Improving the NHS

I would like to relaunch today a couple of  ideas I have talked about before to  improve the service and assist with efficiency.

The NHS issues large number of items to help people with their injuries and to assist their mobility. Many of these items like walking frames, crutches, wheelchairs, and various supports could be reused after a deep clean and checking, but are often left with the patient or the patient’s family. The  NHS could appoint contractors who would pick these items up from the patient or from the hospital after use, carry out the checks, and return them to the NHS for another patient. This should be cheaper than buying new every time, removes the costs of dumping them as waste, and would be a visible contribution to recycling.

The NHS also uses a large quantity of other supplies every day. There are two issues about this that might be amenable to improved handling. The first is to make more use of suppliers willingness these days to supply just in time, delivering to  the ward or surgery that needs the item. Parts of the NHS still have a tendency to double and treble bank stocks, with a central stock, a hospital stock and a ward stock. The more you stock the more chance there is of damage or of things going out of date. It also takes up  valuable space. Some pharma  products need fridge storage.

The second is to have good dispensing of the product where it is needed, with guidance to busy medical staff as to which they need. Modern stock control and access systems allow precision delivery of the items needed related to a specific task. These systems also keep check of supplies and can ensure re-ordering in good time so there is also back up. Making supplies available to people discharged from hospital could also benefit from better control of stock, so people get what they need in a timely way, but are not burdened with large deliveries which turn out to be in excess of their needs.


  1. Duncan
    January 31, 2018

    I’m not sure if this article is well meaning or deliberately evasive but the author knows full well that the NHS’s primary function is not the efficient use of financial resources but the expansion of its budgets using all the means at its disposal

    The NHS ceased being a provider of medical services to the end-user many, many years ago. It’s raison d’etre is now primarily an employer. It is important to understand the difference between the former and the latter. When understanding is reached then it becomes clear as to why the NHS is now simply another state employee vested interest

    Efficiency savings through process changes are seen as an anathema to the NHS because less spending means smaller budgets and smaller budgets equals less room for pay increases, earlier retirements and less opportunity for part-time employment

    Let’s stop the pretence here John. We all know the NHS is bucket of waste. It cares not one jot for efficiencies. It cares only for creating the next crisis that provides another tedious pretext for further funding calls to politicians in government

    Politicians are unable to confront the epitome of waste that is the NHS because that would be political suicide and therefore they pander to it and throw our money at it. The NHS can hold both government and public to ransom at any time it likes, and it does, frequently

    Personally, the NHS died years ago. Now it’s little more than a vessel for political and union action with patient care an after-thought

    Too big to reform. Too entrenched to change. Too powerful to confront. This is what happens when politicians pander to unionised state vested interests.

    It’s all political power and expanding taxpayer financed budgets. The NHS winter crisis farce is now little more than an annual revenue raising exercise by NHS management and with useless politicians in government it succeeds every time

    We have a government with zero imagination and zero courage except to manage political events. What is required is absolute and total reform. That means confronting the UNIONS who represent a massive barrier to serving the needs of the public and the taxpayer

    Moreover, the feminisation of the NHS employee base will in time destroy the NHS.

  2. Bob Dixon
    January 31, 2018

    My wife passed away 3 years ago from lung cancer.Her last 3 months was at home.The NHS provided a hospital bed and various items of equipment.We had 4 visits a day from careers.After her death all the equipment was recovered .There are contractors employed to recover NHS equipment for reuse.

    Reply Not true in many cases

    1. Lifelogic
      January 31, 2018

      They should charge for the equipment when given out and refund when it is returned to them. Loads of valuable stuff gets thrown away or not collected.

      Not their money so what do they care? Also they like that nice sales rep from the wheel chair and crutch company who entertains them.

      1. Lifelogic
        January 31, 2018

        Many overseas patients who should and could pay are not even billed for their treatment. Many who even have insurance for this purpose.

        1. Iain Gill
          January 31, 2018

          many who actively try to pay find it impossible to give the money over… and eventually give up trying

        2. Leslie Singleton
          February 1, 2018

          Dear Lifelogic–Last time I was in hospital and had to pick up medication from the hospital pharmacy before going home I was bemused to find myself standing in a queue as each person in turn in front of me was routinely asked, Do you pay? And Yes there were foreigners in the queue who apart from all else couldn’t uderstand the question.

          1. Lifelogic
            February 1, 2018


      2. jerry
        January 31, 2018

        @LL; “[the NHS] should charge for the equipment when given out and refund when it is returned to them.”

        How would you suggest someone earning the NMW pay for this equipment?…

        1. Iain Gill
          February 1, 2018

          or living on the streets, as far too many single men do

        2. Lifelogic
          February 1, 2018

          There would clearly need to be some arrangement for the few who really could not raise the money.

          But most people could pay and should do so.

          1. jerry
            February 2, 2018

            @LL; There is already a means-test, most people already do pay, its called taxation – Duh!

    2. sm
      January 31, 2018

      My husband died 3 years ago from a rare lung disease, and in his last few weeks he was given a shower seat – it took 5 telephone calls (at a time when I was grief-stricken) to get it collected.

      I can – just about – forgive the NHS for not diagnosing his disease over a period of 20 years, but I cannot forgive the constant fighting that it took to get assistance in the last year of his life for things like oxygen tanks, ambulance transport for hospital treatment, GP home calls, and the physiotherapy he needed (never won that one) for someone who could hardly breathe and was going blind from steroid treatment.

      I should add I have nothing but praise for the ambulance and A&E staff who cared for him through his last hours.

    3. Sir Joe Soap
      January 31, 2018

      The Red Cross is taking up the slack by offering equipment where the NHS won’t.

      1. alan jutson
        February 1, 2018


        “Red Cross”

        Yes they are excellent, but charge a small fee per week for the hire and use of it.

        Thus they have a record of who has such equipment.

    4. Hope
      January 31, 2018

      No mention of immigration again JR. Funding should match per head of person. Therefore in real terms spending per head has vastly declined. When set up 70 years ago the population and those entitled to receive care totally different. Imagine after the war the UK made it known all persons in European countries and the common wealth were entitled or able to access free health care at the expense of the British taxpayer! Do you think the NHS idea would have got off the ground? No. Asking people on entry have you lived here for more than a year and expect them to say anything other than yes is a stupid test that only Hunt could be responsible for? Get the basics right first, cut immigration, stop health tourism, provide funding and staff to cope with the volume of people using it. Not hard really. But when you try to hide immigration as a factor you are never going to solve the problem of the NHS becoming a third world service to the world. Stop or reduce our taxes so we provide health care for our selves.

    5. Mitchel
      January 31, 2018

      My father passed away in December 2016;there was a fair amount of re-usable equipment at his home-despite numerous phone calls we found it hard to find much interest from the NHS and in the end found a charity that was interested in having most of it.We also found large amounts of disposables-way in excess of my father’s needs.

      1. jerry
        January 31, 2018

        Mitchel; “a fair amount of re-usable equipment at his home-despite numerous phone calls we found it hard to find much interest from the NHS”

        Simple solution, have drop off points at Hospitals, out-patient’s and perhaps even GP’s in the same way as unwanted medication can already be deposed of? Obviously large items of equipment could not be dealt with this way, although pick-up could be arranged.

        1. Iain Gill
          January 31, 2018

          unwanted medication can already be disposed of? where is this? not in the parts of the country I know.

          one part of the country I know quite well you cannot even get rid of full sharps bins, nobody but nobody (from pharmacists, to GP’s, to hospitals, etc) will take responsibility for taking them. you can get new empty ones prescribed, but there is absolutely nowhere to hand in the full ones. these are supposed to be incinerated, yet people are forced to put them in the regular council bin collection. another scandal.

