The NHS and social care

Today Parliament will debate social care and the NHS. Although it will not come across like this, in practice all the main parties are in agreement.  All want a high quality free at the point of use NHS. All want extended and caring support for frail and elderly people to live at home or in well run care homes. All agree the amount spent on these services needs to carry on increasing, as it has been doing under successive governments.

So what is the row about?  The disagreements come about over the amount of the increase in money, and whether any kind of reform or better management is needed to ensure the spending is well made. Traditionally governments seek reform and try to impose some limit on the amount of the increase in cost, whilst Oppositions demand more money and criticise reforms. It is always easy to criticise past reforms, as it is very difficult for any group of Ministers and senior officials to achieve major change in the NHS, whilst social care is supervised by a wide range of Councils with varying degrees of competence, and widely differing views.

I Agree with those who say we do need to spend more on the NHS and social care. I also think the government and Councils responsible do need to work closely with the senior staff to try to get better  value for money and to raise the quality of what is being achieved where it is not good enough. Quality and value for money  need not  be a  variance with one another. Doing things right first time, and avoiding mistakes, saves a lot of money as well as providing a much better outcome for the patient. Jeremy Hunt’s mantra of putting patients first and having full transparency on what hospitals achieve is part of the solution.

There are many ways more efficiency can reduce the strain on resources. Collecting all the fees owing from overseas visitors and foreign governments would provide useful additional revenue. Controlling the release of supplies could cut down on waste. Requiring the return of robust longer term medical equipment for cleaning and reuse would reduce costs. Having more permanent staff and fewer temps and locums would also cut the bills. Putting together prompt and decent social  care packages would allow freeing beds in hospitals for others and would cut the costs of  caring for the patient discharged from hospital. .

All these things are easy to see from the outside and easy to write down. We also need to ask why have good people managing the NHS seen this and not done them?  There needs to be leadership from the official heads of the NHS that all these things matter, with follow up where they do not occur. Managers also need to work with doctors and nurses over their terms and conditions, to try to reduce the perceived advantage in working as a contractor, locum or temp rather than as a full time member of the team on the permanent staff.


  1. Duncan
    February 27, 2017

    Let’s be brutally honest about the dynamic of the NHS. It is in its primary form an employer of medical professions and until this dynamic is deconstructed then the NHS will continue to be run for the benefit not of the patient but of those it employs.

    The Mid-Staffs scandal exposed this unbalanced employee-patient relationship at its most toxic with the health unions making all types of threats and applying pressures on Ministers to protect their members from criticism irrespective of the pain and suffering they inflicted upon the people they were employed to protect and care for

    Unfortunately we have politicians on all sides who choose to remain silent on the quite obvious need for NHS reform for fear of damaging political headlines

    It is testament to Hunt and his determination not to bow to the pressure and intimidation from the public sector health union lobby.

    When can we have a tory politician(s) who has some mongrel in them? A brute who can take it on the chin, a bruiser as it were. Someone who can take it to the enemy that is the left leaning, public sector lobby machine which comprises the BBC, Guardian, unions ie the usual coterie of public sector vested interest groups who selfishly peddle political slander to achieve their aims?

    Go on the attack and stop pandering to fear

    1. Edward2
      February 28, 2017

      Excellent post

    2. Bob
      February 28, 2017

      Mr Redwood,

      Duncan has hit the nail squarely on the head.
      Rather than reform and review spending priorities, I read that Phil Hammond’s solution is to adopt Labour’s idea of additional death taxes (an idea that he once derided).

      The govt finds so many billions to squander overseas while plundering the estates of British people that have worked, paid tax, scrimped and saved to provide a legacy for their children. A policy that rewards fecklessness and penalises the prudent.

      Is your Chancellor a Tory or a Fabian?

  2. matthu
    February 27, 2017

    Just wondering: why do all want a free at the point of use NHS? Is this free at every point of use?

    I can understand why emergency care, for example, should be free at the point of use. But is it also self-evident that a routine visit to the GP should be free at the point of use? I suspect that many people have become used to paying when they go to a dentist. There are many examples across Europe and the world of people paying when they visit a GP, so why are we not prepared to challenge this practice?

    If more people paid when they made a visit to a GP, might they find more time to give proper attention to anorexic patients instead of telling them to come back when they have lost more weight?

    I think many MPs are being too complacent in accepting the status quo and I am sorry if the MP for Wokingham is amongst their number.

    1. Narrow Shoulders
      February 27, 2017

      I pay enough tax without shelling out to see the doctor thanks.

      I would advocate a £25 deposit being paid to secure any NHS appointment refundable on attendance.

      1. Narrow Shoulders
        February 27, 2017

        And proof of qualification of free treatment.

