Like others, I warmly welcome the workforce plan. I am grateful to my hon. Friend the Member for Winchester (Steve Brine) and his Committee for producing a detailed and interesting report that highlights many of the things we need to study.
I suspect most of us in this Chamber, of whatever political party, accept the broad principles that we need to train more medical staff in this country and that we need to expect to recruit more people to deal with the rising workloads and rising population in the years
ahead and to clear the current backlogs. And who would not want progress on better working conditions and decent levels of remuneration, so that many more people are proud to remain in these jobs?
It is not as if we have not had these issues before, and it is not as if the workforce has not been expanding. As the report reveals, the number of full-time equivalent staff in NHS England has expanded by 263,000 since 2010, which is a very substantial increase. It is rather more than 263,000 people, because it includes part-time arrangements too. Of those, some 55,000 are nurses and 42,000 are doctors, which means that more than 160,000 are not in those two leading medical professions. NHS managers, who have increased substantially in number during that time, need to demonstrate that they are recruiting the right kinds of support staff, administrative back-up and IT help so that medical professionals are better able to concentrate on treating people and doing a good job.
In the past, I have led a couple of large industrial groups, and in the days before we had an elected Assembly to run the Government of Wales, I was responsible for the very substantial public sector workforce in Wales, including the NHS workforce, as Secretary of State, so I have some experience of the complexities and difficulties of helping to supervise or run large workforces. I freely confess that none of those workforces was on the scale of NHS England, which is another degree larger, with a workforce of 1.5 million. None the less, whether it was tens of thousands or hundreds of thousands, I understand the complexities of dealing with large workforces.
I have reflected on what worked and on my experiences. My first reflection reinforces the point we have heard from the Committee. If I had experienced a 9.1% rate of turnover each year, I would have been quite alarmed. Had that been added to by a 6% or 7% absence rate, as is reported in some professions and areas of NHS England, I would have been even more alarmed. Although I had lesser problems with absence and loss of talent, I regarded them as a challenge that the leadership and management teams had to take on. To deal with the frictions, there were nearly always things that could be done to improve conditions of employment and to improve the understanding between management and those trying to execute policy.
The frictions were not always about pay. Of course, increasing pay is greatly helpful, and I welcome the results of the independent reviewâI was one of the many voices saying the independent review had to be implementedâbut we now need something for something. We need to complement pay by making good decisions so that people feel they have a worthwhile, feasible job.
The one thing on which I disagree with my hon. Friend the Member for Winchester is his point that, with an organisation this big, it might be rather difficult to do the right kind of mentoring and individual treatment. The NHS is a series of small organisations under a general umbrella. There have been endless arguments, not particularly on party lines, about how much should be decided by experts and well-paid people at the centre and how much should be decided in the hospitals and surgeriesâabout how much delegated power there should be.
There is certainly management at all levels. As my hon. Friend reminded us, there are chief executives and other senior staff in hospitals, and there are practice managers and others in GP surgeries. Quite a lot of the
mentoring, understanding, and evolution of a personâs role or job must occur in those local places, where one of the local managementâs main tasks must surely be ensuring that their staff are looked after and well motivated. This service is a great example of a people-led service. It has millions of potential patients and a million and a half staff, and it is the interaction between them that matters. The quality of service is almost entirely dependent upon the skills, attitudes and approach of the medical professionals and their support workers in delivering a good quality of service to those who turn up as patients.
We need to say to the 36,000 managers of the NHS England system that they have an important task; that surely they know their staff and what some of their staffâs problems are; and that it is in their hands, not in the hands of Ministers, how the jobs are described and made into realistic jobs, with tasks that people want to do and can do. It is for those managers to work out how staff are rostered and how people become eligible for a promotion. Good staff management is about managing all those things.
Let me further the debate on this. We talked to the trust chief executive about this yesterday. She said that she does good exit interviews with people who leave her trust. They leave for varying reasons, but often it is because they have got a different job in a different part of the country, and their family circumstances have changedâthey are not always off to Sydney. So this comes down to leadership. The Secretary of State would talk about the Messenger reviewâI assume the Minister would concurâwhich talks about leadership in trusts and integrated care systems. That is not as good everywhere as it might be.
That is right. I hasten to add that there are many examples of good practice in the NHS. In the hundreds of trusts, units and management commands in the NHS, there are some very fine examples. In a large organisation such as this, part of the skill lies in spreading the best practice from the places that know how to do things and are doing them well to those that need help or support. They may not be aware of what is feasible, given the resource to which they are committed. I have found whenever I have been involved with something that was not working well that bad management have often made a mistake and appointed some good people but not in the positions of influence and power where they can really make things happen. Where someone is trying to recover something that is not running well, it is often about identifying the people who are good but who may be sidelined, frustrated or not being used properly, and then transferring them into different roles, to give the idea to the others that the organisation can be a good one.
My hon. Friend was hinting at where someone wants to get to if they are leading any organisation. They want success, because success breeds success; people want to work for a successful and happy organisation. If morale is allowed to sink, performance starts to get poorer. If performance sinks, really good people perhaps do not want to be associated with it or they are frustrated that they are not given the power to sort it out. The organisation could then get into a downward spiral, which it needs to avoid.
Let me move on to a slightly tougher message and spoil the party. I take as my text the work that the Chancellor of the Exchequer and his team have been doing and his recent big speech at the Guildhall on productivity. His research revealed that productivity in crucial public services, particularly the NHS, is considerably below its 2019 levels. We are all sympathetic to the fact that there was a major disruption of the NHSâs work for the period 2020-21, and probably we would also expect there to have been difficulties in in 2022 after the impact of a major diversion of effort and activity into tackling the pandemic. We are all very grateful to those brave and talented staff who did what they needed to do to see people through. However, over that period a large additional amount of money was provided, not just for the pandemic, but now on a continuing basis, along with some additional staff, as we have been commenting on, yet we are still not back to the productivity levels we were at in 2019.
As the managers of the NHS go about creating a more contented and happier workforce, in the way I have been describing, they need to say to people, âYou are going to be better paid, but we can also look at your promotion, grading and job specifications,â because the good ones should be able to get additional pay and go up the scale into more important jobs. There has to be something for something. The managers have to help the staff to deliver more treatments, consultations and diagnoses, which must be possible because we are not even at the levels we were at in 2019.
I have met scores of people working in the NHS at different levels; I am sure the right hon. Gentleman has too. When I talk to them about the productivity gap, they give me two or three clear examples of why there is a productivity problem. One is that there are more sick days because of burnout and exhaustion. It is unfortunate that the Government are cutting funding for mental health hubs, which have been a huge source of help for staff, particularly in hospital settings.
The NHS workers I have spoken to also talk about scanners that are way past their use-by dates and take far too long to get going, and about IT systems that do not speak to each other. They have to use eight or nine different IT systems between wards, or even on one ward, and old computers take too long to set up in the morning. It is that kind of tiresome daily grind. We sometimes know about that here in Parliament, when computers do not start in the morning and things do not work, and people end up getting frustrated.