          1. jerry
            January 31, 2018

            @Iain Gill; You appear to be talking solely about Sharps, my parents do need to use them but from what I’ve seen my LA or NHS trust (not sure which) appear to have a weekly collection from those who do.

            As for unwanted medication, have you actually asked your high street or supermarket dispensing chemist?

          2. Iain Gill
            February 1, 2018

            Re “have you actually asked your high street or supermarket dispensing chemist?” oh yes

            problem seems to be cost of disposal, same as sharps bins, seems to cost to have them incinerated and nobody wants to be the one to pick up the tab

    6. acorn
      January 31, 2018

      British Red Cross dispenses and recovers, with volunteers, medical equipment.

      1. libertarian
        January 31, 2018

        The Red Cross currently provides the community equipment service in the following areas:
        North Nottinghamshire
        South Nottinghamshire
        Nottingham city
        In each of these areas, they hold contracts with local authorities and social services departments to manage and distribute their community equipment.

        In Kent ans Sussex they recover, refurbish and sell wheelchairs only

        1. alan jutson
          February 1, 2018


          Red Cross Hire out equipment in Berkshire as well.

          Age UK (Age Concern) along with other charitable organisations also bid for local Local Authority paid contracts to help patients on discharge.

    7. Iain Gill
      January 31, 2018

      Bob Dixon,

      Its different in different parts of the country. Different clinical commissioning groups do things in completely different ways. Not based on patient or GP needs, but based on fashions in the local bureaucrats.

  3. Mark B
    January 31, 2018

    Good morning .

    This is actually quite a serious problem in the NHS, but even tackling this is just tinkering around the edges.

    There is no getting away from it, the current model of socialised healthcare is simply not working. We have to face it, free at the point of service to all those who seek it, irrespective whether or they have paid into it no longer works.

    What has made the inefficientcies of ALL State run services is MASS immigration. When it is government that is supplying services it simply does not have the structures that can facilitate rapid change. Government is good at big, difficult, longterm and financially risky stuff but for our everyday needs it is an impediment. To give an example. We all know what a State run supermarket looks like -empty ! It exists only for itself and does not need to compete, so offers customers only what it can get for a price that is determined elsewhere y some faceless official.

    In short, we need to look at how other countries manage their systems. Government taking monies and simply puttng it into a pot is not working. Pensions for pensions. Health insurance for healthcare and so on. It is time we paid for what we owe.

    1. Lifelogic
      January 31, 2018

      Well I agree with most of that. But not that “Government is good at big, difficult, long term and financially risky stuff”. No they totally hopeless at that too.

      Look at the EURO, the failure of bank regulation, the ERM, Carillion subcontracting, the renewable lunacy, the counterproductive wars on a lie, the whole of the EU. the absurd tax system, the dreadful road and rail systems, They are absolutely hopeless at almost everything they touch or regulate.

      The NHS is sort of a sad but entirely predictable variation on the “tragedy of the commons” economic problem. Thousands die and suffer as a result.

      1. Iain Gill
        January 31, 2018

        Re Government is good at big, difficult, long term and financially risky stuff. No they totally hopeless at that too. CORRECT.

        Its only in odd cases like the military where the junior staff can pull off miracles despite not because of the leadership of the public sector including the military.

      2. Mark B
        February 1, 2018


        The reasons you cite are more to do with policy and bad administration.

        Government’s primary role is the making of laws, something we have subcontracted out to the EU. But when it comes to areas such as disaster relief and defence etc, governments do work best. Rationing during the war was a case in point.

        1. Lifelogic
          February 1, 2018

          Government’s job should be to ensure that the state sector actually acts in the interests of the public and delivers efficient services. No one other than government can protect the public from the state sector. They fail abjectly in this task general.

          Passing more laws does very little towards this and usually does more harm than good.

    2. Peter
      January 31, 2018

      Yes retrieving items would be tinkering at the edges. Rather than employ collectors a deposit on items might encourage their return with even less cost to the NHS.

      Health tourism should also be combatted. Foreigners could simply bee refused treatment if they have no insurance. Harsh maybe, but that is how it is done in the USA.

      That said, the fundamental purpose of the NHS to provide free treatment of illness for UK citizens must be maintained. No gradual/stealth privatisation.

    3. Hope
      January 31, 2018

      Rudd sent an open letter to EU citizens in the U.K. Inviting their families here without any assessment how it would effect public services. The same woman who told the police any request for more money would fall on deaf ears. The same woman who has curtailed stop and search through political correctness and now has the rising records of knife, acid and violent crimes which appear to be fueled by drugs! Is she capable of forming a coherent strategy, or better still is she up to the job? Three terror atrocities last year where people died and were maimed, any sense of decency would have seen her resign. We are unsafe while she remains in office.

      New York got its gun, drugs and violent crimes down through introduction of rigid stop searches and sufficient numbers of police officers on patrol tasked with carrying it out, not writing reports for PC stats, or thought crimes or gender initiatives.

      We only see last week warboys let out after eight years his US comparison got 175 years.

    4. Chris
      January 31, 2018

      As you indicate, there are many, many thousands using it who have paid nothing into it. It is not sustainable. In addition to the pressure put on the NHS by relentlessly rising, unplanned for mass immigration,

      Prof Meirion Thomas, leading consultant in the UK has on many occasions made clear that the NHS cannot afford to deal with current demands, in particular from health tourists from whom costs are often not recovered. He mentions cancer care and maternity care where the greatest extra costs/losses are incurred. Also the article goes on to say that the total costs of health tourism to the NHS is in the order of £2 billion per year:
      “…The abuse is particularly bad in maternity and cancer wards. At St George’s hospital in Tooting, South London, deliveries by mothers from outside the European Union totalled a fifth of all births, according to figures released by the NHS board last year.
      Around 900 women were treated, costing the hospital £4 million in unpaid bills. It beggars belief that so many patients were seen — nearly three a day for an entire year — yet no one appeared to care whether they were eligible for NHS treatment….”

      He goes on to highlight an attitude amongst young NHS doctors that it is our duty to care for everyone that comes here and that to question the huge demands of health tourism is to be apparently racist. In my view, it seems that yet another profession has been infiltrated by cultural Marxism where legitimate questions about the reasons for a problem are not permitted. If the causes of a problem are not correctly identified, then it will never be solved. Hence the NHS continuing to lurch from one crisis to another, or more accurately, the NHS being in a permanent state of crisis.

    5. Caterpillar
      January 31, 2018

      Mark B,

      Yes major political parties, possibly under media pressure, seem to want to act under the assumption of making the NHS better not making healthcare better. It is an odd starting point. Other countries have demonstrated success with public insurance, social health insurance and various mixed models. The narrative does need to move from better NHS to better healthcare.

  4. Dame Rita Webb
    January 31, 2018

    Why do you need the NHS split into local trusts when it’s supposed to be supposed to be a national service? From memory Brum has at least three of them and inside each of them there is an individual payroll, hr function etc which leads naturally to a duplication of roles. Why do you need people employed in “equality and diversity” roles when the majority of staff are female and a substantial part of the workforce come from overseas and are employed in senior roles? A recent recruitment ad for an assistant e & d officer offered a salary package equivalent to what TWO newly qualified nurses would get. The NHS has the cash but lots of it is wasted and Mr Hunt does not seem to give a toss.

    1. Lifelogic
      January 31, 2018

      Well the NHS is mainly run for the benefit of the senior staff who work there. The non fee paying patients are just a nuisance to them.