        1. hefner
          February 28, 2017

          What would you think is a proof of qualification? NHS card, EHIC card, Council tax bill, HMRC bill, passport, … ?

          1. Narrow Shoulders
            February 28, 2017

            P 60s for the previous three years will do me @hefner

            But in the interests of debate a valid (number checked against a database) NHS card backed up by acceptable photo ID.

          2. a-tracy
            March 2, 2017

            We’re all getting put electronically into the NHS Spine system and it wouldn’t be long before your national insurance record could be attached to your national insurance entitlements, entitlement and proof will be part of the future because sooner or later a crunch is coming.

  3. eeyore
    February 27, 2017

    Isn’t the crisis in social care a direct consequence of the giant Ponzi scheme known as the Welfare State, which takes money from the economically active young and spends it immediately on the old?

    The young, stripped of their surplus, are thereby disabled from providing for their own age, and must depend in their turn on the State. The public – no fools they – rapidly learn that prudence and honour are no longer paying virtues, but fecklessness and cynicism will reap handsome rewards.

    Now we discover that even after systematically debauching the currency for three generations the State finds itself unable to meet its self-imposed social debts. “Oh! What a tangled web we weave when first we practise to deceive!”

  4. stred
    February 27, 2017

    Much of the problem of inadequate funding and bed blocking comes from the decision to hive off social care to councils. As a result, we now have highly paid officials working out ways to pass the cost onto each other and the cheaper option of social care is only possible by putting up council and business taxes. In the end, it is the people working hard to pay taxes who are punished and receive poor service from the NHS. There should be a single fund and councils stripped of their responsibilities and overhead charges.

    The other missing item from the discussions on NHS inadequacy is the fact that both parties do not want to admit that their PFI hospitals are a disaster, with trusts paying through the nose. Interest rates have been minimal since the banking crash, while the PFIs have continued to make very high returns. So high that some have been sold on as cash cows, often to companies in tax havens. The Treasury no longer has any principles when it comes to retrospective taxes on individuals such as landlords or businesses. But the thought of a windfall tax at source, taking it from NHS trusts and then ploughing it back into social care is apparently unthinkable. Perhaps it is because banks and hedge funds now own the PFIs and future jobs would be in jeopardy.

  5. Richard1
    February 27, 2017

    It is not an honest and open debate, I wonder why Parliament bothers. At the margin Conservative ministers like Jeremy Hunt are doing their best to tweak reforms – obvious things like trying to persuade doctors to work weekends. But it is abundantly clear that the ‘communist’ model (words of the eminent oncologist Karol Sikora on Newsnight the other day) is failing. Ever more money is demanded, but with no market mechanism, however able well intentioned or hard working health staff, ministers and civil servants are, the results will never match demand and expectations. We have learnt this message in (almost) every other segment of the economy, why not in health?

    The truth is monopoly state funding of the NHS is a religion in the U.K. And politicians can no more dissent from it and expect to survive than say an avowed atheist could have done 150 years ago. Free market politicians would be more honest to say ‘we know this subject can’t be debated properly, let the ministers do their best given the absurd constraints, we can revisit the issue when public opinion allows’. How much suffering and how many premature deaths will be required to enable consideration of a mixed funding system for health, such as exists everywhere else in Europe and in virtually all OECD countries, it is impossible to say. It it will surely change one day.

  6. sm
    February 27, 2017

    The structure, management and – above all, the aims – of the NHS require total overhaul before yet more taxpayers’ money is chucked down the drain.

    There HAS to be an honest public and Parliamentary debate about what should (as opposed to what can) be done within a ‘free at the point of use’ system, which is currently incapable of coping with all the medical advances of the past 40-odd years.

    If the State spent 100% of its tax revenue on the NHS and social care, it still would not be enough to cope with an ever-ageing population and its concomitant problems.

    I won’t hold my breath…

  7. margaret
    February 27, 2017

    a high quality free ?
    What needs to happen is to decide what is the first point of contact. Every new referral to any department , to any Nurse or Doctor consultant is the first point of contact. Any patient who comes to see me in a GP setting is the first point of contact, any patient who goes to see the Doctor first is the first point of contact. Any Nurse or Nursing assistant who sees the patient for the first time and decides on their care, is the first point of contact . The A&E departments , urgent care centres , Walk in centres , Surgeons advice and operations are usually the first point of contact .!

  8. alan jutson
    February 27, 2017

    We used to have smallish local hospitals, which did the so called simple routine /minor operations, they also used to handle minor injuries cases.

    These venues meant people had a hospital local to them, so did not have to travel far, it reduced the waiting load on A&E at the more major hospitals, and was a halfway home for those in the later stages of recovery before they were fit to go home.