Does the right hon. Member recognise that the productivity problem is not just about rotas, but about investing in technology, IT and scanners that work, making sure that water is not coming through the ceilings and giving mental health support?
I agree with all that. I have been very careful not to criticise the staff; I am talking about a management problem. If there are too many agency staff, then time has to be spent explaining to them how that particular hospital or department works, which would not be necessary if the regular staff had turned up. If there are gaps because of staff absences or people having resigned, that puts more strain on people and the system does not work efficiently.
All my remarks are made in the context of what I said at the beginning about trying to make these jobs more worthwhile and feasible. We need to look at how that can be done, and managers have to answer questions about whether some of them are imposing too many requirements on people that are not directly related to them performing their tasks better. There have to be limits on how much other general management information or other management themes they want to pursue, when the main task is to clear the backlogs and to treat the patients. The patients should come first, second and third, and that is not always possible if managers are making many other demands. So that is where the management teams need to take the organisations.
I was coming to the other good point that the hon. Member for St Albans (Daisy Cooper) makes, which is also well made the workforce plan. We are living through an extremely exciting digital revolution. It may even be speeding up with the developments in artificial intelligence, which could be dramatically helpful. There is a continuing task in the NHS, which sometimes thwarts those attempting it, to make sure technology is applied in the right way and is understood and friendly to use, so that hard-pressed and busy medics can find it a support, rather than a tribulation or a barrier.
Given the NHSâs huge range of data and experience, artificial intelligence should be an extremely valuable support, aiding diagnosis and decisions on treatment. I am not one of those who think that computers can do these things on their own or are about to take over the world. In the model we are talking about, the computer is an extremely important assistant that can do research and produce first draftsâthat kind of thingâin a way that speeds up the work and effectiveness of the professional. However, it has to be controlled and guided by the medical professionals, who have the judgment, wider experience and expertise. The quality and speed of what they do could be greatly enhanced with the right kind of AI backup. For example, if they are facing a condition they do not know much about because it is rare, the computer would be able to give them immediate access, one assumes, to the details of what has happened in similar cases, what it looks like and how it might be treated.
We have the time, so let us explore that briefly. My right hon. Friend is right to talk about technology and AI in particular. We produced a report a couple of weeks ago on digital NHS. We are struggling with first base on digital. Medics talk to us about having to log in to multiple systems in order to do one very simple task. I worry that, while we are talking about 21st or 22nd century technology on assistive AI, we are struggling with first base. We were at the Crick Institute yesterday. Teams there were talking to us about the challenges of bringing together all the datasets that exist across the NHS to assist in their research, and they cannot even do that. This should be an assistive help to the workforce, but we have a long way to go on that. I know the Secretary of State is very seized of this opportunity, but my right hon. Friend knows that there are problems.
Yes, indeed. Wishing to be optimistic, I was pointing out, as many will do, that there is huge opportunity in this area. None the less, my hon. Friend is quite right that there are all sorts of issues and
questions, such as: what the existing technology delivers; whether the systems talk to each other sufficiently; and whether it has data in a format that can easily be transferred to a more common and modern system. We are obviously back into arguments onâI do not have a strong view on this, but experts shouldâhow much has to be laid down centrally, so that there is an England-wide, or NHS-wide, system that is freely interoperable, and how much is best determined by local units, which know their own needs and will be organising the training and will want things that their own staff find helpful to them and fit into the sometimes differentiated approach that an individual hospital or a GP surgery may have.
It is good news that we are taking future manpower requirements seriously. It is good news that we are having an informed conversation about what might be possible. It is good news that most people, I think, agree that technology is part of the answer. Having better motivated and happier staff is clearly fundamental to the answer. I hope that, when the Minister sums up, she will have a few thoughts for me on what actions the senior management of the NHS and its various trusts are taking so that they can get those absence rates down, so that they can get the loss of staff substantially reduced, so that they have fewer staff saying, âThis is not feasible,â or, âI am burned out,â and more staff saying, âI am really proud to work here,â or, âThis is going extremely well; we cut our backlog last week,â and, âDid you know that many people are now getting over this condition because of our treatments?â
That is clearly what we want. We want high-morale organisations. That takes money and the right number of staff. It also requires great leadership, but it is not just leadership from the political top; it must be, above all, leadership from the very senior managers at the top of NHS England percolating down to the very important senior managers that we have in every trust and every major health institution under the framework of NHS England.
July 16, 2023
What we want is an organisation that actually responds to paying “customers” and not one that has their money already and so treats “customers” as a liability to be inconvenienced, deterred or pushed from pillar to post. Pushed from the absurd GP queueing systems, to the ambulance service, to 111, to casualty, to hospital then kicked out again (usually too early) to 999 then back again to social services and the GP’s one hour queueing system – this while getting little of value from any off them.
They take all your tax off you under PAYE (so you cannot then probably cannot afford private treatment) and then give you whatever is the least they can get away with, when they feel like it in perhaps 18 months time if you live that long.
Take it or leave it mate we have your cash already so you to use are just a cost for us. It is in the NHS interests if you just die before treatment. Saves on state pensions and benefits too.
July 16, 2023
Oh Hear! Hear!
July 16, 2023
Cynical, but sadly true !
July 16, 2023
As I get older/wiser I find that one rarely be cynical enough in so many areas, politics certainly being one of them.
Remember that Labour PR woman emailing ministers that âtoday is a good day to bury bad newsâ when two aircraft were flown into the world trade centre towers on 9/11 and other hijackings killing nearly 3,000 people? It seems that was what occurred to her first!
July 16, 2023
Until they get the basic working it’s doo.ef.
45 minutes of BBC propaganda on Casualty lat night. Organised chaos. Pretty realistic.
July 16, 2023
@Lifelogic +1 – Maybe we could get to the same free at point of deliver service by giving the our National Insurance(NHI) some added meaning. You pay in as now on a compulsory basis, and those that provide you with a service get paid out by the system. Then we have the service providers chasing the money â a bit like real world every day life.
July 16, 2023
All people (other than those who really cannot afford to) need to pay something when they access the service. The GP etc. need to be paid by their customers. Then they would want actually to see and service them rather than wanting to deter, delay and inconvenience them as now. Tax people far less and make them pay for medical care. But with a safely net for the few who really cannot pay anything and for those with very severe ongoing and expensive medical needs.
July 18, 2023
No. We need an Insurance Company protecting its profits (by ensuring its insured are as healthy as possible) between each of us and the medical profession. They will ensure we are not medicated unnecessarily and that what we do get is good and value for money.
The medics need to know there is no payout without evidence of good outcomes. No swabs lift in that patient etc.
You donât want to be sodding about with the bank when you are ill – you want yo have some sentient person, healthy, standing at your side.
July 17, 2023
But the private sector and the NHS are inextricably linked. Not forgetting that the vast majority of doctors (and nurses) going into medicine to HEAL people not to make money (money important for sure, but healing first). The money men in politics just don’t get this.
