how the issue of stress will be addressed or will the state be offering psychological analysis and counselling in place of our “unacceptable” culture, proper parenting and the church?

      3. Teesside brexiteer
        February 13, 2021

        Exactly right.l

  9. Sea_Warrior
    February 13, 2021

    ‘… removing some of the competition provisions in current health regulations … and to limit competitive tendering.’ This bit of the plan is just anti-Conservatism. The NHS needs pressure to become more efficient.

    1. graham1946
      February 13, 2021

      The ‘internal market’ is not ‘conservative’ – it is socialist in practice. There is no real ‘market’ just government employees shuffling things around among themselves and the current arrangements have resulted in more pen pushers than clinicians all on big money telling doctors they can’t use drugs they don’t approve of for instance. We have over 200 clinical commissioning groups, all with their directors, accounts, purchasing and managers of all descriptions, duplication of effort all over the country. The 2012 Lansley disaster is where we are today, a so called Conservative arrangement which concentrates more on pen pushing than health outcomes, which is why we have the costs and results we do. It needs scrapping entirely, not just the ‘Tory Tinker’ which we so often get and this looks like being, as they can’t admit to getting it all so wrong.

  10. Lifelogic
    February 13, 2021

    Lord Falconer apologises for calling Covid a ‘gift’ for lawyers – always dangerous to tell the truth mate – as James Damore found out at Google!

  11. Martyn G
    February 13, 2021

    Sir John, I would observe that it seems unlikely that adding further layers of management and administration external to the NHS, which already has extraordinary numbers of managers and administrators within the system, will be overall beneficial. There is also the fact that we have the lowest number of beds per 1000 of the population of any other civilised country, hence the annual winter queues of people waiting to be seen, so would the proposed changes actually rectify that deficit?

    1. J Bush
      February 13, 2021

      Not just winter queues. These manic decisions about a virus that is in the same family as the common cold, which they have still not (after 0ver 50 years) found a cure for , have not only stopped diagnosis and treatment for cancer and various other life threatening conditions, but also treatment/surgery none life threatening but painful conditions. For example, I have been waiting for a hip replacement for nearly 2 years and now it is not likely to happen. So I will live the rest of my life with a painful condition that disturbs my sleep, is rehabilitative because it stops me getting the exercise my body needs, for a virus that has 99% survival rate!

  12. Caterpillar
    February 13, 2021

    Another distraction. No such discussions should happen whilst the dictators are in place, they need to be removed. One fear is that the extreme central power will mandate annual (or more frequent if big pharm want) experimental treatments to access any health or social care, or of course to work or to travel. A reinforcing feedback of an increasing reliance on narrowly selective treatments that has been opportunistically accelerated these past months is high risk and high control. Hypnotised by propaganda, we have sat by watching the destruction of human rights and liberty.

  13. Sharon
    February 13, 2021

    Two new bodies in each government area. Why does government always need new bodies, but never does away with previous- and I’ve no doubt they’ll just move on the previous inefficient staff to the new body? So that idea won’t work.

    All seems very top down and very controlling.

    It would be far better run by medics with admin staff to support. Those three points sound more of the same.

  14. Iain Gill
    February 13, 2021

    Well CCG’s were designed to hand power closer to the patients, in their case to the GP’s, as CCG’s were setup to replace PCT’s and hand the power to GP’s who are supposed to dominate the CCG decision making. The problem being of course, if you speak to the average GP, that they have no power at all over CCG decisions. The CCG’s were taken over by the same managers who ran PCT’s, and in very short time just started acting in exactly the same way. No meaningful transfer of power closer to the patients happened in practise.
    My view is that these new bodies will be exactly the same, new names on the building signs, new ID badges, new lanyards, but exactly the same staff in exactly the same positions so they will act just like the CCG’s and PCT’s before them.
    The only way for real success in the NHS is to transfer the power even closer to patients, to the actual individual patients themselves. Allow patients to have real sustained ongoing buying power in the relationship with providers of care, and let their buying decisions continually force the providers to optimise and innovate. Put what patients are entitled to in a written document, enforceable in court, and give them payouts for whatever is listed in that document to take wherever they want. Stop rationing and allocation behind closed doors, which the patients have no access to the decisions made, or by who, or why.
    As it is its just rearranging the deck chairs on the Titanic, the NHS is rubbish from top to bottom. We would be better just copying the New Zealand or Australian healthcare systems in their entirety, and stop politicians messing with that.