    We also used to have convalescent homes where you were often sent after major surgery in the later stages of recovery and were put through intensive physiotherapy to get your body back to some degree of normal movement before you went home.
    Thus you needed less care at home.

    The above have now been substituted in some part for day care wards, which fit some of the purpose for the above, but do not contain night beds, so do not help the so called bed blocking problem.

    Thus more beds and more staff seem to be the obvious solution to our present day problem, in our quest to get hospitals to operate at higher and higher so called efficiency rates of 95% plus of bed occupation, we are now suffering lack of productivity (patient throughput) because there is absolutely no flexibility left in the system for anything that is unplanned, and thus planned operations are being cancelled due to emergencies or extended stays, where a patient has developed some complications.

    Given the above, surgeons and nurses may be dashing around like headless chickens searching for beds, but are not doing what they do best, which is actually giving quality treatment and care to people who are in desperate need.

    Yes medical science is moving forwards, recovery times are reducing, so patient throughput is increasing, but to counter this we are living longer (with more problems) and our population is growing fast.

    It has been reported that since 2010 the NHS has lost 15,000 hospital beds, this is absolute madness given the present situation.

    Afraid if you want the NHS to run more efficiently and if you want better outcomes for patients, then the only solution I can see is a vast increase in beds and staff.

  9. Bert Young
    February 27, 2017

    I agree with all the points in today’s blog ; the NHS – the largest organisation in Europe , needs to be re-assigned in Government policy . It is too big to be managed from one Board room and it is in need of drastic overhaul . Funding – and how it is done , needs to be prioritised against other forms of disbursements ; foreign aid should not feature until all national costs are taken care of . Certainly the problem of care of the elderly should not be pushed on to Local Authorities .

    Discussion and debate on the NHS has gone on for too long .

    1. Lifelogic
      February 27, 2017

      Politicians always just call for a thorough debate/review/public consultation investigation, new laws or an expert report…….it is so much easier for than doing anything useful, saying what they actually want, managing things well or actually addressing the real problems.

    2. graham1946
      February 27, 2017

      Unfortunately, Bert, it is not run from one boardroom. Each CCG (there are dozens and dozens of them) have their own boards, directors, management and all the rest with the medical staff seemingly tacked on the end.. The ‘internal market’ is inefficient and pits one hospital against another in the expectation that competition and ‘choice’ reduces costs. As we all know, from the privatisations it doesn’t – it usually leads to more bureaucracy, higher costs and lower standards. The rest of you blog I agree with.

  10. Tax Increase
    February 27, 2017

    Where is there an Opposition to social care fees, and indeed higher ones, being placed on Council Tax bills?
    There is an unrepresentative undemocratic acceptance in the House of Commons that our Council Taxes have ongoing continual additions or precepts. Put it to a Referendum!
    The “Leave the Council Tax Alone” campaign would win. The “Remain Forever Raising Taxes, Precepts, Additions” would lose overwhelmingly.

  11. a-tracy
    February 27, 2017

    How are Managers of each Trust in England measured against each other?
    How large is each Trust do they each have the same number of patients?
    Do the Government identify best practice and best value for money?
    Do the English NHS compare with their Scottish and Welsh services and the best of Europe in healthcare cover.
    I feel we could do so much more by combining University research departments, mathematicians and statisticians to interrogate the outcomes as part of their post-grad degrees.
    If one Trust uses more Temps rather than ensuring they train sufficient staff they need investigating to discover why and who is responsible and bring them to account as that is simply poor Management. Our university degrees should have assistance paying back tuition fees for all of those that stay working within our National Health Service if they leave our NHS their fees become fully repayable by the student as students have to pay in other disciplines at 9% undergrad and 6% post-grad.

  12. Ed Mahony
    February 27, 2017

    Spot on i think.

  13. agricola
    February 27, 2017

    The NHS and Social Care should be free at the point of need. How it is achieved is the question. It cannot be left to national or local government to run the biggest business in the land when in my opinion they are incapable of running anything. If you think otherwise , please tell me what you consider they do run efficiently. Local government cannot even run bin collections.

    The NHS is in part already run privately, or they sub contract to the private sector. In many cases their very buildings are privately owned thanks to an incredibly crass PFI, dreamt up by politicians wishing to hide real spending. I would advocate making it completely private, but ensure it’s quality and costs are overseen by a professional value analysis organisation responding to government policy.

    Social care should not be in the hands of local government whose talents are limited. Run it privately , but paid for out of national income, supervised as per the NHS above in terms of quality and cost. The current paucity of social care lies behind much of the problems suffered by the NHS.

    Once out of the EU there is around £10 Billion to consider using along with a good portion of the £12 Billion that goes on Overseas Aid. All should at least in part be used to ensure an NHS and Social Care budget that is adequate for both services.