    2. Hun
      January 31, 2018

      E&D staff required following passing of Equality Act in 2010. NHS management will just use it to silence whistleblowers and non-conformists as ever.

    3. Duncan
      January 31, 2018

      The NHS is constructed around the needs of itself and its employees. Duplication (greater cost) is an essential component in driving up budgets (because of the greater cost created through duplication) and larger budgets is the fundamental objective. The patient and the taxpayer are secondary considerations simply because they find it almost impossible to impose their influence.

      The NHS’s only concern is to expand its reach, its budgets and its spending. More reach equals more spending equals larger budgets and larger budgets equals ever more spending.

      The Tories, because they’re gutless and unprincipled, pander to this farce, because they have failed to explain to the public what the NHS is and what the NHS could be with reform and an attention to efficiencies.

      The bank of Taxpayer is always on hand to be facilitate the abuse of scarce resources. In the private sector duplication and wasteful spending equals bankruptcy. In the public sector duplication and wasteful spending equals larger budgets, more spending and more opportunity to hold governments to ransom

    4. Narrow Shoulders
      January 31, 2018

      I was going to comment on the substance of the blog in that modern supermarkets sell off excess stock and run out of staple items even with modern stock systems and my father’s equipment was collected after he died.

      Your post resonated so much I forgot what I was going to say on the other matter.

      Why are taxpayers’ funds invariably spent poorly?

      1. jerry
        January 31, 2018

        @NS; “Why are taxpayers’ funds invariably spent poorly?”

        Because all to often some unthinking politico has placed a ‘for profit’ motive no a contract…

        1. Narrow Shoulders
          February 1, 2018

          Yes that’s it Jerry, nothing to do with unforeseen consequences of interference r poor thinking by politicians and civil servants.

          Always a for profit motive. Not people wasting other people’s money on their own grand schemes at all

          1. jerry
            February 2, 2018

            @NS; Funny how the same (so called) “group think” by politicians and civil servants were about from 1947 until the early 1980s yet the service did not suffer from the incompetence it does today – the only thing that has changed is the introduction of profit motive, either as part of a internal accounting method (the internal markets) or an actual for-profit motive via outside contracts.

          2. NickC
            February 2, 2018

            Jerry, I would rather use the current NHS than the NHS of the 1950s 1960s and 1970s, thank you very much.

          3. jerry
            February 2, 2018

            @NickC; Purposely misreading what I said again. We are talking about the way the NHS is managed, not the range of treatments it offers, no one is suggesting that treatments should return to those of 1990 never mind earlier.

      2. APL
        February 2, 2018

        Narrow Shoulders: “Why are taxpayers’ funds invariably spent poorly?”

        Because there is no price signal. There is a cost, but that’s disguised, and the original cost of a tax funded service is almost never the actual cost the purchaser ends up paying.

        As there is no price signal, you have no gauge to judge value for money. You can’t tell whether you are getting good value for money or are being price gouged.

        Especially in the NHS where it’s free at the point of delivery.

        That means, no measure of what a valuable service is. Next, as with free handouts of any sort. There is unlimited demand for free.

        Throw in, no border controls, an expensive service free at the point of delivery, leading to inflated demand for a limited service. Hence queues and waiting lists.

        It’s a political SNAFU.

    5. Leslie Singleton
      January 31, 2018

      Dear Dame Rita–Me, I used to think I knew what a trust was until these silly names were brought in

  5. David Cockburn
    January 31, 2018

    My daughter had diabetes of pregnancy and needed testers etc. Long after the baby was born when there was no longer a problem and despite phone calls and emails, they continued to deliver equipment to her home which had to be taken to a pharmacy to be destroyed.
    The pharmacy wasn’t surprised, commonplace waste of money by the NHS.

    1. Iain Gill
      January 31, 2018

      I have been in operating theatres where the blood sugar testing machine is setup with a PIN number, to ration the number of testing strips used. and I have seen fully staffed operating teams with operation in progress, and nobody in the room has been told the PIN number. thats penny pinching dangerous NHS nonsense at its worst.

      And I dont make this stuff up!

      1. Lifelogic
        February 1, 2018

        What a false economy. They only cost about 5P a strip each on amazon. While the operating staff and the theatre might be costing £2000 – £10,000 per hour or so.

        Doubtless the NHS negotiated a deal and pay £10 for each one but it comes with the pin machine!

      2. nigel seymour
        February 2, 2018

        So what do you want to be done about it matey???? Don’t just send in Labour based rubbish…

  6. alan jutson
    January 31, 2018

    Took some crutches back to hospital a couple of years ago after a family member had recovered, and they looked at me in amazement, no drop off point, no facility to record such, had to pay to use the car park to do so, perhaps a simple lesson here !

    Local hospital spent £53,000 on refurbishing a reception area with a new desk, 3 years later all changed around again, desk torn out and scrapped !

    Many hospitals seem to use agency staff on a regular basis at huge cost, why not simply employ more people on standard rates.
    Yes aware that they also use “bank staff”

    Given many hospitals work at over 90% bed filled rates and are treating more patients every year why not simply build more wards with more beds.

    Why import more workers, why not train enough people who already live here, training them free, on the understanding that they must stay after training by signing a contract for at least five years (similar to the armed forces)

    Thus they can earn whilst they learn.

    1. fedupsoutherner
      January 31, 2018

      Alan Why import more workers, why not train enough people who already live here, training them free, on the understanding that they must stay after training by signing a contract for at least five years (similar to the armed forces)

      Agree totally with this. I am amazed at the number of student nurses I speak to that are already planning to emigrate to Oz or NZ and not work for the NHS. It’s a disgrace.

    2. acorn
      February 1, 2018

      Do you think that the Doctors and Nurses we have stolen from developing countries to reinforce our NHS, should have signed a five year contract to work in there own countries? The countries that paid for their training.

    3. Iain Gill
      February 1, 2018

      We should be significantly cutting immigration of both staff and patients!

      And we need the incentives in the system to be broadly in favour of hiring and training locals, rather than importing cheaper or more subservient foreigners in such large numbers.

  7. Lifelogic
    January 31, 2018

    Sorry this is so long, but I do think it needs to be said. The group think – isn’t the NHS wonderful must go. It is very far from wonderful, damages the economy & kills thousands.

  8. Annette
    January 31, 2018

    The NHS’s virtual ‘single use’ policy for many mobility aids is a disgrace. Despite signing for things, & confirming them in audit requests, they still wouldn’t take back a lot of the stuff saying it was for us to dispose of. My Mum ended up with three walking frames in the house. I did manage to get them to take back some stuff, but was still left with some re-usable & unused bits that they refused to take.
    Part of the problem is that there appears to be no single point of contact.
    I had two different collectors for some stuff, three if I add Social Services to the mix. On the stuff, which was unused & expensive looking I had to visit several depts in hospitals to give them back their equipment.
    Early last year, my husband was fitted with a loop recorder as 1 & 7 day recorders didn’t identify the problem. On the first device check he was also given a State of the art’ (their words) modem/transmitter. It downloaded the data to the hospital system, thereby saving a trip to the hospital & was available for review. With an 10 mile round trip, it certainly seemed an advance & an efficient methodology of collecting the data. After the initial set up test, we received one letter to download. Then he was sent appointments. I suspect that, as the Consultant required readings before the consult that they decided to go back to doing the same download but in a hospital.
    My husband subsequently had a pacemaker fitted in September. At the first device check, I forgot to bring back the now reboxed transmitter & apologised for forgetting it. The response was ‘Oh, we don’t want it back. We might be liable if there’s any retained data & we give it to anyone else. You dispose of it’. It will be returned & forced on them at the next check up. The responsibility for the safe deletion of data rests with them. It is also eminently re-usable & seemed an efficient way of collecting data for analysis, saving transport & reducing the physical numbers of patients on site when it’s not necessary.