    1. Mark B
      February 14, 2021

      “Allow patients to have real sustained ongoing buying power in the relationship with providers of care . . . “

      And this is why I advocate Private Healthcare Insurance as a cost free benefit provided by, in part by employees and, employers. Once people realise that there is a better way the market will drive the forces of change upon the NHS. This can be seen and understood better if you look at what is happening to the BBC. It refuses to change its funding model even though it is decades out of date but, no fear, technology, the market and of course the money are heading elsewhere. Hence why it is facing a funding crisis that will only get worse.

  15. Leslie Singleton
    February 13, 2021

    Dear Sir John–You should try auditing the NHS. On retirement from banking I was for a while an external internal auditor (doing the internal audit but employed by a large external firm of accountants). Any kind of surprise visit was vetoed because the admin people were too busy. There were never any procedural manuals so one would spend half the allocated (purchased) time learning the system. Anything there was tended to relate to perhaps two or three (regular) re-organisations ago so next to no help. The staff didn’t like that we didn’t somehow already know the system. I once had to make a brief personal urgent call to my solicitor and did so and was promptly reported for using a public phone without permission. I did not last very long.

    My abiding memory is of hospitals built on old estates in which the central mansion now housed the hospsital High Command. Back in the day that would have been the Chief Executive, Matron and the Accountant. Today the admin function has expanded out of sight–a two story ghastly modern building stuck on the side of the house not quite but close to reaching the horizon. People with funny titles chasing each other photocpying and comparing budgets–cannot be more specific because I never really grasped what anybody thought was being achieved.

    As is always said, because it is true, the clinical staff were amazing but did I read the other day that they account for only 52% of the budget? And of course the beautiful old mature grounds, where patients used to convalesce, have been ruined. Too much money has gone in to buildings and horror stories like PFI.

  16. Nig l
    February 13, 2021

    Taking out competition yet improving health provision sounds like an oxymoron to me. Equally less bureaucracy equals two new bodies in each area. Also control of the private sector is worrying. The only reason that we appear to be moving out of the pandemic is the private sector plus the Army from fulfilment to computer systems to vaccine development.

    Zero acknowledgment of that I find worrying. What I am certain of is the the public and especially the families of the bereaved that according to Sage were killed through contracting it in hospital must see those responsible held to account.

    Sage’s report is an appealing indictment of Hancock etc at a political level and the so called leaders of the NHS.,will it happen, of course not, yet we will continue to get the hubris on the vaccine roll out.

  17. Adrian Lloyd
    February 13, 2021

    We need more competition and choice, not less. We need to learn from other countries. We need better outcomes for patients and for staff, for whom the NHS is a monopoly employer, with all that entails. And we need to avoid the state taking complete control of care provision.

    All in all the proposed reforms look like a big step in the wrong direction.

  18. Alan Jutson
    February 13, 2021

    I am all for getting a better link up between NHS and Social Care, and so would millions of people who have fell foul of the gap between these two services, but how is it all going to be funded ?

    At the moment we have the NHS funded by Central Government, whilst Social care is funded in part by Local Authorities, and therein is the problem, as each fights the other not to pay for treatment from their own budgets.
    Add in the mix of GP budgets, and then individual health care regional budgets and surely even a fool can see what the problem is.
    A further complication is the post code lottery of approval for treatment, with different areas of the Country setting different qualifying rules, when we are supposed to have a NATIONAL health service.

    Solve the funding problem, and you will at least then perhaps start to get some co-operation between all of the services. Thus the key to all of this is money, and how much the taxpayer will cough up.

  19. peter
    February 13, 2021

    Slightly off the main topic, but relevant to the NHS. My wife had a cancer operation last week. Today blood was pumping out of her mouth. I phoned 111 who were very helpful and called an ambualnce and said to call 999 direct if any worsening. Ambulance turned up promptly and wife taken to Wexham hospital (not via M4 as shut for “improvements”). All actually very efficient EXCEPT the 111 number goes through about 10 recorded messages about Covid asking for a response or press ‘2’ to speak to someone. Probably at least three minutes wasted. I can understand 1 or maybe 2 Covid messages, but this lot with no number to press if non covid??

    1. Christine
      February 13, 2021

      I had the same problem ringing 111 with a non-Covid problem. There was no way to bypass the time-wasting Covid information that wasn’t relevant. After several minutes I ended the call and dialled 999. It’s a good job I did as my husband was rushed into hospital. The treatment at the time was fantastic. The ambulance arrived in under 4 minutes and he had the tests and treatment to save his life but the aftercare was appalling as he waited 4 months to get the further tests that should have taken 4 weeks.