    Via universities ensure we have an indigenous supply of doctors and nurses. Introduce a level of nursing that does not require a degree to look after the humanitarian needs of patients.

    Look at the way the car manufacturing industry and main dealerships operate and learn some lessons. Government only facilitates such industry, allowing it to run competitively and then surprise, surprise, achieving a nice little tax earner. This does not happen because it pays too much for it’s inputs, overpays or underpays it’s staff, employs more than it needs, and then treats it’s customers badly.

    1. Narrow Shoulders
      February 27, 2017

      Car servicing outlets should also be referenced for invoicing and funding purposes.

      The Trusts should be paid for delivery with each procedure having a fixed price claim. Trusts can then start planning through margin and cost of sales and would be in charge of their own income raising.

      At a stroke a swathe of managers could be cut.

      Fixed price invoicing, it’s the way forward. Private hospitals can also be used to reduce waiting lists as the price paid will be transparent and the same as if delivered within the NHS.

  14. alastair harris
    February 27, 2017

    It would be helpful if it was run for the benefit of patients, over the interests of all other parties. Also high time that that which is not charged for was given sensible consideration.
    There is a large network of highly skilled pharmacists whose skills are under utilised in the GP world. And the change to requiring all nurses to hold a degree is surely one to review and evaluate.

  15. Drain the Swamp!
    February 27, 2017

    Quite a wodge of money is openly triumphantly and regularly wasted by Councils. The local newspapers and regional TV are even invited along. These awful irresponsible overpaid bureaucrats do not have a free media to actually proclaim: “What an utter grandstanding criminal waste of money!”

    So Parliamentarians are going to spend more money on healthcare? If they follow the example of their own Local Authorities they will have done a fact-finding investigation in Europe and elsewhere accompanied by family members, fully expensed, with visits to the medical facilities near Disneyland Paris and one in America ( to compare the difference ) Oh!!!!!!, Please do not think I exaggerate!! Please!! One group of Councillors and their families from a small northern town went on such a fact finding tour of small airports in America to see “if a small airport for the town was a good idea or not.”

    The answer to a shortfall in care funding rests with local councils and central government’s failure to relieve them of responsibility. They are a well-recognised “joke” , a swamp more like.

  16. Lifelogic
    February 27, 2017

    I see that “Terror chief Max Hill warns risk of attacks in Britain is highest since dark days of IRA”.

    Surely this is just helping the terrorists cause, frightening people to change their behaviour? We all know that they could attack at any time and that the authorities can do very little about it unless they get very lucky.

    What is achieved by such warnings, they just frighten people and help the cause of terrorism? The government’s role is to do what they can to prevent an attack through intelligence and to pick up the pieces (and catch the terrorists) after any attack.

    1. graham1946
      February 27, 2017

      Perhaps, LL it is coming up to budget time?

  17. mike fowle
    February 27, 2017

    Last year I read Henry Marsh’s Do No Harm. He was a consultant neuro-surgeon (now retired) and comes across as a thoroughly caring and honest man. But the impression of dysfunctional management in hospitals is alarming. On the other hand the professional bodies such as the BMA, the RCN, RCS etc. seem to be trade unions stuck in the 1970s. But any suggestion that something founded 70 years ago might not meet present day attitudes and expectations is invariably shouted down.

    1. libertarian
      February 27, 2017

      I too have read his book. It is one of the best books I’ve read and I highly recommend others read it if they haven’t already

      It also nicely puts to bed those anti democracy lefties that say we should leave things to experts ” if you need brain surgery you’d ask an expert near surgeon ”

      Henry Marsh very poignantly and honestly shows that no such expertise exists really

  18. David Warren
    February 27, 2017

    One of the most thoughtful and common sense articles I have read on this subject for some time.

    Waste in NHS and social care is a major issue.

    As someone who cared at home for an elderly person for a number of years I experienced this at first hand.

    Equipment was supplied to us that we didn’t need and the things we did require were left in my home when the lady I was looking after moved into full time care.

    Thousands of pounds were wasted just on us!

    1. Lifelogic
      February 27, 2017

      Not their money, what do they care!

  19. Kenneth
    February 27, 2017

    The media tends steer politicians to the wrong end of the telescope, concentrating on inputs (policy/financing) and then processes (waiting times, bed retention etc) and forgets to look at how well we are doing at prolonging life and making people better which is surely what healthcare is all about.

    Inputs and processes are extremely important but I am amazed at the lack of interest – and therefore the lack of data – about outcomes.

    For what it’s worth, it seems to me the government is doing the right thing and should try to stick to its current policies. In the meantime I wish the media, would advance from simply calling for more money to concentrating on life/death/health outcomes.