  9. stred
    January 31, 2018

    Visiting the tip last year, a fairly new looking wheelchair was being scrapped. I asked why and was told that this was one of many. We keep crutches for the next time anyone breaks a leg. I phoned to say I could return them but nobody was interested.

    It would be very welcome id just in time worked for flu vaccines. Currently, there is a shortage of the quadruple vaccine, the NHS having advised GPs to order the triple jabs which work for the older flu strain but not the new. I was refused when I found a GP that had quadruple jabs, as I was not a patient and told to use my own GP who has none.

    I spoke to an old friend who was a very good GP and had to wait 9 months for a scan after a brain hemorrhage found he had cancer in 3 organs and has been waiting 2 months for any treatment. Commenting on the flu vaccines, he said that the new strain Australian flu was a return of the 1917 type, which killed many more people than died in WW1. He said that they must be using up old stocks of the triple jabs, because they always over order and have a lot left over. How typical of a state monopoly run by functionaries more interested in their own performance indicators and inflated salaries.

    Well, the Commonwealth Fund says the NHS is the most effiicient, so it must be right, especially as one of its directors is Simon Stevens who is in charge of our national treasure.

  10. Iain Gill
    January 31, 2018

    Was it not Peter mandelson who famously said he was not a quitter, while in a hissy fit.

    Just reinforces who Ms May has as role models.

    1. jerry
      January 31, 2018

      @Iain Gill; I seem to recall a certain Mrs Thatcher saying something similar in Paris back in mid Nov. 1990 to – careful what you wish for, Mrs thatchers successor signed the Maastricht Treaty, never mind taking the UK into the ERM…

      1. Mark B
        February 1, 2018

        The ERM was a precursor of the EURO. Much pain was had from the former, but it did at least keep us out of the latter and, I would argue, lead us to voting to leaving the EU altogether. Well, in name only that is.

    2. rose
      January 31, 2018

      I thought “quitter” was another rude word aimed at Brexiteers. By the one who called us swivel-eyed loons and closet racists, I think. Therefore a most unfortunate word for her to have chosen.

      1. Lifelogic
        February 1, 2018

        Indeed May is not a quitter, she is a remainer pretending to be a leaver. Also a Libdem pretending to be a Tory PM.

  11. Sir Joe Soap
    January 31, 2018

    Again, we have to tackle the disease rather than a couple of symptoms. The disease is that there is no incentive for NHS to be more efficient, quite the reverse.

  12. APL
    January 31, 2018

    “The NHS could appoint contractors who would pick these items up from the patient or from the hospital after use, carry out the checks,”

    Another Quasi autonomous operation in the making. How long before they introduce a scale of fines – because it will be ‘self funding’?

    Why not incentive people to return the items?

    if it costs £100 for a pair of crutches, offer £10 to return them in good condition.

    1. Narrow Shoulders
      January 31, 2018

      Or ask for a 10% deposit. On a credit card only taken on non return. Hotel style

      1. APL
        February 1, 2018

        Narrow Shoulders: “Or ask for a 10% deposit.”

        That might work too. Except, the Labour party would make hay and consequently it’s probably politically ‘difficult’.

        Making little johnny pay for his crutches when he was knocked down by a nasty uncaring capitalist driving his Mercedes. Nah, I don’t think so.

        That would be a difficult case to make.

        The refund/incentive, would cost money, but the cost could be offset against the cost of new equipment that now won’t have to be purchased.

  13. Ian Wragg.
    January 31, 2018

    The mantra that immigrants are generally young and don’t burden the NHS didn’t seem in play yesterday.
    I took my wife to ENT and about half were of foreign original.
    In the anti natal clinic next door they were in the majority
    No more resources are added just increases in population.

  14. Glenn Vaughan
    January 31, 2018

    The NHS is like a car with only two wheels. Consequently it’s pointless spending billions of £s upgrading the engine when the model can no longer function as intended.

    We’re living in 2018 and not 1948.

    1. jerry
      January 31, 2018

      Glenn Vaughan; “The NHS is like a car with only two wheels.”

      So you would scrap a car because it has a puncture and needs a new tyre or two?! Most would advise the repair option than replacement, unless one works in the showroom and need to earn some commission on a new or used car sale of course…

      1. Iain Gill
        February 1, 2018

        The NHS is a Trabant, designed by politicians and mandarins, we are always told how wonderful it is, waits for delivery are long, quality is poor, and it lags the outcomes of similar things in the rest of the developed world.

  15. Chris S
    January 31, 2018

    Simple changes like appointment-making via email would help. People on regular medication are only given prescriptions for 2 months and then there is no connectivity between patient and most surgeries for repeats. Why not go to quarterly prescriptions ?

    1. jerry
      January 31, 2018

      @Chris S; “Simple changes like appointment-making via email would help.”

      Emails can be unreliable, even more so if the message is time sensitive!

      “Why not go to quarterly prescriptions”

      Prescription needs can change, medication can have a shelf-life, also some medications carry intentional or accident al overdose risks.

    2. Leslie Singleton
      January 31, 2018

      Dear Chris–Two months? Lucky you–Round here it’s one month. That said it is obvious enough that the medicine bill would shoot up with anything like an extended period, the major reason being that many people have their prescription changed frequently especially if they have multiple issues with the consquence that (even) more medication has to be destroyed.

    3. a-tracy
      February 1, 2018

      Chris, I had my last hospital appointment reminded by text! I thought this was excellent, I hadn’t forgotten the date or time but it was a good reminder for those that do.

  16. formula57
    January 31, 2018

    And the courageous Health Secretary who has to explain avoidable patient deaths arising from failures in “suppliers willingness these days to supply just in time” can likely just cut and paste with only minor adaptions Mrs. May’s apology for the now traditional winter NHS crisis and so we will all be reassured and contented.

    I regret my comment is negative when I would wish to be encouraging but benefit financially of this inventory control measure may well be eclipsed by operational impairment of a non-trivial kind.

  17. Blue and Gold
    January 31, 2018

    Having recently left the NHS after 21 years I can tell you that the vast majority of sticks, crutches and frames are indeed returned and re-used. Occupational Therapy departments do arrange for the delivery and collection of items.

    Hospitals are not in the retail trade and ‘just in time’ delivery would be ridiculous, when you are talking about medical supplies. Surgeons, doctors, nurses need to know the medicines, surgical appliances etc are in store, on site, without the fear of last minute non-delivery.

    One of your contributors could not resist mentioning mass immigration, what a surprise.

    The NHS could not run without the skills (in all areas and levels of the service), of citizens from the EU and across the world. If they were all sent home or prevented from coming here, the institution will totally collapse and that is fact, not scaremongering.

    Too many British workers are not interested in doing the tasks that many of those workers undertake.

    The majority of NHS workers will tell you the same thing.

  18. Bert Young
    January 31, 2018

    Any organisation – including the NHS is capable of improvement ; medical supplies must account for huge amounts and any unnecessary stockpiling ought to be outlawed . I am a great admirer of the medical profession and of the underlying dedication that exists in the service they supply , most of them do not have what I would call a “business brain”their primary modus operandi is in providing care .

    The NHS is a huge organisation and its control and management is confused and difficult . Often the localised committees do not have individuals with the skills it takes to guide and decide on their operations so it is no surprise there is a wide discrepancy between one and another . I have always prescribed that in creating change one must start at the top ; the NHS has long been criticised for not addressing the differences that exist between one group and another and taking any sort of corrective action ; its complexity and size mitigates against this . I would want to change this and re-design it into regional controlled bodies with a mixture of private enterprise.