Problem with the NHS now is CULTURAL (a kind of left-wing lack of hierarchy / accountability). But that problem is systematic to our culture in general – not just in the NHS.
So as things stand now, there’s not a huge amount politicians can do, using politics, to transform the NHS. There’s already a balance where doctors can make extra money in private care on secondary-level health issues. But when it comes to emergencies / life-threatening and serious illness, the vast majority of doctors want to do what they got into medicine for and that is to HEAL not to make money.
So the real issue with the NHS is much greater than politics. It’s ultimately CULTURAL. Which is something we can only change through the CHURCHES, EDUCATORS, THE ARTS & MEDIA. To imbue these more with sensible Conservative values.
July 17, 2023
In other words, the great problems of the NHS are similar in origin to the great existential problems facing our culture / civilisation in the West in general. The Decline and Fall of Western Civilisation (although I believe that decline and fall can be halted and reversed with some imagination, wisdom and courage!). Politicians trying to radically fix things in the NHS (and in our country in general) is a bit like a plumber trying to tinker here and there say with the Victorian sewage works of London when the whole works need to be radically transformed from the bottom up (no pun intended, ha, ha!).
July 18, 2023
No. We have cooks looking at working plumbing and because itâs old, replacing it with their own dreams of bendy pipes at no cost.
Meanwhile plumbers are boiling eggs.
July 18, 2023
I heard what was wrong with the NHS from a really clever, smart private doctor. No doubt not just what he thinks but what other clever, smart doctors like him think. Again, so many politicians (Labour and Conservative) just don’t get the the medical world. They use it as a playing field for politics. But most doctors couldn’t care less about politics. They became doctors primarily to HEAL people not to make money. Of course, making money is important too (and a lot of private doctors own lovely houses in the country, educate their kids at private school, and generally have a high standard of living – and they deserve it! – but my point is doctors are not ultimately into medicine because of the money or politics but because they want to HEAL people. Until more Labour and Tory politicians get this, then the healthy sector will carry on as usual. However, the real problem regarding the health sector is money or politics but culture from outside the health sector affecting every area of our culture in general and economy.
So politicians first need to shut up more (and stop being so bossy, know-all, politically ideological and dogmatic) and listen more to doctors. Doctors are pretty smart people and understand their sector better than politicians – whether Labour or Tory. And even that isn’t enough. But it’s a start.
July 16, 2023
Over my life so far (circa 60 years) I have had very little indeed back from the NHS – my birth delivery midwife, a few vaccines, some nasty orange stuff as a child, an appendix op, an x-ray & boot for a sprained ankle, a scan for gall stones, some antibiotics three times… Total value delivered perhaps ÂŁ16,000. Tax, NI, CGT. VAT, stamp duty, car tax, fuel duty, alcohol duty, road taxes, council taxes… that I have paid to HMRC so far perhaps circa ÂŁ2 million 40%+ of which is spent on the NHS. So I have had under a 2% return from my healthcare payments to the state so far. They even severely mucked up on the appendix diagnosis twice and once on the gall bladder diagnosis. They hugely mucked up on the net harm Covid vaccines too, doing huge net harm for hundreds of thousands (fortunately not it seems for me – so far anyway).
So not exactly good value.
July 16, 2023
I suppose the NHS needs even more than just our money for various exploits.
Who, for example, I wonder, funds The Medicine & Healthcare products Regulatory Agency?
A little transparency where our âHealth Serviceâ is concerned might be in order?
July 16, 2023
Cuibono – FOLLOW THE MONEY.
July 16, 2023
Rather a silly post. Complaining about not being ill or injured enough to get your money back. Think yourself lucky, not hard done by. If you have paid for private medical care and not been ill, do you complain about that? Do you get a rebate? No, all you get as you age is higher and higher costs and of course private hospitals do not in general run Intensive care or emergency ambulances. If you have a smash on a motorway it will not be a private company that picks you up and makes you well again. If you have an operation in a private hospital and it goes wrong, they will transfer you to NHS intensive care. This is not to say that the NHS is perfect, far from it and it was further mucked up by the Lansley re-organisation of 2012. As you seem to have had so little experience of the NHS, I wonder how you can be so dogmatic.
July 16, 2023
I am not complaining and (so far) have been lucky in health terms as has my family, but why are we paying so much into the NHS and getting so little of any value back? The same is true of so much of the UK government activity in general.
As to insurance I tend to self insure as far cheaper on average. This as most for what you pay in premiums goes in 12% IPT taxes, insurance company profits and overheads, the many fraudulent claims, incompetent people talking stupid risks, processing claims and sales costs and similar waste. This also saves myvtime in making claims and buying suitable policies. Very hard to judge the value of insurance policies unless you devote months to analysing the policy document and your personal risk and cover. Unless you are a much higher risk than normal but can get a standard premium it rarely makes any sense.
July 16, 2023
Why? It’s to pay for those less fortunate than yourself who do get ill, sometimes with major things. What would you like to get back from the NHS if not care when needed? You pay 2 million in tax – good for you, that’s twice what the average earner earns in a lifetime. I don’t think I’d complain in your shoes, you have hit life’s jackpot. Many haven’t.
July 18, 2023
They donât get value for Lifelogicâs money either. Thatâs the point.
July 16, 2023
Indeed. But you are an English taxpayer and are expected by our politicos to pay for all and sundry who arrive in England to get their free health services. 10 million plus in the last 20 years. In context, a scary number, the size and population of Switzerland. And still they want more to reduce health services more per capita, whilst pretending growth by GDP, NOT PER CAPITA.
English people can claim free health services when we travel the world. OOPS, NO WE CAN’T. So when are the Westminster fools going to get around to charging foreigners properly for their health care or privatise the lot and stop taxing me to pay for this madness? I too would like the private option as I’m sick of waiting in line for a rubbish service, so the reckless, feckless and idle can get their free health, housing and welfare at the 46% expense.
We desperately need a conservative Government!!
July 16, 2023
+1
July 16, 2023
I take it you haven’t taken part in producing children? The NHS usually bears quite a cost.
July 17, 2023
Yes plenty of children, I was talking about myself. My wife and children pay or will pay their own taxes.
July 17, 2023
Yes … but doesn’t make women flying into the UK to have their babies pay those costs upfront…. or after.
July 17, 2023
@Lifelogic
But most doctors (and nurses) don’t go into medicine to make money! They go into medicine primarily to HEAL people! Like you, me, Sir Richard Branson, a working class man, whoever, whatever.
I think most doctors (and many nurses) like the idea that they can make EXTRA money in medicine via private healthcare (perhaps after doing their bit in the NHS and then doing part time work in private if they are doctors or full time if they are nurses etc). But private healthcare is essentially for secondary health care. Primary healthcare (urgent, serious stuff) is NHS.
Perhaps, you’ve just been lucky to have had good health. Be grateful for that. But at end of day, most doctors aren’t going to follow your philosophy. And the problem with the NHS isn’t so much internal but external – and the cultural (or lack of) cultural values in the world we live in today that impact negatively on the NHS, in particular, lack of hierarchy and accountability. Something like that.