  20. Christine Constable
    February 27, 2017

    Having been trained as an NHS administrator but went into business I have some thoughts about how we can get the NHS we all want.

    1. Waste and over charging. The Government should put in an independent auditor (private company) who will at their own expense identify cost savings and they get paid from a percentage of the savings they accrue to the taxpayer. Checking on the costs of generic drugs; sweet heart deals with suppliers and general poor management of NHS resources.
    2. All foreign visitors coming to the UK must have a valid health insurance before making the trip from recognised companies for the trip duration
    3. No pregnant woman should be allowed to board a plane or ship without evidence their medical situation will be covered by private medical insurance
    4.The NHS should reappraise the “free” part of its service and limit these to life saving interventions. Everything else should be on a fees based approach lower cost for more serious elective work to at cost for minor cosmetic procedures etc.
    5. The NHS should concentrate its efforts on prevention rather than cure and should offer an affordable MOT service that is paid for at cost plus to generate income and reduce the numbers of dangerously ill people coming into the NHS through interventionist programmes to identify and treat people with at risk conditions before they become critical (and expensive) to cure
    6. A&E should charge self inflicted casualties for their time in A&E drunken louts; fights; careless accidents as a result of stupidity.
    7. Use private effective suppliers for niche treatments to speed up operations such as hip replacements.
    8. Charge for catering in the NHS – this is something everyone would have to pay for in or out of hospital so charging for meals is important to improve the quality of those meals and to provide a good service to people in recovery.

    All we need is imagination and the eye of the accountant to improve the NHS and before we invest further, let’s sort out the holes down which precious funds are already flowing.

    1. fedupsoutherner
      February 27, 2017


      I believe you have some great ideas here. Some so simple it makes you wonder why we haven’t implemented some of them. I am in particular agreement with Number 5. If people are responsible then they can often help themselves. My friend was recently told after a random blood test that she was borderline diabetic. She wasn’t over weight and took regular exercise but she ate a lot of low fat produce not realising it was high in sugar. Since cutting down on sugary things her glucose levels have returned to normal. More of us need to watch our own health and lifestyles.

      1. margaret
        March 3, 2017

        points 1578 are already in operation and have been for many years

    2. Dunedin
      February 28, 2017

      @Christine Constable – a very good “to do” list for the NHS – which makes you wonder why many of these ideas are not in practice already?

      Point number 5 – the health MOT is a very good one. Blood pressure, blood sugar, cholesterol level, etc. tests could allow individuals to make changes to diet and lifestyle before their health deteriorates and conditions become expensive to treat.

  21. Richard Butler
    February 27, 2017

    Meanwhile £25 million per day in foreign aid…

    1. Derek Henry
      February 27, 2017

      Nothing to do with it Richard.

      There is no HUGE shed on the Isle Of Wight that holds our taxes. We have ran budget deficits for 300 years.

      When you play Monopoly do you fund the banker ?

      Of course not.

      They spend by typing 25, 000,000 on a computer key board. It does not come from anywhere.

  22. graham1946
    February 27, 2017

    You rightly identify the problems, but what of the solutions? Will the government listen?

    If these things and a hundred others are not being done, what does Jeremy Hunt do all day? It’s no use saying it is up to the NHS managers – he must lay down the law. We had a ridiculously expensive and useless re-organisation by Lansley (why isn’t he Health Secretary if he did such a good job?) Things are noticeably worse since 2010.

    We have far too many administrators doing what exactly? Doctors should be trusted to prescribe what is needed and not have to face bureaucrats on high salaries telling them they can’t.

    Centralised buying, drug companies reined in, convalescent homes run by the NHS, collecting money owed may all help, but the basic problem is that how ever much money the government claim to put in it is still way short of first world standards. They say it was what Simon Stevens asked for but is that really the case? I saw reported to the time that he had asked for 20 billion but was told by the Treasury he could have 8 billion. Is this correct, as I haven’t seen it mentioned since?

    Whatever suggestions are made, politicians don’t seem to want to listen. They always seem to have the ‘We know best complex’, so, laudible that it is that you ask for ideas, I’m willing to bet that none not thought of by the government or their focus groups will be implemented.

  23. Antisthenes
    February 27, 2017

    All the measures you propose may or may not be the ones needed to improve healthcare. Even if they are they will only bring temporary improvement and change will have to be forced on it again. Only them being tested by competition within the market place can that be truly known. It is there where innovation and enterprise can deliver the continuous productivity, competence and efficiency healthcare is so desperately in need of. Whilst it remains a political and government interventionist enterprise it will never be fit for purpose and will only continue to bleed the exchequer dry.