  19. agricola
    January 31, 2018

    You make two valid points. The waste in equipment and consumables must be enormous. For example my secretary still has equipment and consumables in sealed packets five years after her husbands death. I use a pair of nail clippers given to me by an NHS chiropodist because they would be thrown away after single use. They are in stainless steel and would cost at least £20.00 in a shop.

    Your just in time (Kanban) ideas are valid with one or two caveats. The NHS should demand it and it should be at the expense of the suppliers. My experience of it is that it worked very well, apart from the Kobe earthquake. The Japanese overcame even this set back and none of my customers in the UK suffered. For the UK NHS I would suggest Pharmaceutical warehouses run by such as Boots at the suppliers expense , adjacent each trust. I would further suggest national purchasing negotiation from a central office manned by buyers with knowledge of drugs and value added. Trusts should only pay on drawdown but within ten days. I would also recommend an end to drug company conferences in places like Davos and Bermuda which in reality are product using bribery of consultants. Finally why not a central computer handling salaries at all levels in the NHS so eliminating myriad duplication at trust level.

    My absolutely final suggestion following the health record failure. Put every individuals records on a USB stick, one to hang around their necks and one on their bunch of car/house keys, all encrypted and only readable in NHS facilities. In emergencies such information would be invaluable.

    Now you know, lets crack on with it.

  20. JimS
    January 31, 2018

    Hospitals should perhaps be run by those with some experience of running small engineering companies, they understand the concepts of work flow and handling ‘one offs’ and ‘specials’.

    A friend recently had a fall and on return home had someone make an assessment of needs and then three workmen arrived at different times to fit aids onto the stairways and bathroom. There is no reason why the fitting couldn’t have been done with one visit by one person. Perhaps the fitter could be trained to do the assessment too? I guess a stovepipe mentality and medical closed shops prevent that ever happening.

  21. Roy Grainger
    January 31, 2018

    Just-in-time supply for the NHS has far to much risk (political and actual) to be a good idea – any disruption in a supplier or elsewhere in the supply chain would mean equipment or medicines not being available.

  22. Epikouros
    January 31, 2018

    If the NHS was not a socialised public sector monopoly then your ideas and many more would have been tried and those that work adopted and those that do not rejected and would be doing so as an ongoing exercise. It would do very many other things as well such as improving productivity and consumer satisfaction with better outcomes. It would tirelessly work on reducing costs and waste reward excellence and punish mediocrity increasing efficiency and competence. However whilst it is structured and paid for in the way it is it will never actually give the level of performance and service that it should and it will become evermore financially unsustainable.

  23. a-tracy
    January 31, 2018

    I know of people that stockpile all sorts of pills and cottonwool and other things they get for free because of their conditions – some of these conditions are brought on by poor diets and lack of exercise too. We just need to encourage a none waste campaign and allow people to take them back to their local GP surgery (hospitals are too far away now) they could just be collected up in the same vehicle as the drugs and other items that go between surgeries and the local hospitals.

    People whose drugs are no longer suitable and have them changed the GPs just tell you to throw the unopened packets away?

    You could even have a twice a year bring your NHS none needed equipment back to x place in your local area (council offices with a big van parked outside on a Saturday morning) different location each week all going back to one main depot for steam cleaning or repurposing.

    The NHS could offer people to buy these plastic orthopaedic walker boots and arm casts instead of having bandaged casts on their breaks, you can have the bandaged casts for free or a £40 – £100 boot at your own expense we shouldn’t just get what we’re given all the time because of essential rationing.

    This is all just fringe savings though, the biggest problems are the labour costs and division of work with the 2004 GP contract putting pressure on Paramedics, A&E and other staff, we are just moving deck-chairs all the time, and the GPs got a minute cut in salaries £6000pa at the time (which was made up with other targeted funds) to create this massive need for yet more money and massive loss of services to the public. We should never have got into a situation where more than 20% of our labour wasn’t training within our Country with UK residents, the qualifications from abroad aren’t as stringent as ours and the language barriers are causing problems in some areas.

  24. JoolsB
    January 31, 2018

    I’ll never forget after I broke my leg a few years back when I tried to return my crutches to the hospital and they were gobsmacked that I had. They told me nobody ever bothered. From what you say, no doubt they were then thrown away. What an absolute waste of taxpayers’ money. A deposit should be charged and they should be re-used. There is no excuse not to disinfect and re-use equipment except no doubt it is below anyone’s pay grade to do so.

    Secondly John, when talking about the NHS, do you think you and your colleagues could start referring to it as the English NHS, seeing as the NHS in England is the only part of the NHS the UK Parliament, including 117 Scots, Welsh & NI MPs have any jurisdiction over?

    1. Lifelogic
      January 31, 2018

      I think the word English, England and British are largely banned words in the state sector. They even want you to put your “country of birth” and Nationality down as UK now. Rather than England & British.

      1. Mark B
        February 1, 2018

        The put, Other and then write English as I do 😉

  25. jerry
    January 31, 2018

    “The NHS could appoint contractors who would pick these items up from the patient or from the hospital after use, carry out the checks, and return them to the NHS for another patient. “

    That already is the case in my area, and it is that sort of system that causes the problem of equipment retention (never mind delays in issuing) due to the bureaucracy involved.

    “Parts of the NHS still have a tendency to double and treble bank stocks, with a central stock, a hospital stock and a ward stock.”

    In the same way as the MOD also triple banks their stocks, thus minimising the risk that the front line will run short. “Just in time” stock control might work for factories were the worst that can happen is a stopped production line and people sent home, in the NHS, as in the MOD, any failure of supply puts lives at risk.

    “The more you stock the more chance there is of damage or of things going out of date”

    No more so than in any rotational stock system, including those who provide “Just in time” stock control, unless they also carry little or zero stock themselves, if the latter is the case then there are now two pinch points were failures of supply can happen, what is the manufacture also has a problem….

    “It also takes up valuable space. Some pharma products need fridge storage”

    Which will still be needed even in a “Just in time” stock control system!

    “large deliveries which turn out to be in excess of their needs.”

    Define “in excess of their needs”, for some that might be more than a couple of days, for others it will mean a month, and that is the problem pen-pushing “blue skies” tinkerers always forget when they try to streamline the NHS and its services into a one-size fits all system – just as primary care is all to often bespoke so is after care.

  26. Duncan
    January 31, 2018

    The NHS many years ago died when the unions got their grubby claws into it and turned it into an employee convenient organisation

    We need to turn our attention to the forces now stacked up against Brexit and democracy

    I am telling you that if your leader betrays us my party, as opposed to the socialist crap it’s been turned into, will simply be eliminated and that will be a tragedy for all of us

    1. David Burrows
      January 31, 2018

      Speaking of unions i was in the local hospital today for a clinic appointment and happened to pass the union notice board. I wasn’t looking but TORIES OUT in big letters did catch my eye. Not exactly inclusive?

    2. Hun
      January 31, 2018

      Not sure it would be a tragedy as an alternative, centre-right, party will emerge. If the Brexiteers are stitched up by the Tories with a BRINO then the remainers would be foolish to presume that the Brexit issue has been resolved forever.

    3. Lifelogic
      January 31, 2018

      Indeed it will. But May & especially Hammond certainly look set on this appalling betrayal. Not only that they are running an idiotic, socialist, expensive energy, PC, big government, tax and regulate to death, economic agenda too.

      Who will rescue us?