    2. Fred.H
      February 13, 2021

      I recently had the same problem with my wife and extreme atrial fibrillation verging on immobilising heart attack. After x minutes I said ‘I’m ringing off and dialling 999 – who were to the point and paramedics on their way.

    3. NigelE
      February 13, 2021

      My assessment from the symptoms you describe was that you had a 999 emergency. Or better if practicable, a direct trip to A&E.

  20. Bryan Harris
    February 13, 2021

    The white paper is short on detail but high in rhetoric.

    How do they plan to achieve the aims they set out, which sound like good ideas?

  21. formula57
    February 13, 2021

    This latest reorganization is probably aimed at addressing the grotesque failures that saw pandemic planning and anticipation so inadequate. Whether so or not, the previous reorganization will have contained the seeds of its own deficiencies and so to correct those this one should certainly be permitted as should be one after.

    But why is NHS administration always so endlessly complex? If it were run by a commercial firm, it must be doubted that it would exhibit the byzantine characteristics in which the NHS perpetually wallows.

  22. I. Firth
    February 13, 2021

    The NHS needs scrapping and you need to start again -it is not for for purpose . People in this country get a second class health service compared to Germany and France -preventative care or regular screenings are unheard of- specialists numbers are kept artificially low and they are only practicing in hospitals -most women have never seen a gynaecologist in their life – the medical care during the pandemic has been nothing short of scandalous . NHS dentists not working and remaining on full pay whilst private dentists were able to work as they would otherwise lose their livelihood. GPS diagnosing over the phone and virtually no face to face appointments.
    The slogan stay home protect the NHS makes me want to scream-why ? Because it is not fit for purpose at the best of times !
    I have noticed that when it comes to medical care you are far better off in this country when you are a dog or a horse or a cat . Specialist vet with specialist equipment from day 1 -food for thought maybe .
    Get rid of all these people with clipboards and make them set up their own practices on the high street and let them work hard and have some healthy competition.

  23. jerry
    February 13, 2021

    For moderation brevity, and needless repetition, I refer to my comments and points of debate made within the recent “Reform of the NHS” article published by our host on the 10th Feb.

  24. XY
    February 13, 2021

    The NHS is a religion and no politician dares (yet) say that it should not exist.

    However, it has all the flaws that a public sector body will always have. I have seen the waste. It’s not the ones discussed in the media, it is the 105 people employed in a small village in the north to “correct data issues” – these people are correcting problems that should never have existed.

    The design of the integration/interfaces (the links between the systems) was appalling. They went live with error rates between 54% at best and 83% at worst. Normal error levels are… zero.

    I wondered why. It turns out that in that small village the NHS site is the only real employer of any size, so everyone is someone’s brother or auntie or mum. I’m sure you can join the dots for yourself.

    How can this be prevented, other than private sector involvement (and accountability)? That’s the real challenge in the NHS – or any other national health solution.

  25. a-tracy
    February 13, 2021

    Don’t bother asking us, our views aren’t taken into account. Indeed I would warn people here if you speak out you will be told ‘it’s be hope’s you don’t need us’. I’ve been through this once with the 2004 Doctors contract you take a pounding if you dare speak out.
    Ask the Unions what they’re prepared to offer, grovel, applaud, beg the doctors, offer up a lot more money.

  26. Walt
    February 13, 2021

    Sir John, “two new bodies in each local government area” is at least one new body too much in each area. The two will vie with each other. We need less administration not more, fewer liason committees etc., not more. State benefits are a safety net; people are encouraged to make their own way without dependence upon the state. Why should health care be different? Do we really want socialist model health care?

  27. turboterrier
    February 13, 2021

    As my previous posts on this subject never get past the moderator, god loves a trier so what the heck
    If one thing that is well proven is that 80% of your workload comes from 20% of patients. So any new plan has to address the 20% to make a real impact on costs and savings.
    Free to all is no longer tenable so that said the whole doctor relationship has to be refigured. The GP service is a part of a 24/7 operation but only open on average 9 hours 5 days a week. Surgeries operating on 8 hour shift patterns could be beneficial to younger doctors with families to be able to do split shifts more suitable to family commitments.
    Every surgery should have a triage system so every patient has blood pressure, weight, questions on diet, smoking, drugs and alcohol intake etc. Over a period of time it will become very apparent if the patient is helping themselves. There must be a situation where if the symptoms are due to lack of care by the patient the doctor must be able to refuse to see the patient on the premise that unless they sign to help clinics nothing further can be done.