    Quality free at the point of use NHS is a delusional ambition it is unaffordable. It is possible to have one not both. Introduction of an element of patient self funding incorporating safeguards for those who it may adversely effect is the only practical solution.

    Healthcare as it is currently provided and funded coupled with the debilitating effects of government policies and regulations have made the healthcare industry completely unsustainable. Minimum wage, restrictive practices, bureaucratic and political meddling, administrative aggrandisement and monopolistic practises all contribute to this overpriced and poor quality healthcare service. This current situation to me is as obvious as the nose on my face. Few agree with me.

    However I would direct them to observe foreign healthcare systems that perform considerably better than the UK one. They reject much of the way our healthcare is provided and funded encouraging a considerable degree of competition . Which ensures a continuous observance of self improvement to maintain productivity and efficiency and therefore quality of service affordable at the point of use. It incorporates many benefits besides such as controlling health tourism, the minimisation of discrimination and treatment rationing

  24. Lifelogic
    February 27, 2017

    I am reminded of the absurd glorification of “free” NHS universal health care at London 2012. The NHS is a outrage it is killing thousands through incompetence and rationing.

    The director of a small company is sent to jail because his company truck’s brakes fail and someone dies as a result of the accident and yet nothing ever happens to managers/staff/government ministers at the NHS who know this is happening every day, so why the difference?

  25. Mockbeggar
    February 27, 2017

    I must be careful how I word this, as I have no wish to cause offence, but one cause of the shortage of doctors – particularly GPs – is that so many of them are women. Of those, a proportion are mothers of young children and therefore are working part time. There are only two ways to overcome this; one is to increase the number of medical school places and the other is to recruit more from other countries.

    1. fedupsoutherner
      February 27, 2017


      You are right to bring this up. One of our doctors is female and she has only just come back from maternity leave and she is pregnant again. That means she will be away for another year or so. In the meantime we have to have a locum and our doctors are hard pressed as it is. All this maternity leave, thanks to the likes of Nick Clegg have cost our country a fortune. What was wrong with the 12 weeks or so that we used to have? You either want children or a career. The two cannot always go hand in hand. Before I get slated for this, I am a woman.

  26. forthurst
    February 27, 2017

    A very experienced male nurse employed at the local ‘teaching’ hospital, whom I met whilst campaigning, told me that much of his time was spent interpretting between elderly English patients, and foreign staff; he further told me that agency staff were hired by the shift such that they had no familiarity with the patients under their care or even the geography of the establishment. The NHS is pure neo-liberalism in practice. Until the government starts accepting its responsibility to train and employ English people, they will never be able to compete in terms of efficiency or performance with continental health services who accept the costs of training and employing their own quality staff.

    1. David L
      February 28, 2017

      I have worked in various social care settings for many years. Often, we English staff are a minority. Managers have told me quite often that recruiting UK staff is a major problem, maybe it is regarded as a poor career (it can be), or there’s a stigma attached to the need for personal care for vulnerable people. One lady who started at an establishment I worked at was asked on her first day to help an elderly woman resident get cleaned up, responded “Oh, I should have made it clear, I don’t do “poo”!” (It proved to be her last day, too.)
      Maybe the NHS is similarly stigmatised in the eyes of we Brits.

  27. Tom William
    February 27, 2017

    While we should increase the NHS budget by about 1% to bring it into line with most EU countries the amount spent on hospitals is actually the OECD average.

    Questions to be asked are : why is there a shortage of GPs? Why does the NHS have a lower cancer survival rate and a higher stroke and heart attack mortality rate than comparable countries? Why have so many hospital beds been removed? Why do so many die in hospitals from dehydration?

    Belief in the “wonderful NHS” is not borne out by international comparison figures. I know doctors and surgeons who do not recommend going into medicine in this country because of the way the NHS is run.

    Something more than pouring more money into a bottomless pit is needed. The NHS was set up 70 years ago and the world is very different now. As no single party is able to do more than “shift the deck chairs on the Titanic” we need an all party royal commission on the
    NHS and how it is funded and managed.

    1. sm
      February 27, 2017

      One of the reasons for the GP shortage is the stupid system of them being private contractors within a nationalised system.

      The main reason for the shortage of hospital beds is because the Royal Colleges have advised for 25 years that fewer were needed because more cases didn’t require overnight stays. They didn’t realise that with an expanding elderly population and the ability to give therapy at least, if not cure, serious diseases, demand would increase.

      And what no-one will address is why patients, such as the elderly with incurable dementia, are kept alive when they get infections; quantity of life keeps getting priority over quality of life.