  27. ralphmalph
    January 31, 2018

    I would start with the large issues of costs. I do not believe that any management team can run a 1 million plus organisation in the public sector. I would make the NHS multiple regional independently funded organisations, based on county. Every piece of NHS infrastructure above to be removed, costs given to regional organisations.
    I would change the funding by reducing NI and putting a specific NHS cost on council tax (yes pensioners would pay) this would mean that the costs are far more transparent to the users. Central funding still available as well to top-up.
    The regional NHS board should have the local MP’s attended once a month for an update so they are fully informed. Then the stats on performance should be provided to the local population. We get far to many “BBC” stories that the NHS is failing, in fact in certain areas of the country the NHS is very good whereas in others it is not so good, but it is far to easy to say that the whole NHS in England is failing because all the stats are national. Make the local CEO and seni0r management accountable for performance and share
    Sorry for the Long post Mr Redwood but the NHS structure today is basically communist ideology.

  28. Kenneth
    January 31, 2018

    A few ideas:

    1. Like all large organisations, the NHS needs to keep pruning empire-building middle management.

    A sure sign of when they have too much time on their hands is when they attend a lot of conference jollies.

    I see little sign that the NHS is vigilant in this regard. In fact, all I see is a continual bloating of management.

    2. £80K GPs are often carrying out a £40K triage service. Is it not time to do away with the surgery that ties GPs down for many hours and replace this with triage centres?

    We could have less GPs covering greater areas and replace them with nurses, feeding the GPs intelligence on their register. This will allow the GP to prioritise and take a more holistic approach to patient care.

    3. I hear that the buying functions in the NHS seem to get ripped off and they even have their own inflated inflation rate to reflect this. Perhaps the buyers need to be rotated more and some replaced. Also, are buyers properly tied in to the logistical needs of the NHS?

    4. We all accept that medics make a profit from tending to the sick. The NHS is a rightly a professional service. However, I think we should consider having a national voluntary corps including those with medical know-how.

    At the moment we have some ad-hoc services supplied voluntary but I am talking about a far more organised and formal set-up.

    Would some retired medics wish to do some part time work voluntarily? Surely, with some good organisation, volunteers could be incorporated into the NHS?

    5. Finally, every organisation takes advantage of new technologies to make work more efficient. I understand that new technologies can increase some work especially as new treatments become possible, but it is a 2-way equation and I wonder if the NHS is really putting effort into saving taxpayer money by realising efficiencies.

  29. agricola
    January 31, 2018

    Just sat through President Trumps address to the nation. My verdict, very inspirational, yes very American, but much of what he had to say translates very well to what is required in the UK. I think our commontariat are in for a disappointment, he will be around for a long while yet.

  30. Prigger
    January 31, 2018

    Mrs May’s press conference 10 am British time 31st January 2018 with Premier Li Keqiang 10 am British time 31st January 2018 with in Beijing

    I had some difficulty watching it LIVE. First CNBC showed silent video and talked over what WAS being said but briefly. So I switched to Bloomberg, saw some minutes LIVE but then they cut it off. I switched to the BBC which showed it LIVE. But then they cut it off. Then I switched to Sky News who showed it LIVE until they cut it off.

    I guess I saw the first 30 minutes of it in total. Questions were taken readily from the floor from a female British and then female Chinese journalist on Brexit, international relations.

    Conclusion: A remarkably open meeting and press conference with Premier Li Keqiang interrupting Mrs May’s opening speech with a joke. They both laughed was about steel quotas. Mrs May was, in my opinion, the most relaxed and confident I have ever seen here. Completely at home. They had obviously had a very good meeting indeed. She wasn’t jubilant. I would say the next best thing to it. I would say buoyant more than I have ever seen any Prime Minister, including herself with any other leader including Trump. Premier Li Keqiang behaved as though he had very good talks with a good friend. You could see a wonderful atmosphere, almost feel it. He says that despite China being well and able to produce enough food for its people, China will be buying Beef and Dairy products from the UK in large amounts to give their people more choice. Mrs May says these sales would start in six months time. She noted 150,000 Chinese students study in the UK each year and ours have risen by 60% this last year to 9,000 including English teachers. Each of them indicates very much more increased trade, big money also a Trade Review Board to be set up to investigate what more trade we can do when Brexit results allow.Premier Li Keqiang says Brexit does not present any problem at all and will increase free trade between the UK and China. They are in agreement over North Korea.
    Mrs May has done extremely well. It is obvious. It is noticeable the two get along together very well indeed. She says she meets President Xi Jinping tomorrow.

    Given the importance of Mrs May’s visit , I find the coverage of the BBC, SKY News, Bloomberg, based here in the UK poor. I could not watch the press conference in its entirety. Just think, open questions from the Press to the Premier of China, open ones and our media faints!!!Perhaps they too was taken by surprise at the frankness and cordiality of the whole thing.

    Again Mrs May has greatly surpassed expectations., and her trip isn’t over yet. Oh Premier Li Keqiang spoke of a liberalisation of stock markets of Shanghai and us. Something I know has already started in the Hong Kong stock market with extra capacity being added for both A and H shares. It should be ready in October but there will be dummy runs for testing and a backup system in place to avoid the problems American stockmarkets had when updating their systems which resulted in shut downs.

    All to the good. I just wish we were out of the EU NOW!
    I believe the EU is about to get a shock.

    1. Prigger
      January 31, 2018

      Interesting too that the BBC when showing a clip of Mrs May’s speech/answers picked the one fifteen seconds when she looked and sounded the most indecisive and least personally confident. It gave the exact opposite impression to the whole take on her over the small time they raised the quality their general coverage and showed something important. They did however spend some time looking and interviewing a professor who had taught a whale how to say , one , two, thwirptz, and the linguistic analysis of animal mimicry of human sounds. The BBC is a Beauty.

      1. rose
        February 1, 2018

        I expect she felt happy and relaxed with that smiling and obedient unenfranchised proletariate. Heath always did.

    2. stred
      February 1, 2018

      Hopefully, she has taken a gas mask. She thinks London air is bad at 30-40. Bejing is approaching 1000.

  31. Iain Gill
    January 31, 2018

    On the NHS I dont think you are being radical enough, these ideas are just minor tinkering at the edges of a system completely unable to plod on like it is.

    It needs first and foremost real, proper, and ongoing consumer (ie end patient) empowerment. Give the patients power to take their business anywhere they like at any stage of the treatment cycle. I dont care how you do it, just do that. Then accept that some providers of care are going to fail as patients avoid them. And allow the money to follow the patient.

    Copy from the best of the rest of the World, not the USA, but places like New Zealand, Belgium, Italy, and so on.

  32. Geoff not Hoon
    January 31, 2018

    Agree 100% with your points Mr. Redwood. My friend died of a brain tumour last year. Prior to death he had become completely immobile. Our local council paid an outside contractor to install a ramp to the house for wheelchair access. It was all aluminium and would not have been out of place in a 5 star hotel. After he died his daughter asked the council if they were going to take it away. They said no, so to sell the house she had to pay someone to take it all away. Just like used stairlifts etc there is a business to be made out of saving Councils and the NHS money.

  33. Richard Butler
    January 31, 2018


    Exit Brexit and we’ll see a referendum on an independent England.

    Leave 53.38%
    Remain 46.62%,_2016#England

    1. Mark B
      February 1, 2018

      I find it odd that had Scotland voted to leave the UK all the MP’s in parliament, including our kind host, would have carried out the will of the people of Scotland. ie Allow 4-5 million people to breakaway from a largely successful union of 200 years.

      But think of this if you will. Had Scotland not been part of the UK when we had the EU referendum then the percentages would have been even greater for Leave. But do you think that the rUK would be allowed to leave a political union of less than half a century with undoubtedly better percentages for Leave ? No, I do not think so either.