July 17, 2023
And your essentially apply your ideology onto the health system. Ideology never works. It’s just trying to show-horn what’s in your head into the heads of others. Doesn’t work. You have to communicate with these people (doctors in particular), if you’re going to be listened to. And you also have to listen to them! And more. Because they are the ones who are the heart of the healthcare system. And they are the ones who primarily enter health to heal not to make money.
July 16, 2023
The NHS is not well. It’s in its seventies.
July 16, 2023
Three score years and fifteen so well past it. But it was always going to be a disaster as it is “free” at the point of use. So the only way to match supply and demand is rationing, delays, inconveniencing the public, absurd booking systems for GPs, waiting hours for an ambulance, years for a hip or knee…
People dying while waiting treatments saves a bit of hassle for them I suppose they think. How many thousands of ops were cancelled for their absurd and sickening birthday church service? With the stand in Vicar Ms Amanda Pritchard
July 16, 2023
How may NHS staff attended this years absurd NHS religious service – it seems that the last one five years ago was attended by 2200 NHS staff. Were they all on full pay? I assume so. Did they publish the number added to the waiting lists by these thousands of days off on I assume full pay?
July 16, 2023
LL,
â But it was always going to be a disaster as it is âfreeâ at the point of useâ
Nonsense. The NHS was working fine in earlier decades. It was a huge benefit to the people of this country who did face not face financial ruin due to serious illness. Look at the situation in America for comparison.
However, having set the service up it needed close monitoring. That does not mean simply throwing public money at it.
Still less does it mean creating extremely well paid bureaucratic roles that add nothing but are used for patronage by politicians of all stripes.
Now we have a huge workforce, many of whom are a drain on the business and need to made redundant. Unfortunately, no politician can make this simple statement. So the possibility has to be alluded to and danced around.
Regionalisation might provide cover for a cull, but it seems unlikely that any party will go near this in the near future.
July 16, 2023
Free at the point of use may have worked when the range of treatments available for many illnesses was so limited and they weren’t also doing so many elective treatments. Personally, I think people should have to fund elective treatments (including “gender surgery”) themselves – either directly or through medical insurance. The NHS should only treat genuine illness.
And back in the 1940s there was no concept of health tourism. That really kicked off with Blair opening the borders. We are funding an International Health Service …. and that’s made clear by the so-called Rwanda Plan whereby we will ship a handful of criminal migrants to Rwanda and in return they will send us the same number who need medical treatment!
July 16, 2023
As you run businesses, how do you think you would cope with at least a ten percent staff shortage in perpetuity? Do you think you could provide a brilliant service to your customers with a workforce that is abused and underpaid, but over managed? You say you assume. You assume too much for a so called scientist.
July 16, 2023
Given the funding the NHS has I am sure I could deliver a far better service than the foolish Amanda Pritchard (a history graduate) or the last chap Simon Stevens (PPE I think) did. Hard to do much worse! I would not piss money down the drain on religious NHS worship services for a start.
July 16, 2023
Nor the endless trust rebranding lunacy, the net zero insanity and the diversity agenda & officers. I would also have some nursing home, rest byte places attached to major hospital so people can always be released from the acute wards as soon as they are ready to be released and taken back in if needed for any reason. Stop the fighting between the NHS, social care and GPs pushing people from pillar to post. Just so one part of the state pays rather than another.
July 16, 2023
Then again given all the political interference forced onto the NHS, the endless net zero green crap, the inability to fire useless staff easily, the diversity, sustainability and equality cr** and all the rest then why would anyone sensible want to do the job even for ÂŁ400k PA ? I am sure that within all the many bright doctors they employ there must be at least five thousand who would be more competent than the current or last CEO.
The arguments and legal actions from the net harm vaccines they coerced into the arms of people (most of who had no need at all of Covid protection) in an act of surely gross or even criminal negligence will surely go on for 20+ years. The excess deaths do not even seems to be dying back much, still circa 140 each day. Many in ages where they were never at risk from Covid anyway.
July 16, 2023
I don’t think I could do a better job, I know it. Lets start off with any of the backroom people and what they actually do and are they needed or could they be removed? Any job with diversity/equality or hurty feelings can go. Admin staff and what do they actually do? The list is endless but it all needs radical reform based on the best models in the world. We need to stop pretending ours is best when we all know service delivery is appalling and getting worse.
Our politicos have only just realised we aren’t training enough of our own people instead of stealing the worlds medical staff. No shit Sherlock.
July 16, 2023
No argument there. I have said many times before the NHS and Education (for starters) should not be under political control. They are just playthings for politicians who know nothing of what they are doing and want to experiment with their crazy ideas. This is what we get for it. It will ever be thus while we continue with this crazy system
July 16, 2023
!00%. agreed! But where do we find the right management? I do not think they can be found in the civil service.
July 16, 2023
With private medical care you pay when the hospital bill arrives.
With NHS medical care you pay when the tax bill arrives soon after.
July 16, 2023
many would say ‘DNR – do not resusitate’.
July 16, 2023
If the govt. allowed a GP shop on every corner and small local hospitals run by ANYONE but the NHS and govt. with no attachment whatsoever to either bodyâŠ.then I know where I would go!
And yes, Iâd pay but there would be competitive rates.
It is what the wealthy used to have ( and maybe still do?) and to a large extent the horrific NHS has removed even their choice.
And I would not expect to pay NI ( National InsuranceâŠ.WHAT a joke!)
July 16, 2023
This is the thing. Back in the 70’s when you wanted a phone it took ages and you only got a limited choice of colours as you could only go to one supplier, the GPO. Now look at today and what competition has done. A wide choice of phones, suppliers and tariffs plus, lower prices.
We need choice. We need to be able to access private medical care and have insurance. Currently the government see this as a benefit in kind. It would be a benefit to all if private healthcare providers could access the market and show people that the NHS isn’t the wonderful thing it is and demand change.
July 16, 2023
And if you had a major illness, say cancer which might cost hundreds of thousands, would you be prepared to pay for that? Minor illnesses are one thing, major trauma is something else.
July 16, 2023
Good pointâŠ
But are they really all that successful? They manipulate figures and juggle with thresholds in order to alter apparent outcomes.
The NHS also jealously trashes all competition..even standard procedures provided by charities.
Presumably competition would bring down costs?
And nothing is as bad as no medical provision, as has been the case, surely?
July 16, 2023
Bring back Mental Hospitals.
Whoops too late all demolished and built over.
Care in the Community ( for goodness sake)
What a disaster!
July 16, 2023
They think they are saving money I assume but then how much do all the extra murders, violence and stabbings cost.
July 16, 2023
Bring back convalescent homes as well. I have argues that for donkey’s years, but they prefer to clog up hospitals with highly trained staff – in effect using a race horse to pull a coal cart. These decisions are not NHS, they are political and mostly Tory at that.
July 16, 2023
++++
Yes! Yes! And yes!
July 16, 2023
Cuibono – fully agree
July 16, 2023
Nothing works any more in this country.