  28. William Long
    February 27, 2017

    ‘In practice all the main parties are in agreement’ – this to me sums up exactly what is wrong: when political parties all agree one immediately has to be suspicious because it must mean there is no really radical thinking about how to solve what is manifestly one of the great social and hence political issues of our age. How are we to deal with a public service that cannot cope with the demands upon it now, and which must worsen given the demographics of an aging population?
    Nothing you have put in your post is anything other than tinkering about at the edges; in order to provide a free health service for those that cannot afford to pay, and for those diseases which are so expensive to treat that arguably no one can afford to pay we need to look at all the other forms of funding that there may be: insurance, paying for part of a treatment privately or whatever may present itself. At the moment though no one seems to even be looking for a solution for fear of offending those who regard the NHS as a religion rather than a service provider taking its place among others.

  29. acorn
    February 27, 2017

    The UK introduced the OECD “System of Health Accounts 2011 (SHA 2011) last May, an EU requirement. The ONS has found more people spending health related money, now totalling £180 billion. Up from £159 billion under the old system. I doubt the minister has a clue about it anyway.

    I am now convinced that the level of disorganisation; dysfunction and demoralisation that aggregates in any one of our major public sector or privatised institutions; be it hospital; trains; electric etc etc; is a direct function of the number of amateur MINISTER changes they have to contend with per decade.

  30. Timmy
    February 27, 2017

    The Agenda for Change Terms and Conditions within the NHS make the risk for the organisation of recruiting permanent staff too great. The very generous redundancy arrangements, 6 months full pay followed by 6 months half pay when sick…., these make the risk of employing slightly too many staff seem very high to the Finance Director (who is the one who gets the heat for overspending).
    When you add in that no one is ever held accountable for failure or loses their job for incompetence you have a system that prefers to stay in crisis and cry for rescue.

    Without addressing the inefficiencies above and those of the medical contracts, you will struggle to deal with locum costs. In whose interest is it to sort it out?

    What’s the answer? I suspect getting rid of national pay bargaining would be the best move that you could make if you want to save the NHS. Some competition on T&C would start to energise the system and reduce costs.

  31. Timmy
    February 27, 2017

    To add to my previous comment:
    I do not think that the basic pay of NHS staff is too high, indeed I see it as too low in general and particularly in the south-east. The problem is the T&C

  32. agricola
    February 27, 2017

    Just read the Daily Express account of your debate on the Daily politics which they described as snappy and heated. I thought it was a very affable and calm exchange of views. Nobody appeared to get upset in the slightest. Such reporting makes me realise that perhaps Donald Trump has a point.

    1. Leslie Singleton
      February 27, 2017

      Dear Agricola–Absolutely correct–I am no lover of politicians (frequently John jettisons what I write on them–I bear no grudge) but I am sure I cannot be alone in having watched something myself and then reading, hearing or watching its being reported, and as you say wondering and doubting whether I was reading, hearing or watching the same subject–wound up of course every which way. I unequivocally agree with the POTUS’s approach of doing without the media, or such media as he chooses, whenever he wants. Let them climb up the walls, who cares–few will miss the scurrilous muck raking. Dear John, Please forward to the White House.

  33. Billy
    February 27, 2017

    I find it hard to believe your stance on this John.

    Currently, trying to get an appointment at the Wokingham Medical Centre is like digging for gold in the ocean. Its not going to happen!

    The centre faces chronic staffing shortages for an increasing and ageing population, and yet young family’s like mine cannot access basic services.

    Stressed, under staffed services make bad mistakes, and as such increase waste in systems that could be avoided.

    What will you do in the centre across the road John?

    Reply I am willing to take up any issues for the local health providers where they need help from government.

    1. Michael Wood
      February 27, 2017

      I think a lot of the problems occur in areas of high population, which, for SE England are everywhere!

      I consider that we are very fortunate in West Wales as it is possible to call in at our local surgery most mornings and see a doctor within an hour or so at the latest.

  34. BOF
    February 27, 2017

    At the risk of incurring the wrath of many, I would suggest a serious clampdown on motability, to separate necessary provision of vehicles from the very large number that are a blatant abuse of the system. I would hesitate to call it a racket but it must come close.

  35. PC glitch. Wha?
    February 27, 2017

    Mr Rt Hon Hunt MP Secretary of State for Health was unable to say in response to one MP’s question how half a million physical records were lost for such a long time without anyone being aware of it. He accompanied his displayed lack of knowledge with a good-natured smile. Another MP attacked saying it might have been a good idea if he had come to the House with such data. He reiterated his belief that paper records are inferior to online records and, had the information been online then its disappearance would have become obvious immediately.
    Too few MPs have real-life genuine experience of IT and working with the public. An eighteen year old clerk in a housing, rent rebate, or financial company office can tell you how masses of information can be lost forever, bits updated but then lost without a soul in the world being aware of it… as it is in cyberspace
    Could you believe private contractors could send bills for their alleged work to the Council, it being paid automatically without checking who they were or whether they were owed money and no record accessible of the details..and for it to go on for over a decade. It happened.
    Storing Info online is becoming an increasingly foolish idea. At least with paper..the very bulk of it has a physical presence that can be seen notwithstanding the fact the government has indicated that after five years it should be destroyed, automatically, by unskilled destroyers in Local Authorities.with affectedly wide-eyed people above them authorising it.