    Doctors should not be paid for the number of patients they have on their books but for the actual work they do. Regular performance reviews and their vision on introducing changes into the practice. In industry it is called continual improvement.
    Introduction of a different way of utilizing the GP system would impact on the work load to A & E. It will give GPs more scope to improve their services and achieve better performance and job satisfaction and encourage those who have left the profession to consider returning thereby cutting out the waste of fully trained doctors talking with their feet.

  28. Fedupsoutherner
    February 13, 2021

    What more management? How about more doctors and nurses and allow the to run the hospitals and wards? Layer after layer of pointless bureaucracy which gets us nowhere.

  29. Andy
    February 13, 2021

    “I know, let’s reorganise the health service service. In the middle of a pandemic!” Said nobody sensible, ever.

    1. formula57
      February 13, 2021

      “I know, let’s escape from the Evil Empire. In the middle of its experiment that is going badly wrong!” Said 17.4 million sensible people, once upon a time. 😉

      Of course, sometimes (rarely) there may be something to be said for a “wait and see if it gets worse” approach.

      1. Fred.H
        February 14, 2021

        I didn’t want to wait and see the Evil Empire get worse, which it has already.

        1. bill brown
          February 15, 2021

          there is no empire and they have made mistakes like all institutions do all the time including our government

    2. MiC
      February 13, 2021

      It’s because they know that the exhausted but committed staff cannot go on strike or otherwise defend against the destruction at this time, I think.

      You didn’t think that there was a limit to Tory cynicism, did you, Andy?

      1. Fred.H
        February 13, 2021

        about 100,000 have had a lovely long holiday from NHS work since April. Some are almost neighbours.

    3. Fred.H
      February 13, 2021

      Andy, millions have talked about reforming, slashing, merging the hundred or more sub-divisions of NHS for years. Have you not been aware of the growing complaints re-ever growing waiting lists, postcode lottery, weird priorities on spending, difficult to defend drug refusals? This pandemic has illustrated the issues like a slap in the face with a glove.

    4. secretaria
      February 13, 2021

      Better perhaps to reorganise the reorganisers.

  30. Mike Durrans
    February 13, 2021

    Sir John,
    We need proper aims and objectives to consider!

    They must not include the word BETTER as that is unquantifiable and personally subjective and at the worst meaningless.

    My first objective would be to slash The numbers of non medical pen pusher in the organisation and develop remaining objectives from there.

  31. ChrisS
    February 13, 2021

    I would have thought that the last thing we need now is another NHS reform package, especially the proposed one.
    Politicians should be even further at arm’s length from the service, than now, deciding the level of funding, agreeing the direction of travel, and then holding NHS management to account. The precise opposite is now being proposed and the end result will be that the NHS will again be a political football between the parties.

    Taking away commissioning groups and removing the need for any form of tendering process will mean that in-house groups will no longer have to compete with the private sector.
    This will inevitably result in the cost of individual services to increase.

    This is not the way to get rid of the omnipotent status of “our” NHS which stifles debate and objectivity.
    The NHS is a public service like any other and needs to be questioned and criticised like any other. A perfect example was the decision to release elderly patients into care homes without a Covid test. How many died as a result yet nobody was fired !

    Managers and clinicians who make mistakes need to be held to account. Heads never seem to roll anywhere in the State sector, do they ?

  32. James1
    February 13, 2021

    So “ The White Paper envisages removing some of the competition provisions in current health regulations, ………and to limit competitive tendering. ”

    You don’t have to be a genius to realise what the result of this will be. The only thing that protects me as a consumer of goods and services is competition. We need more competition not less. I’m not criticising the people who work in the NHS. I believe that by and large they are doing their best. It’s the system that needs root and branch reform. When the health care statistics for the likes of cancer care and other outcomes are looked at in the cold light of day it is clear that the health care systems in many other countries are ahead of us. Is there anyone who thinks the public sector would be able to run supermarkets better than Tesco, Sainsbury’s, Waitrose etc?

  33. acorn
    February 13, 2021

    Are we going back to Primary Care Trusts, Strategic Health Authorities or even older District Health Authorities? I surmised yesterday of a metric for acceptable economic death rates. Commenters said it was about containing government embarrassment for its decade long neoliberal austeritising of the Health Service, which became blatantly obvious to the voters in 2020. The two are coincident. To quote the ONS “How does UK healthcare spending compare with other countries?

    In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD (£2,913 per person).

    However, of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736). As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.