The obsession with computers ( to save money) has left us without law enforcement, medical care, transport and education.
Yet still the govt. piles in newcomers.
Presumably any reform of the NHS is exclusively for them?
It canât be for us poor old mugsâŠthe govt. has very effectively and determinedly destroyed our health.
July 16, 2023
So where has all that extra money post-2019 been spent?
July 16, 2023
Wages, pensions and haka dancing lessons.
July 16, 2023
The NHS runs a permanent shortage of staff. What happens to the 130, 000 wage packets they are not paying? They could easily use that to pay the staff a proper wage commensurate with their skills and end the strikes, but no, they prefer to abuse the remaining staff goodwill. If by a miracle the NHS were fully staffed tomorrow, they would find the money, just like they did for Covid. Never happens to politicians of course, all recommendations fully implemented in their case and 86 grand plus for no experience, knowledge or skill starting salary, not bad. Never a shortage waiting to go on that gravy train.
July 16, 2023
And people on minimum wages they keep importing at 1.2 million a year plus illegals!
July 16, 2023
The NHS is too big to manage effectively. It should be broken up so there is real competition and patients should be able to choose which healthcare provider they use.
It could still be free at the point of delivery by using a voucher system which is only available to BRITISH citizens. Health tourism must be stopped: we are currently paying for an International Health Service, used and abused by people who pay nothing into it.
I recently had a (fairly minor) issue which just needed a prescription. My GP’s surgery offered me an appointment in 3 weeks’ time. As a member of Benenden Healthcare I had an online consultation later the same day; got the prescription I needed and the medication the next morning. Why can’t the NHS do that?
Aren’t we lucky that the man who was Health Secretary for 6 years and left it incapable of dealing with a Low Consequence Infectious Disease is now Chancellor. Failing upwards!
July 16, 2023
The NHS needs competition. Currently the government just has evermore money over due to emotional blackmail and threats from the unions.
Health tourism could be solved very easily. Just make it a condition of entry that ALL foreign citizens must have health insurance with a UK supplier BEFORE entry which lasts throughout their stay. Those countries where liberties are more often taken will have higher premiums so discouraging such behaviour.
July 16, 2023
Mark B
Yup, add this to the simple Customs check on entry, problem is it does not seem to matter if you have no paperwork at all at the moment, they still let them in !
Something else not working and not fit for purpose.
Alternative show at Hospital on arrival either National Insurance number or health cover if a tourist, no cover or credit card, then no treatment unless you are highly infectious, then patient or family member signs a legal document for payment.
Seems whichever way you turn things are failing, for goodness sake we cannot even repair holes in the road which are clear and obvious hazards !
July 16, 2023
@Donna +1
A real National Insurance (NHI) that pays out to those that deliver. Then the money chases the delivery, not as now the other way around. Ego and self-gratification of Government is the only block to a sensible practicable approach
July 16, 2023
Well, that Voucher system is precisely what the Reformuk Party are proposing, if you do not get treatment in three days you get a voucher! Good Idea?
July 16, 2023
Surely any budget has an element of Capex? Why has Executive Management allowed computer systems to get into such a mess. Where is/was a national plan? You talk about people management and recruitment but how many days are lost and people to fill them because of grossly inefficient working practices?
Letâs have a figure.
The truth is that like the rest of the public sector supported by frankly naive politicians they think that more money is the only solution as displayed by Sunak agreeing a large wage increase without any performance improvement conditions.
The NHS has finally got so bad that this truth cannot be covered up. Itâs senior management and the DOH are not fit for purpose. Amanda Pritchard is an NHS lifer. She was appointed as an easy option. An outsider would have rocked the boat.
Once again your ministers too weak, in denial etc to challenge the appalling status quo and who pays/suffers.
Yes us again.
And talking of incompetence the Home Office at it again. Failed to see/plan for large numbers leaving our borders on holiday so needing emergency support from the MOD. Quite right Ben Wallace I would b off as well. Get out of the blobs clutches. Whoops. Did I offend Simon Case? Good.
July 16, 2023
The public sector hasn’t been given a huge wage increase; their pay increase doesn’t match the inflation the government has created, by all its money printing.
They’ve been under-compensated.
July 16, 2023
Dave only one of our family members has had an increase in the last year, and that was 2%, all of the others have had nothing, they all work on/for the Private sector, or are self employed, thus if the employers/customers cannot afford it, then they cannot pay it, simples.
Why should they then as taxpayers with no wage rise, fund wage rises for those in the public sector, and also pay for their gold plated pensions (employers contribution element) as well ?
July 16, 2023
and how much extra tax in various demands has been extracted from them?
July 16, 2023
Public sector productivity is reportedly down by 5.9 percent so, as one of those who is paying the bill, I believe that this should be added to the increase as the true cost of the raise
July 16, 2023
I have a question for Sir J.
From this personnel review or any other recent NHS analytical paper or any discussion about it in parliament, have you or your colleagues in government diagnosed the problem(s) with the NHS?
First rule of problem solving: correctly state the problem.
Reply This speech sets out sone of productivity/ personnel problems!
July 16, 2023
Reply – Reply.
John you have certainly outlined many of the causes of problems with the NHS, and many in politics and the NHS itself seems would agree with you. Why then given so many know what the problem is, has nobody taken action to correct all of its problems, are they all waiting for someone else to take action.
We have had family members work in and for the NHS as well as commercial businesses, and the difference in the way they operate is the difference between light and day.
There is no one driving change, action, progress, customer/patient service in the NHS management structure, and certainly no one interested in value for money, staff motivation or performance, its all about “that is how we have always done it” !.
Afraid it needs a radical shake up, not so much from the front line clinical set up, other than more recruitment and training, with more modern equipment, but certainly from administration, logistics, and management planning of purchasing, and service provision and backup.
July 16, 2023
The last statement captures the reality.
July 16, 2023
Well it still seems to me that if a company like Google can link our data from disparate and fairly elusive sources then setting some company like that on this problem would yield results. It will end up like this in 2,5 or 25 years; a data organisation company will organise and manage the medics. You just don’t need a cast of millions of receptionists, administrators and keyboard people to inefficiently run this thing.
July 16, 2023
No mention of the militant unions who now rule the roost and determine all things NHS related including how much Ministers spend on the NHS and indeed on other public sector services now governed by the militant unions. These ideological organisations block reforms if it doesn’t serve the unions vested interest. The union nobbling of the Midstaff’s inquiry is indicative of how pernicious the union have become
I listen to the Tory trash on all public sector issues as they try and avoid criticising the unions to avoid confrontation and damaging press headlines.
John can moan all he likes about management staff levels, pay and all the other issues but he knows he can condemn white collar employment without political controversy but trots the usual line about ‘we need more clinical staff’ cos that affords him brownie points.
I have NHS staff in my wider family and many work both part-time and work privately as well so the narrative of an understaffing of clinical staff is nothing more than political positioning rather than based on reality.