  36. The Prangwizard
    February 27, 2017

    An off topic comment.

    Listening to Mary Creagh’s very good speech in the Flood Prevention Budget debate. This subject is I’m sure a devolved issue yet there was an interruption from the SNP benches.

    No need for English parliament says Mr Redwood. How does EVEL help when English MPs can’t debate without the Scots?

  37. A.Sedgwick
    February 27, 2017

    We may have a May/Truss poll tax event looming. The revised insurance injury payout scheme announced today which has rocked insurance share prices could apparently add £1b cost to the NHS. From a personal standpoint potentially adding £300 to my car premium, which for 2017 has gone up by approx 25% for my being a year older and the hike in insurance tax. The chance of my returning to the Conservative fold was tenuous, I have significant doubts about whether May, Hammond and Hunt really know what they are doing. I suspect I am not alone and this stupid decision could be the end of their period of grace for many of us.

  38. Derek Henry
    February 27, 2017

    It is all about what skills and resources are available for the monopoly issuer of the £ to buy.

    Nobody talks about how the private healthcare system is currently stealing those skills resources and getting subsidised by the state to do so.

    Now Brexit is finally here there are 2 things that need to be done

    a) Put the privatehealthcare system at the back of the queue

    b) Train more of our own doctors and nurses and stop stealing them from abroad. Allow them to train for free without getting into debt. Incentavise them to stay here.

    Thus we can create more jobs at home and provide more skills and resources for both the NHS and private healthcare.

  39. Jack
    February 27, 2017

    The deficit is far too small. Before having the micro debates about efficiency or whatever, at least put our total productive capacity to use and make sure that there is no unemployment whatsoever.

    Get the macro right, then let’s discuss micro.

    1. Jack
      February 27, 2017

      Unemployment is a created by the state. It is unsatisfied demand for work that pays in the state’s currency.

      A monetarily sovereign government can always sustain full employment at all times.

      Whether the other real resources are available for there to be prosperity is another question, but with low enough taxes there will always be full employment.

  40. Denis Cooper
    February 27, 2017

    According to Major there’ll be little left of the NHS unless we heed his advice on Brexit, it will be a catastrophe. And after all he is somebody who knows about catastrophes …

  41. fedupsoutherner
    February 27, 2017

    Off Topic and media related.

    Can anyone believe that the BBC put the gaff with the Oscars as headline news and the sexual abuse inquiry afterwards??? You couldn’t make it up.

  42. John
    February 27, 2017

    As the voice of England John, it would have been nice if you made clear that you are talking about The English Health Service. As all you British politicians know – but dare not say – there is no such thing as the NHS. I also suppose that Welsh, NI and Scots MPs were allowed an input to the English health debate.

  43. Prigger
    February 27, 2017

    JR on BBC Daily Politics today for the whole programme.

  44. Lindsay McDougall
    February 28, 2017

    Sorry to strike a discordant note, but this country spends too much public money on the retired elderly, of whom I am one. It is investing in yesterday. Because the number of retired elderly is still increasing and will probably increase for another 10 years, the total spend is likely to increase but we can reduce the spend per capita.

    Firstly, hospitals should not be providers of social care and bed blocking must end; it’s expensive, results in postponed operations and is damaging morale. We need to designate in law the authorities that are responsible for ensuring that social care is available. That does not mean that they have to pay for it. The elderly people or their familes must do that. District Councils are the right level for that responsibilty and in extremis hospitals should have the right to dump bed blockers in their local District Council offices.

    The financial background is that pensioner households are on average £20 per week better off than non-pensioner households. Many pensioners can downsize or take out equity release if they get into financial difficulties.

    And then there’s the fact that an unholy alliance of the medical profession, the God Squad and the body political have extended many people’s lives beyond their natural term, so that dementia is now the most common cause of death. And of course assisted suicide is illegal, unless you spend a fortune going to Switzerland to do it.

    1. hefner
      February 28, 2017


    2. Narrow Shoulders
      February 28, 2017

      In response to dumping the elderly in councils’ offices, we can not get NHS staff to hold out their hands for payment from tourists claiming it is their vocation to look after the sick. You have two hopes of them discharging ailing bed blockers

  45. Joanna Fuller
    March 7, 2017

    Crikey is your diary ALWAYS this dull? Way to engage the electorate, John.

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