    The UK’s publicly funded NHS-based health system contributes to the UK having one of the highest shares of publicly funded healthcare (79%) in the OECD.

    In 2017, the UK spent the equivalent of £560 per person on health-related long-term care, which was less than most other northern or western European countries, but a similar amount to France (£569) and Canada (£556).

  34. glen cullen
    February 13, 2021


  35. Duyfken
    February 13, 2021

    May I suggest the Australian health care system is a better model than that of the NHS. Its hospital and care services are first-class (as experienced by several of my siblings and other Oz family members).

    Taken from another website, here is a short description:

    Medicare is the universal healthcare system in Australia and the primary form of access to healthcare services in the country. The system is publicly funded (Taxpayers in Australia pay 1.5 percent of their income to Medicare. However, if you’re a higher earner, you can pay 2.5 percent).

    The service is operated by the Department of Human Services and gives Australian residents access to subsidised treatment from a wide range of healthcare professionals, including medical practitioners, midwives and allied health professionals throughout the country.

    For most people under Medicare, care within state-funded hospitals is fully covered for 100% of the cost. However, only 75% of the cost is covered for primary care services (such as visits to the GP).

    Should an Australian citizen wish to use private healthcare services, Medicare will cover the cost up to what state-funded hospital care would incur – the rest is up to the citizen to pay, either by themselves or via a private insurance policy. Medicine in Australia is, again, partly paid by Medicare and partly paid by the citizen.

    Medicare will not cover dentistry, optometry or transport via ambulance. However, many Australians choose to take out a private insurance policy to cover these services.

    An aspect that strikes me is that Medicare could encourage efficiency from the element of competition
    state v private and private v private, and the all-important private insurance which so many choose and can afford to effect.

  36. rose
    February 13, 2021

    Why is Gove blocking the way to removing the NI Protocol? Does he still want to to have a Norwegian arrangement with the EU? Is he just wonky on fish and the Union? Or does he want to foul up this stage for the PM so he can become PM himself?

    1. turboterrier
      February 13, 2021


      For crying out loud don’t wish that on us. Surely if anything is to come out of all of this is, we need real experienced older heads to take the tiller and steady the ship.

  37. Christine
    February 13, 2021

    Let’s be honest. Governments have been trying to improve the NHS for decades and it never improves. Throwing even more managers and bureaucracy at it isn’t the answer.
    You need to:

    1) Tackle the endemic sick leave that exists in the NHS and all public organisations.
    2) Train more of our own doctors and nurses with more bursaries that must be repaid if they leave before a certain number of years.
    3) Prioritise UK citizens for medical training places rather than the totally unfair system we currently have that encourages colleges and universities to take higher-paying foreign students.
    4) Stop health tourism.
    5) Cut the number of managers and the numbers who are overpaid for the level of work they do.
    6) Stop trying to run our lives and stop taxing the many because of the few who can’t manage their own lifestyles.
    7) You have the perverse situation that obese people are given sickness benefits which allows them to buy even more junk food. Put a stop to this.
    8) Recycle NHS equipment like walking frames and crutches instead of throwing them away which the NHS currently does. Let a private firm do this job.
    9) Remove all NHS non-jobs relating to diversity and those coming up with ludicrous ideas like chest feeding and pregnant people that the majority of you MPs seem to be buying into given the wording in your latest bills going through parliament.
    10) Stop people living abroad from receiving free prescriptions via their families living here. I know many people who currently do this.

    These are only a few suggestions which you can have for free but no doubt all that will happen is another quango will be set up to look at the problem and another ten years will go by. The British people deserve better but the Woke nonsense seems to have permeated all areas of society. We need a new political party that really does work for the people.

  38. No Longer Anonymous
    February 13, 2021

    “Better health and well being for all.”

    Which is already within reach for the vast majority through personal responsibility. Stop eating crap. Stop eating too much of anything and move a little bit more. Stop smoking and stop drinking/drugging to excess.

    How can we have the Left telling us that poor people are getting fat because they can’t afford to eat well ? The biggest cause of obesity isn’t what people eat but what they drink. Gallons of fizzy pop and tea loaded with sugar. The healthiest thing you can drink is by far the cheapest. Tap water !


    Off topic, sorry.

    It looks very much like a water tight lockdown where I’m living. Other than going to the supermarket under strict conditions and going for remote walks/runs with the dog I have not been out for months. I have not seen friends and relatives for months. Friends and relatives report exactly the same from other areas of the country.