If you reform the NHS to increase efficiencies then expect an all out, brutal war with militant unions and scum Labour. This is why the NHS will never be reformed ie it’s a vested interest for the unions, and will collapse under its own weight
Don’t listen to Tory MPs talking nonsense
ps stop all race based public sector and NHS staff indoctrination using CRT. This ideological cancer is a crime and not ONE SINGLE TORY MP EVEN DEMANDS ITS CRIMINALISATION
July 16, 2023
Here here.
July 16, 2023
DOM – summed up perfectly.
July 16, 2023
Basically, too many & low quality managers across NHS management structures. Not working collectively but in silos. Creating too much duplication & waste of effort, time & cost.
Every trust & surgery being run differently. We need best practice implemented across all management levels. Equipment maintained & kept current.
Improve training by reducing the fixation on degrees. Bring back cadets & SEN grades asap & on the job training.
Remove all roles that do not contribute to patient outcomes. Like Diversity managers & Art curators!!
Put patients back as the core of the NHS not separate Trusts. Just have one NHS Trust that manages the ‘Boards’ for England, NI, Wales & Scotland. Keep it contained, mirrored & simple.
That’s based on my NHS experience & a successful business career.
July 16, 2023
Why are the public able to see the problems and answers, there is nothing more to say on this subject, all the problems are identified and mostly solved by the preceding comments.
However, the thing that rattles me most is the free treatment and maternity service we provide to the WORLD! Once as a British Seaman I was hurt in an engine room accident and taken to Baltimore General in the USA! Their first words were âinsurance number pleaseâ and I was not treated until the shipping agent arrived to vouch they were paying. Can Britain not do this? Oh! No, our illegals get daily medical and dental free daily!
Iâm disgusted
July 16, 2023
Quite a few years ago a large colleague fell off the bottom couple of steps disembarking from a plane at Tokyo’s Narita airport. Lying on the tarmac in some serious pain, probably ankle break, the medical team arrived. First words to him were ‘how you gonna pay?’
July 16, 2023
For the last 18 months I had thought that the Conservative Party could turn things around and win a small majority at the next election.
However, the combined forces of the Bank of England and the Treasury have conspired to crash the economy for all the reasons our host has complained about for at least two years.
Liz Truss was the last chance we had of turning things round but, although she made a couple of mistakes by moving too fast, she was actually ousted in a silent coup by Bailey and his friends in the Treasury and the markets who will accept no other course of action than their own traditional and discredited policies.
When they foisted Sunak and Hunt on us, any chance of promoting growth disappeared and with it almost any hope of winning the next election.
Only a catastrophic campaign by Starmer can save us from a further lurch to the left. Labour is perfectly capable of losing the campaign but we need clear bluewater between the parties. A good start would be to abandon Net Zero, starting with announcing IC-engined cars can continue to be sold after 2030 and abandoning the enforced switch to heat pumps from gas boilers.
Insufficient speed in dealing with both illegal and legal migration is doing immense damage to our prospects.
July 16, 2023
Do you really want this utterly appalling, treacherous Not-a-Conservative-Party to be saved? It is just a branch of the Establishment’s Uni-Party, intended to prevent any real change from being implemented.
I’d like to see it consigned to the dustbin of history.
Then its conservative replacement will be able to deal with Labour.
July 16, 2023
I totally agree. The Tory’s have failed at everything. I can’t think of success in any policy area. Standards in public life are the lowest they have ever been. Taxes the highest. Minority issues given priority over anything for normal English tax paying public. They have got to go so we can elect a conservative alternative and it isn’t present in the House of Commons and certainly not in the Lords.
July 16, 2023
Let’s be realistic. We have a first past the post system and neither party will agree to change it, nor should they. If we did, we would end up with endess coalitions like Germany or, heaven forbid, Belgium !
Assuming we lose the next General Election, for the Conservative party to be replaced by another, and I assume you mean Reform, is unrealistic.
Our only chance is if the Conservatives lose the election and the real Conservatives within the party, like our host, take over and take the party in the Right direction. If they ditch Net Zero, they might then have a chance of winning in 2029/30, as long as the electorate will back a Thatcherite party in the 21st Century, and that is by no means certain.
Sadly, I believe that the electorate has gone soft and won’t necessarily support Thatcherite policies, like self reliance and a minimal state. With the exception of their allegiance to Net Zero, I believe that Sunnak and Hunt are actually not a million miles away from policies that a majority of the 21st century electorate is comfortable with.
As for Reform, it would take three or four election cycles for any new party to have a chance of winning. The first cycle would see them pick up a by-election or two, the second might result in a few seats and then voting intentions would have to be seen to be transformed for the new party to have any chance of winning in 20 years time. In other words, it won’t happen.
July 16, 2023
Just wondering, Chris. Why are coalitions necessarily such a bad thing? In your example, Belgium, what we saw a few years ago is that the country carried on for months being administered fairly successfully by their civil service.
You probably just need the government to meet a few times a year to agree on and vote for a budget.
Surely a coalition represents the spread of the population’s views more fairly than FPTP, and when compromise policies are needed, as they will be, that’s just in the nature of any association of people with different views, who have to compromise to get things done.
I wouldn’t be saying this if I thought FPTP had produced good governance of this country in recent years.
July 17, 2023
You gave the reason in your first paragraph : Leaving government just to civil servants would leave us in a worse state than being in the EU. We would be being governed by an unelected group of Remainers who would very quickly move to put us in a position to rejoin the EU.
The most likely outcome with a PR system ( rejected by the electorate, in a referendum, remember ) is the constant presence of the Lib Dims in government preventing the largest government party from pursuing the policies their members have voted for.
July 17, 2023
Starting to trot out the old “there is no alternative” argument.
In the early 20th Century the Liberal Party went from government to virtual elimination at the hands of Labour. We need a similar event on the right.
July 16, 2023
Donna – Change is coming but many are totally unaware.
July 16, 2023
Sam Cooke : A change is gonna come’ 1964
EXTRACT….
‘ It’s been a long
A long time coming, but I know
A change gon’ come
Oh yes, it will
It’s been too hard living
But I’m afraid to die
‘Cause I don’t know what’s up there
Beyond the sky’
July 16, 2023
@Chris S +1 Like all Conservatives we see it, we voted the Conservative Party, because we wanted a Conservative Government and it is the Party that betrayed us they allowed a Socialist WEF Cabal to high jack them in Parliment
July 16, 2023
Why vote for imposter conservatives? If you want their policies and actions/wokery/ pro welfare/ mass legal and illegal immigration/ net stupid/high taxation/ anti industry/ non energy strategy etc etc vote Nu Labour not Sunout who’s a dead man walking.
July 16, 2023
NHS has be one a cash cow for administrators, pharma and consultants.
July 16, 2023
The NHS stands comparison with a naval armada. Lots of individual ships (hospitals and hospital trusts), all crewed by sailors with specific skills. Apart from the captains writer all the admin is ashore.