      The hypocrisy !

  34. dennisambler
    January 31, 2018

    One major cost issue in the NHS is repeat prescriptions, with people on drugs which they no longer need. My mother was on a cocktail of tablets and when she went into hospital for an infection, they stopped all her medication because it wasn’t needed. My father in law was on anti depressants for 14 years, should have been six months.

    Pharmacies are often taking responsibility for this and the requirement to re-assess by the GP is paid lip service.

    GP’s should earn the major salary increase they got under Labour and which, with the removal of out of hours, led to the increased attendance at A&E.

  35. Beecee
    January 31, 2018

    Recently I had reason to take a family member to my local Minor Injuries unit – the service was excellent.

    On a different matter a few days later I had to take a family member to the main A&E which is in a town 30+ minutes drive away. Again the service was excellent, uncluttered by myriads of ‘bosses’ and sundry people wandering about with clipboards and bits of paper.

    To my untutored eyes it seemed that at least 50% of the 50 or more people at the A&E could have been treated at either a minor injuries unit or their GP.

    If the main A&E’s had such a unit then the first assessment could direct people there thus taking some pressure off the doctors etc to enable them to focus on the problem and more serious cases.

    1. Iain Gill
      January 31, 2018

      the few minor injuries clinics we have do not have X Ray kit, and so if there is a chance you have broken a bone you will need to go to A & E in this country. other countries the minor injuries clinics could do it.

      also remember in this country if you are away from home, or out of hours there is often no real GP service available. and even in daytime an appointment can take a week from first phonecall to actually sitting in front of a doctor.

      we have also dumbed down our minor injuries clinics (and some A & E’s) by mainly using nurses to supposedly diagnose, and people correctly dont trust it.

      we are barbaric in being the only developed country that expects a child to wait the 4 days of a long bank holiday to see a GP (best case), when they are screaming with ear ache, because ear ache is supposedly not serious enough for A & E (which is nonsense as any good ENT consultant will tell you, when they often have to pick up the mess of the standard NHS “do nothing” approach to ear ache.) Also our standard “do nothing” ear ache approach is completely different to the rest of the developed world, and our own medics often do private to ENT consultants because they themselves do not trust the NHS approach.

      so yes having proper access to GP’s, proper 24×7 minor injuries units staffed by docs not nurses, and so on would help a lot

  36. fedupsoutherner
    January 31, 2018

    I still have sticks that the NHS provided to me when I had a knee replacement 4 years ago. Recently I went in for a hip replacement but was told not to bring my sticks in as I would be given new ones. I am going in again soon for revision surgery on my knee. I expect I will be given new sticks again!!! I will have a nice collection of them soon. I was also provided with a raised toilet seat and some cups for the legs on my armchair to raise it. I still have all of it at home and nobody has contacted me to ask if I still need them.

    So many times my husband and myself have also been given the wrong dosage of drugs which we have had to take back to the pharmacy and get changed. Because we have had them at home they cannot be reused and we have been told they get donated to poorer countries. Yet another bill to add to foreign aid. What a waste of NHS money. You are right John when you say this needs to be tackled.

    1. Leslie Singleton
      February 1, 2018

      Dear fedup–Blister packs are not safe (I have no idea how to make them so) because there are nutcases out there that will inject poison and worse direct in to the tablets using today’s narrow needles and just for fun apparently. Very hard to detect.

      1. fedupsoutherner
        February 1, 2018

        Leslie, that maybe so but I have also seen people still in the pharmacy being given medicine that is not correct and even though they have not taken it home it still goes in the bin. What I am saying is that perhaps a bit more care is needed at the time of dispensing.

  37. majorfrustration
    January 31, 2018

    Quote -“our NHS is the best in the world” – well of course it is – most of the world use it for free

  38. Ariadaeus
    January 31, 2018

    Scrap it. Let folk keep more of their taxes and pay for their own healthcare. In any case, it is not a healthcare system. it is a political football.

  39. NickC
    January 31, 2018

    JR, A lot of NHS inefficiency stems from the latest government “target”. And most of those targets exist because they are government wheezes or reflex actions. Management is also both ineffective and idle, compared to doctors and nurses.

    My daughter is a GP; she works and is paid for 3.5 days a week (in practice the days are much longer than paid), but spends another day at work for free doing the paperwork. She has no need to tick the boxes for targets because she is competent enough to see who needs what help. Otherwise she’d be struck off.

    1. Iain Gill
      February 1, 2018

      should be sheer lack of staff in the building, sorry

  40. Denis Cooper
    January 31, 2018

    Off-topic, I’ve just seen it stated on BBC TV that while the UK economy has indeed grown a bit since the EU referendum it has not grown by as much as would have been expected, and so that is more proof of the damage caused by the vote.

    Interestingly if it was the middle of 2015 rather than the beginning of 2018, and I was looking at the downwards trend in the economic growth rate which had already become established since the end of 2014 when it had peaked at about 3.3% a year:

    then I might well suspect that it would in any case carry on down for some time – which is what has happened. But unfortunately that possibility didn’t occur to the Foreign Office minister appearing on that programme.

    In fact he, and the Labour party representative, both produced nothing but ill-informed twaddle about Brexit through the whole of the programme. So then for a change I dipped into the live House of Commons and listened to a Liberal Democrat treating the leaked Treasury Brexit assessment as “facts” rather than as little more than a new edition of the same Project Fear document issued by George Osborne in April 2016:

    “HM Treasury analysis: the long-term economic impact of EU membership and the alternatives”

    April 2016:

    “The economic analysis shows that all the existing alternatives to EU membership would come with a significant economic cost.”

    January 2018:

    “Government Brexit Analysis Says The UK Will Be Worse Off In Every Scenario”

  41. Dan H.
    January 31, 2018

    One possible model for the NHS is to overtly set it up as a Government-sponsored healthcare insurance system. What you then do is set things up so that basic grade healthcare is free for all at the point of use, with minor charges being made for many services.

    Then you stipulate that a higher grade of healthcare can be obtained by a higher set of payments to the Government Insurer, and specify a set series of extra benefits that these extra payments will give.

    In here you also need to permit patients to “top up” healthcare with their own money should they so choose in addition to this higher-rate charge.

    Finally you make it clear that every other healthcare service is a strictly private matter.

    Once this has been done, then every year Parliament debates how much money goes into healthcare, and what that money should buy. If individual hospitals or trusts want to give more, then that’s their business.

    Do this, and you remove the airey-fairey Socialist fluff from the system. You reduce things down to services and payments for those services, and you let markets decide from then on in.

  42. margaret
    January 31, 2018

    No we are talking about contractors. It would be more cost effective if the appropriate staff were appointed to concentrate on retrieval of products. Occupational Health and physiotherapists give out the equipment . On designated staff member from each profession could do this work in between their daily tasks and cases reduced accordingly for those responsible. Why spend money ?
    Pharmacy store products and medications and need to keep a check on what goes in and out of the hospital. It is their responsibility . If medications are flying in from all sources, the Nurses responsibility would be even more stretched. At present we check controlled drugs twice/ three times a day at each shift change . We check our supplies of drugs in cupboards regularly and check that all medication is in date every time it is administered. We are not allowed too much stock and the pharmacy technicians will check this regularly also.
    Direct to wards only serves to confuse and has a potential to be unsafe.

    1. margaret
      January 31, 2018

      of course I meant Occupational therapy …..

  43. Anonymous
    January 31, 2018

    Force medical staff trained by the NHS to stay with it for at least ten years.

    No part-timers/job share.