    Clearly some areas are NOT obeying lockdown. If we’re going to do this then it needs to be done at gunpoint, Chinese style in the areas that won’t obey. I wonder why the government dare not ? Therefore the rest of us are sacrificing our freedoms for virtually no good at all.

    Mr Hancock needs to be told that his threats of prison mean nothing to a population which is already imprisoned.

  39. secretaria
    February 13, 2021

    I start from the premis that the NHS works at the medical and humanitarian level within its capacity to do so. Its routine work has been impacted by Covid, heavily, because it does not have the personnel to do justice to both. We set up Nightingales but lacked the people to run them. The lack of expertise in numbers leads to long waiting times in some areas, which will be even longer when Covid is a memory. Realise you can only utilise expensive hospital facilitise efficiently if you have the skills to man them.

    So what is the answer. Money for sure to train and pay for the numbers you need. Greater efficiency for certain, but the ideas for this must come from the medical personnel within the NHS , not top down from government and all the quangos it insulates itself with. Better purchasing and less waste in the consumables that are purchased , via kaizen from NHS medical staff. Finally you can recruit abroad, in light of time it can take to train medics, you have to, but try not to disadvantage the countries you recruit from.

    As I said earlier, I can’t comment on the paper that SJR has outlined because at best it is aspirational with little solid to discuss.

  40. Lets Buy British
    February 13, 2021

    Thank goodness for a good NHS service but despite having better knowledge of how to treat ailments and diseases there is no doubt in my mind that standards and services have declined over the last 4 decades. Just throwing more money at the situation is not the solution.

    More controls and checks are needed with greater accountability. As well as making the most of current resources. The management of the NHS cannot put it on to auto-pilot and expect it to perform well.

    A few years ago, my mother entered hospital and was moved between 4 wards. If I was to mark each ward out of 4 then I would suggest grading them as 4 for the best followed by 3.5, 2.5 and 1. Why was there a huge range in the quality of care. Were some Ward Sisters better able to motivate and organise their staff ? If a ward was underperforming then who was responsible to ensure that it improved ?

    Going back a few years then we had the dirty ward scandals. Who had their feet held to the fire. Of course, it should not have happened in the first place. But who was responsible for checking.

    Brain drain of quality staff to the private sector is continuous. It’s not helping the quality of service offered by the NHS.

    We are told that Covid vaccines are being left out of the fridge over night. The vaccines are now useless. Who is being irresponsible and careless and who is responsible for checking. Basic stuff. I am led to believe that circa £5.8 million has been wasted, this might include other medicines and might cover a 12 month period.

    My grandmother went into a Care Home in the 1980s. From memory she owned a bungalow and had cash on deposit. To help towards the cost of the care she paid her pensions over but was allowed to retain circa £7 per week for personal spends. She was allowed to keep her home. However the financial support from the Govt is significantly lower today if you have more than 2p in your bank account and own a house. My question is “where has all the money gone. Why can we not afford to give this level of support today”

    Is the NHS getting value for money from drug and other procurement.

    Why is the NHS refusing certain expensive cancer treatments that preserve or extend life. Not acceptable when we have a foreign aid budget of circa £11 billion.

  41. John McDonald
    February 13, 2021

    If All Else Fails Re-Organise. We want fewer Management structures not more.
    Local responsibility for the customer facing operations like the GP practice, Care home, Hospital is a good thing and all involved directly or effectively employed by the NHS. There should be just one Health Authority in the UK the NHS with regional representation. The current system collapsed by why of too much management, introducing capitalist principles, self-funding, trusts, out-sourcing etc. into health care.
    HeathCare is a basic requirement, like Water, Gas, Electricity and other essential services and should be a direct state responsibility. Outsource it or sell-off and trouble and more cost to the consumer in the long run.

    1. Fedupsoutherner
      February 13, 2021

      Agree John. When I moved from Scotland to England 2 years ago half my notes didn’t get sent down and are still missing. Wonderful – not.

      1. Fred.H
        February 13, 2021

        so who is at fault?

        1. Fedupsoutherner
          February 14, 2021

          It’s because the nhs is delved. It would have been simpler if it were all one. Our practise told me this problem is very common now. The computers aren’t linked as they should be. Missing vital notes is not good and doesn’t make life easy for the new GP.

  42. Iain Gill
    February 13, 2021

    I see the dinghy arrivals, who are staying at 4 star hotels are now being given the Covid vaccination at age 20. Thats the NHS we have, pay in all your life and you are at the back of the queue. Really John just resign from parliament there is no way these clowns in power can be supported. 20 year old new arrivals being vaccinated before vulnerable locals. Absolutely outrageous.