I accept that medical staff in hospitals need some support admin but I do not accept that they need a plethora of none jobs to tell intelligent people how to behave towards each other. Again apart from a national, professional purchasing value analysis wharehousing and distribution organisation I cannot see the justification for all the tiers of management between trusts and the Health Ministry . Tesco, Toyota and perhaps Dyson have no need of such a top heavy drag on their operations, what is the justification for having such in the NHS. 47% of all those employed by the NHS are in this category, an enormous unnecessary financial drag.
The next big question is what should the sharp end NHS service consist of. I would suggest it should include GP surgeries expanded where possible to include small emergencies, pharmacies, hospitals with services in house and contracted, road and air ambulances, post hospital care, hospices. A coordinated and connected service comprising national and private inputs, while maintaining the Free at the Point of Need principal. Payment for all this can come via taxation, insurance, or a combination of both. Study what works best in the rest of the World and copy it. Essentially the NHS should not be party political, only the people own it, so run it for the best health outcomes.
The one thing government could do is cease feeding the NHS unnecessary lifestyle patients by getting a grip on the food and supermarket industry feeding the population crap and the education industry not exercising their charges anywhere near sufficiently.
July 16, 2023
âAs the report reveals, the number of full-time equivalent staff in NHS England has expanded by 263,000 since 2010âŠâŠâŠâŠOf those, some 55,000 are nurses and 42,000 are doctors, which means that more than 160,000 are not in those two leading medical professionsâŠ.â
I think NHS England should be made to explain the reason.
July 16, 2023
A patient might need something resulting in a possible appointment. More people to delegate appointments, dictate, arrange typing, email, telephone, send copies out…
Discover the appointment will not work as expected, re-arrange and repeat.
Update a computer system – or not!
Somewhere a patient will want to engage with the appointment, attends a reception when discovery of missing appointment in ‘the system’. Process starts all over, or if lucky patient meets somebody who discusses ailment, determines someone else is required and a forwarding contact ‘up the chain’ is started.
It all takes time, cost, frustration and likely failure to solve original issue.
July 16, 2023
The NHS is a leading example of Robert Conquestâs second and third laws of politics and illustrates the result for the country as a whole if it continues to move further towards the left.
July 16, 2023
The IT problem is fundamental and very basic. When I last had to call an ambulance, through 999 in February this year, while the response time was excellent, I had to give my wife’s details no less than three times, once over the telephone when making the call, and twice more to the paramedics before they could leave, wasting quite a lot of their time. But all the details they required were already held centrally in my wife’s medical records, so why were they not immediately accessible? After all, high street banks manage it without trouble on most occasions.
July 16, 2023
even worse if you make the mistake of calling 111 to arrange a repeat call out of paramedics to attend a known type of incident that is pretty serious and likely to mean admission to hospital. Torture of ridiculous script read through with no ability to jump to the last few important questions.
The paramedics basically say ‘ring 999’ and hope for swift answer.
July 16, 2023
Sir John
A lot to take in at today.
One of the obvious situations is that the NHS is to large to be managed properly. Then how can a Minister of a department of this size apply a âone size fits allâ approach, when every human element is uniquely different whether staff or user, all requiring an individual approach â it is after all for the most part a personal service. So Ministers and Central Government are just playing the self gratification card and just donât care about delivery.
Central Government needs to get over it ego and desire for self gratification and break the NHS into a local service, run by local people for local people â their 100% responsibility. Let the Local elected officials replace Central Government, really sever Central Governments involvement. Sure some will fail, fail big time but the majority will thrive, be amazing, really amazing, meaning then those that fail can be addressed more readily. Central Government has to start trusting the People, they (Government) are rubbish at management, always have been â ego keeps getting in the way.
The other obvious flaw in today’s NHS is the Management, they are building empires not delivering service. The media highlighted instance is the creation of ‘Discrimination Departments’ under the guise of diversity and inclusion staff. These are virtual signalling â100% Political Departmentsâ. They are not there to help provide the best of the best service to the Customer, but to stroke a personal ego. Politics in entities funded through taxation should always be a – No, No, we have Parliament for that, unless and of course the management of NHS Trusts are democratically elected by the People every 4 years.
July 16, 2023
Reforming the NHS yes, but please reform the Office for National Statistics ONS, yesterday I received a letter from them to take part in a study, the letter said that I’d receive a second letter with a code to access their website …what a farce
July 16, 2023
The NHS is too large full stop . It has been directed and run by individuals without a relevant medical background . It needs to be broken down into regions and specialist knowledge . These criticisms have been made over several years to various Governments and the Central Office of the Civil Service with plenty of convincing evidence , sadly to no avail . The outcome is the present mess . I despair that our leadership over several decades have all failed to invoke the changes necessary and , as an individual , I feel powerless .
July 16, 2023
My considerable experience as an NHS patient leads me to question the assumption that taking on more staff equates to a better service for patients. The more admin staff there are the more time it takes for them to find someone who can take âownershipâ of a particular matter and the more medical staff are sucked into what are essentially admin roles.
July 16, 2023
Sir John
As you mention there are some 1.5 million people employed by the State as part of the NHS
Daisy Cooper âOne is that there are more sick days because of burnout and exhaustionâ of the 1.5million how many fall into this situation, one, ten or even a hundred, is it any difference to that in society in general?
â making sure that water is not coming through the ceilings and giving mental health support?â is that ALL NHS Hospitals or may be one or two?
A relationship to size and context is required when talking about such a vast organisation â how many NHS staff were involved in traffic violations last week?
Sir Lindsay Hoyle: The ministerial code says: âIt is of paramount importance that ministers give accurate and truthful information to Parliament, correcting any inadvertent error at the earliest opportunity.â Surely not just Ministers but all MPâs repeating as I have done popular myths doesnât further the aims of good Governance
July 16, 2023
âIt is of paramount importance that ministers and MPs give accurate and truthful information to voters at elections” quite the reverse it seems.
July 16, 2023
Good speech, but what the NHS requires is decent management – FULL STOP.
A movement, known as DO NOT CONSENT, is building to disown this government. It inspired a letter to my MP:
The will of the people shall be the basis of the authority of government.â â Universal Declaration on Human Rights
July 16, 2023
Bryan Harris
+ hundreds
Excellent letter, I will copy it and send it to my MP
July 16, 2023
+many
July 16, 2023
Sir John
Repeating similar to as you have suggested recently (paraphrasing even). If the NHS Trust Management is running the NHS, balancing its budgets and providing services for us the taxpayer how come it is Central Government is doing the wage negotiating?
How can a NHS Trust deliver when another party is imposing costs on them? Then that begs the question why have the self delivered wage rises for NHS Trust Managers been higher than in other parts of the system.
The system the NHS is a shambles, too many bosses(that includes Ministers) and too little management. All enhancing recurring ego and self-gratification that is blurring delivery. Every Corporate sensibility says it should and must be broken up, become a full compulsory National Health Insurance service that buys services from providers. To some that is privatisation, but they have to ask themselves is it a delivery of a free at point of service of a first class health system that is important, or just having a large employer that results in unwarranted death and outcomes?