    1. Alan Jutson
      February 13, 2021

      They are not paying for isolation either, in fact reports suggest they are even given spending money.

      Some even complain it is not good enough accommodation, or good enough food.

      Seems our Governments priorities and polices are all completely wrong.

    2. rose
      February 13, 2021

      More to the point they are not being put in prison for ten years.

    3. Fedupsoutherner
      February 13, 2021

      Ian, I agree totally. I won’t get mine for a couple of months yet. I despair of this government. Friends of mine who are normally staunch Tory supporters actually think Farage and Galloway are brilliant. We’ll done Boris and his team of idiots.

    4. Timaction
      February 13, 2021

      The former Conservative Party promised action on this (health tourism) and immigration. Latest figures show over 5 million, yes 5 million, have registered to live here from the EU. The ons reports 12 million foreign nationals living here. Ever wonder why you cant get a Doctors appointment, our roads contested, our children cant get into our local schools, building on our greenbelt? Yet they dont increase our carbon footprint and Boris is going to nick our cars and boilers with no infrastructure or thought of where the raw materials for batteries are coming from or how they’re mined. Truly shocking Government! No excuses after 10.5 years in office. Has Gove resolved the fish or Northern Ireland trade or taken reciprocal action? Thought not.English taxpayers put into 3*

    5. Timaction
      February 13, 2021

      Yes. English taxpayers on return from abroad having to pay £1750 each to self isolate in 3* Hotels whilst boat people given free board, pocket money 4*Hotels or burning down former army barracks. In the mean time our homeless are on the streets with our ex servicemen with mental health issues. How’s Priti Useless doing with the deportations and removing legal aid from lefty lawyers? Silence.

  43. The Prangwizard
    February 13, 2021

    More work for the oppressive bureaucracy as they mess with the change. Keeps the no-productive in work as they soak up the country’s wealth. Well done ‘Boris’.

    I had thought the government was prioritising our detaching from the EU’s rules but Gove confirms the betrayal of Northern Ireland and iat anorher level instead of getting rid of GDPR your government simply replaces it with ICO. £4000 fine for non compliance.

    Under ‘Boris’ we are being cheated. We need to beef up resistance.

  44. Diane
    February 13, 2021

    Better quality health services for all individuals & additional controls: Are we to believe the DM on line report today concerning illegal migrants accommodated in a not too shabby hotel for weeks and months in some cases & reportedly this week having received free vaccination, those spoken to, who are young, confirming that was indeed the case for them and many others they know of and few were known to have declined. They are reportedly very happy. I’m sure they are, unlike many others including many front line police officers. The report states that the NHS is taking action so this Priority List breach does not happen again. So who exactly is responsible for this breach. What oversight is / was there. Under whose control was this action taken. Or perhaps it’s all made up and in the interests of transparency we should await clarification from those supposedly in control.

  45. Gordon Merrett
    February 13, 2021

    When I read “two more bodies” my reaction was Oh no not more layers of management or what goes for management in the civil service. Please, less is more!

  46. John Hatfield
    February 13, 2021

    I cannot escape the notion that any changes to the NHS without increasing private sector involvement will simply increase bureaucracy and reduce efficiency.

  47. bill brown
    February 13, 2021

    Sir JR,

    As I read the proposal it willmean less competition and a bigger say from government about the NHS.

    Having politicans more involved in the managementand running of theNHSasthe proposal looks for the momentcan based onformerexperiencesonly lead to mroe problems.

  48. jon livesey
    February 13, 2021

    One fundamental question is whether you want an NHS that is so over-provisioned that it can solve anyone’s problem immediately, but is very expensive and uses its resources inefficiently, or an NHS that is good value for money, uses its resources efficiently, but makes patients wait for treatment, sometimes with fatal results.

    If you don’t make this policy choice, and stick to it, you end up with an NHS which is constantly criticised for not being what it wasn’t designed to be.

    1. Iain Gill
      February 14, 2021

      “wait” in the NHS is just rationing, as they are doing it in the hope that a proportion of the patients will die, or give up and go private, before getting to the front of the queue.

      we dont need to organise the NHS, we simply need to organise a proper state backed insurance policy for the patients and give them cheques to take anywhere they want for treatment, and let the market fix the inefficient organisations.