July 16, 2023
1. People don’t always tell you the real rewason they’re leaving a job. Exit interviews are pointless.
2. Most NHS staff stay for the pension, which is a very good arrangement for them.
3. Managerial salaries are very high, as are the pension contributions resulting from them – especially in IT.
4. However, the quality of IT staff is very low at all levels. Take it from someone who knows.
5. Many NHS sites are in small towns where their main aim is to create jobs for everyone, efficiency is not seen as a good thing. I have seen over 100 people employed to do (unnecessary) manual data corrections on a system – unnecessary because in the real world, the data would not be allowed to be wrong in the first place.
July 16, 2023
Am afraid making speeches is not going to do it SirJohn – your party got into government on the back of promises made and after thirteen years what ? also we need more straight talking not like we heard this morning from Kemi and the sunny uplands again jeez
July 16, 2023
By the way, does this “workforce plan” include a definition of how many of each role are needed for current population levels and future projected population?
Without that, how can anyone know what level of funding is required?
Private sector companies could bid for segments of care on a fixed price basis, which is another way to determine and fix costs AND care levels. At present, none of these things are a known quantity. How can anything be run (successfully) on that basis?
July 17, 2023
@XY – You forgot we have a highly intelligence and proficient Government that can manage hands on every minutiae of your daily life from afar and never be wrong. Or so they infer
July 16, 2023
The biggest problem with the NHS is that it is too big!
As an employer, it has the 5th largest number of employees in the world. With 1.7 M (2015) employees with a population of 67M it was just 300K less than the Chinese National Railways (2013) with their population of 1,363M. It is an outrageously high number of workers for an organisation in such a small country. Yet we have a shortage of nurses and doctors and other medical staff. Why?
Surely, it must be so obvious to Number 10 that there are too many administrators who push paper rather than treat patients? And that the answer is to drastically cut the number of paper pushers in favour of actually treating patients? It truly is still living in a Sir Humphrey scenario where non-productivity trumps essential workers.
Such non-productive persons most probably have been inducted through the “Empire building” protocol that now seems the norm within the NHS. Save the NHS – stop this profligate nonsense!
July 17, 2023
@Derek Ah, but No10 tells us they are brilliant and capable of daily micro-managing such a personal and individual service on scale.
July 16, 2023
All very nice but guess what, our dear host who wants everyone to love him and consider him to be fit for the Church, says he will not of course criticise staff. The lazy, the incompetent and the selfish for example, can just carry on as normal.
Sir John is so so heavenly reasonable.
Reply I do not generalise criticisms about so many people. It is a managers job to mentor, incentivise and train staff to work well together. If necessary managers have to reprimand or sack an employee depending on performance.
July 17, 2023
@reply-to-reply, as with most voters we voted for a Conservative Government to âmanageâ. So is it a management failure or a refusal from those in charge that is the root of the UKâs ills? – you donât have to answer that, its rhetorical, as the answer is obvious
July 16, 2023
Where should I start concerning the absurdities of the modern NHS?
The main call on resources is hospital in-patients. There are about 100,000 hospital in-patients (mostly recovering in hostel-like wards of around 20 people, each receiving little individual attention and direct staff resource). There are about 1,500,000 direct staff which is about 15 staff per in-patient when there used to be under 10 staff per in-patient. Indeed mainly for those 100,000 patients there are 36,000 behind the scenes senior administrators and 42,000 seldom seen (by them) extra doctors! By comparison in social care in residential homes for the elderly there are generally just over 1 (much less than 2) staff per resident, though most residents are ailing badly.
Then there is the question how much does having an NHS improve life expectancy compared to not having one? The answer I have seen is about 3 months per person on average. Most life expectancy improvements are due to better living conditions and insofar as medical interventions improve things the main contributor is pharmacy, not hospitals. So we are each working about 4 years of our life purely to pay for the cost of an extra 3 months in life expectancy, most of which would be achieved by a rudimentary, cheap-skate health service.
In other words government ought to strep away from the propaganda of the NHS staff and its ‘sacred cow’ status. It should start directing policy in the light of actual reality which shows it needs slimming down as it is inherently very inefficient. It should be privately operated with that financial discipline even if it is publicly funded via taxes.
July 16, 2023
Dont reinvent the wheel.
Copy the healthcare system from one of the many countries where healthcare is far better, for all demographics, than it is in the UK.
Dont let people in the UK meddle, or reinvent, we need a complete faithful copy of a system that works.
July 17, 2023
@iain gill The UK nationalised NHS, managed by Government is as effective as the UKâs nationalised car, steel, rail, water, energy and so on industries. Governments are 100% rubbish at hands on management, it finishes up with the inexperienced trying to micro-manage things they know nothing about.
Compulsory Insurance as it should be with tax is the answer, as the payout should be on supply and delivery of the service.
July 17, 2023
payout from the state backing insurance scheme should be to the patient to take to any provider they like, at each and every point in the treatment cycle.
July 17, 2023
I see from a council planning portal that NHS Trusts are demanding large sums of money be paid to them through Section 106 agreements. So in order for housebuilders to get planning permission they not only have to cross subsidise road building, local school building, environmental fantasy nonsense like frog walkways, but now also large capital injections into the NHS. All of which will get passed on in house prices to house buyers. Really is the NHS state funded through tax enough already or not? why is the NHS getting away with objecting to house building unless they get big sums of money?
The public sector really is out of control.
July 17, 2023
More succinctly if you agree and want the policies and direction offered by the Conservative Government â you best vote Starmer and Labour. The outcome is the same, just slightly more honesty.
July 17, 2023
Sorry, Sir John, but there will be no general improvement in the NHS until the flow of funds is directed by patients’ decisions. That means patients must have complete freedom to choose their GP, which specialists they see, which hospital they go to and so on. For example a GP in Australia is paid per consultation, not by the size of his register of patients. So if patients choose other doctors he is paid less. If a hospital in Australia develops a bad reputation, patients will go elsewhere. Staff morale is high because they know they are valued, the system they work in is well managed, achieves excellent results and they earn the money their patients choose to direct to them.
Nothing like this can happen in the UK because it is free at the point of delivery and funded by general taxation. Health care costs only slightly more per capita in Australia than in the UK but the outcomes are worlds better and comparative measures such as the number of beds and doctors or nurses per thousand population much higher. All that is simply because the funding is controlled to greater effect by patient choices. Even if the Australian government refunds all of a fee for a service or the service is free – eg blood tests, X-Rays, who gets the money is decided by the patient. The NHS instead gives you a patient survey to fill in.
Give patients choice and control of the funding – by vouchers, insurance or other mechanisms – and there wil be dramatic improvements because the money will go to where patients want it to go, and what patients don’t wan’t won’t get any money. It also means that patients must pay for some things, wholly or partially.
Without that fundamental change the NHS will never get better, no matter how much tax payer money is spent on it or top-down management plans are imposed on it.
The best practical approach is a study of other better systems around the world with a view to incorporating the features that make them better into the NHS. You could not do better than starting with Australia and patients’ control of the flow of funding.