  49. William Long
    February 13, 2021

    As soon as I read about ‘Two new bodies’ the hairs on the back of my neck begin to tingle. It can only mean more useless bureaucracy. The NHS needs root and branch reform and that cannot come from a ‘White paper’ produced from within itself.
    The NHS needs to free itself from the anathema with which it views the private sector, and take every step it can to make use of it and learn from it, and you need to press Mr Hancock on how his back of the envelope (for that is all they can be) proposals are going to achieve that.

  50. Iago
    February 13, 2021

    How many ministers are there now? Is it about 170?

  51. Lindsay McDougall
    February 13, 2021

    This ‘reform’ sounds a bit like the old regional Strategic Health Authority system with different names. Central government ‘working with’ local authorities, local charities and the private sector will result in practice in over centralisation, with central government taking all the big decisions and the other organisations having the grotty end of the stick, responsibility without power.

    The type of reform needed is radically different. If you wanted to design a health care and financing system that led to perpetual waiting lists, poor service, inability to cope with pandemics and incapable of expanding rapidly, you would design the NHS. The free-at-the-point-of-consumption die-on-the-waiting-list model, with no demand management and financed almost exclusively by taxation, does not work, never has worked and never will work. Its over centralised procurement system operates at two speeds, dead slow and stop. Procurement of ventilators and PPE took at least a month more than it should, leading to many unnecessary deaths.

    To achieve demand management, charges are needed. They need not be high and should complement rather than replace taxation revenue. I suggest £20 per GP appointment, £30 per non-emergency use of A&E and £150 per annum for unlimited use of the hospital system in one calendar year, all payable by plastic. Hospitals and GP surgeries would be allowed to set up charities for treatment of ‘the poor’, however defined. The additional revenue would permit staffing the Nightingale hospitals and isolating COVID-19 patients in them, providing the finance for adequate mental health care in the health system and in the community and catching up the backlog of treatments for other diseases. The penny pinching deceipt of ‘centres of excellence’, necessitating patients travelling long distances and paying a lot in parking charges, should be ended. To treat people close to their homes requires more capacity and it would cost.
    I know that 85% of the population believe that the NHS is a great system, praised to the skies and thought to be ‘the best health service in the world’. But answer me this: if 85% of the population believed that the earth was flat, what shape should the earth be?
    Care in the home is best organised locally, with the cost borne by local authorities, who would be allowed to increase Council Tax revenue and to charge £20 per home visit. Councils would be allowed to organise basic nursing care at home, again with a charge of £20 per visit. Such local care should be kept out of the clutches of the NHS and central government.

  52. kzb
    February 14, 2021

    I am deeply suspicious of all this “patient choice” and talk of “customers”.
    Most NHS patients are actually confused and helpless sick or old people. They are not “customers” choosing their next sofa. That is a complete misrepresentation of the situation.
    The real problem is, if you are not completely compos mentis, you don’t stand a chance with the NHS. What is needed is more joined-up care across the system. As it is, the very first reaction of any NHS department is to find out which other organisation you could be shovelled off to.

    1. SM
      February 14, 2021

      I agree, kzb, and may I add (from personal experience) that when you are the close relative or spousal carer of a very sick patient, your judgement and forward-thinking when dealing with NHS problems can be seriously hampered by acute worry and emotion.

  53. Cocokate
    February 14, 2021

    I’m a GP. I’ve given up reading the details of these reforms. The headlines are usually vaguely positive-sounding in way that is hard to argue with. When the changes finally filter down to the front-line they usually make little useful difference to the day-to-day job, and often increase the amount of paperwork or number of meetings to be attended. Every government “reforms” the NHS. The changes go round and round, the newest one often much the same as the idea 3 reforms ago. There’s an argument to be made that the NHS needs reform but no government has had the guts to do it at the scale and cost that might really make a long-term, positive, significant difference. Given that, the next best thing is to leave it alone.

  54. a-tracy
    February 18, 2021

    How much is Helen Whately involved with this “Working together to improve health and social care”.

    “Going up against Ferrari without knowing figures for your policy area is going to get you gotcha’d. Whately tried to bluff her way out without success. Ferrari gently reminded her, it’s £24,000…” Guido, well Ferrari was incorrect. A newly qualified nurse is on £24,907 for a 37.5 hour week with enhancements for nights and weekends, a 25% pension contribution on top by her NHS employer, 35 days holiday, full sick pay for six months and half pay for the next six months and other perks and benefits you can check out yourself on Nursing Today. 1.5x overtime rates and 2x on bank holidays, there is also high cost area supplements and increases done through the pay band through the year – it is misrepresentation like this that makes people think it is poorly paid and the Minister should have a file with information like this in it that she can open to check.

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