    Women doctors in particular go part time and do not deliver full service.

    1. Iain Gill
      January 31, 2018

      no this country needs to 1) train more Brits 2) make terms and conditions including pay competitive internationally (lots of ex pat British medical staff would come back home if this was fixed) 3) fix the liability model, individuals should be reporting errors without fear, and should not be liable when staffing levels are clearly dangerous

      and I am sorry but we have to drastically reduce immigration, and ability of international visitors to freeload on our generosity. if you have not got indefinite leave to remain, and your home country would not treat a Brit for free, then you should not be getting free care here, indeed you should not have been allowed in without fully comprehensive medical insurance.

    2. fedupsoutherner
      January 31, 2018


      Our female GP has only recently joined the practice and has been away more than she has been in work. She has had a baby, took a year off, came back and within a few months was off as she was having twins. She has only just come back. I think she must have only worked a few months in 3 years.

      1. Anonymous
        February 1, 2018

        I estimate (from what I’ve seen) that around 60% of trainees are female.

        It also affects other businesses where recruitment has been biased towards females – lots of newly trained staff yet still the shortages.

        The so called pay gap is based on two things that are conveniently ignored: skill levels and the total unbroken hours put in to get them.

      2. NickC
        February 1, 2018

        Fedupsoutherner, My daughter is a GP and does 3.5 days, or at least that is what she’s paid for. Actually her days are about 12 hours. And she has to put in about another day to do the paperwork because of political “targets”.

        So she’s working for upwards of 50 hours/week (much more than the UK average of just under 40 according to the ONS) for 28 hours pay. She is not at the clinic all the time because of home visits. She has to pay £1000s for insurance and professional fees out of her own salary.

        If she makes a mistake she can be taken to court and lose her livelihood for good. She wants to do her job, but the government doesn’t want her to do her job. Otherwise why does the government employ “managers” on 7.5 hour days to tell her how to do her job?

        1. Anonymous
          February 2, 2018

          It’s easy to tell which sex is taking parental leave, job sharing, going part time and retiring early.

          Both should be equal. If not then there is a problem.

          1. NickC
            February 2, 2018

            Anon, And you direct experience is what exactly? My point from direct knowledge is that what looks like “part time” from the uninformed, actually isn’t.

  44. Iain Gill
    January 31, 2018

    Horray for Lord Bates, we need more decent people like him

    Not people claiming “I am not a quitter”

    Can someone please tell Lord Bates how grateful we all are for some decency at last from the political class

  45. John Turner
    January 31, 2018

    My wife worked as SRN throughout her working life and witnessed wholesale waste and not the slightest concern from most practitioners about it.
    I wear compression socks which are prescribed and collected at a Boots Chemist. Earlier this month I was prescribed 2 pairs but the chemist gave me ladies in flesh colour and looking like ladies stockings. I realised within 10 mins and returned them unopened:the Chemist couldn’t take them back but ordered another two pairs of black; they came patterned and like ladies stockings. I opened them in the shop but same result. Back to my doctors and new prescription for the correct ones. These socks cost £28.50 a pair on Ebay and we say the NHS is underfunded!

    1. Miss Brandreth-Jones
      February 1, 2018

      I too have worked since 1968 and qualified in 1972 as an SRN. We had management and budget control at that time. It worked. The problem you cite though is a pharmacy problem. I use my local formulary to sometimes prescribe these items. There are hundreds of different types , sizes and makes. Today pharmacists have more input in prescribing. They even have their own consultation rooms. It should be their responsibility to measure your legs , show you the different types available in their stock catalogues and prescribe as a supplementary prescriber. All too often the pharmacists want the prestige of being a prescriber but cannot go through the clinical steps to arrive at a diagnosis and send them back to the Nurse of Doctor. This is one example of how pharmacists could really help.

  46. Rien Huizer
    January 31, 2018

    Ask a decent accounting firm to benchmark the NHS against six leading national health systems (some privatized, some not but always with two minimum requirements: (1) compulsory membership (so not opt outs for healthy people) and (2) a role for the government with as a minimum regulating providers and pharmaceutical prices.

  47. Kenneth F Cookman
    January 31, 2018

    What you are suggesting is a return to the government SUPPLIES DIVISON ,which was closed by the THACHER GOV.
    I started work with them, when it was called the 1967.
    With the arranged CALL OFF contracts it saved much of the waste to which you refer.

  48. A different Simon
    January 31, 2018

    I used to travel overseas on business a lot , often only a few days after having landed from the last one .

    Up until 12 months ago I used to be able to reliably obtain 56 days supply of medication in 2 days for a long term health problem .

    Now it takes 7 days to obtain 28 days of medicine as the NHS has harmonised with the rest of Europe in supplying only smaller volumes of medicine .

    The prescribing chemists don’t have the floor space to fill twice as many prescriptions so they end up being assembled offsite which increases the time lag . They have to pass the extra cost onto the NHS so it ends up costing the NHS more .

    I would no longer be able to conduct international business trips and therefore international business (if I was well enough to work and obtain travel insurance which I am not any more) .

    Just in time supply of just enough medicine does not work .

    1. Beecee
      January 31, 2018

      Your GP should use the Patient Access system.

      Appointments and repeat prescriptions ordered on-line, the latter available in 24 hours from the GP, and for 56 days for those with long term health problems such as diabetes.

  49. Iain Gill
    January 31, 2018

    this guy should get sacked

    the persecution of motorists has gone far too far

    getting points for pulling through a red light to let an ambulance through and all the rest of it

    no ordinary traffic cops support speed fines for a few mph over the limit, and in any case its impossible to drive like that for long distances

    we need a proper review by scientists, not political mandarins including this senior cop

    and btw this just demonstrates the way senior officers are selected and promoted at the mo leaves a lot to be desired

    more votes lost this one, who is the government expecting to vote for it?

    1. Iain Gill
      January 31, 2018

      wow and Nigel F has jumped straight in on this speeding by 1 mph issue.

      again he seems to have his finger on the pulse more than any Conservative politicians…

      where are our elected representatives on this matter?

      1. Iain Gill
        February 1, 2018
  50. Helen Taylor
    January 31, 2018

    When my mum died I took a full carrier bag of drugs back to the chemist. Minus the panadol which kept the whole family going for another year or so. When you can buy generic brands of ibrufin and paracetamol for 20p, why is branded versions supplied on prescription. I bet the nhs is charged a fortune by the chemists

  51. auralay
    January 31, 2018

    Saving money is always good but do you have any figures for how much is wasted? My feeling is that after the costs of collection, sterilisation, inspection and refurbishment the saving would be small or even negative. Certainly it can’t make much difference in a £124Billion NHS budget.

    1. fedupsoutherner
      January 31, 2018


      Look after the pennies and the pounds look after themselves. It is your attitude that is costing the NHS dearly. A pound here and a pound there soon adds up.

  52. John
    January 31, 2018

    I went for an annual check up.

    The surgeries are on 2 floors, 12 Drs listed on each of the two floors.

    The 20 mins that I was waiting there were about 20 others waiting:

    1 was an old man, English, he was token ageing population patient.
    1 was an English woman, late 40’s I thought.
    The rest 18 odd were foreign not speaking English but languages from Eastern Europe to Russia, Asia and Africa.

    If we make a simple deduction that the other floor was the same then there were 6 English visitors and 34 recent immigrants served by 24 Drs.

    The six indigenous could be served by 2 Drs, the other 22 Drs were there to service the economic migrants in a Hertfordshire town.

    I have a suggestion how we could improve the service of the NHS and reduce the cost that doesn’t need me to spell it out.

    I would rather provide that service to refugees that what we get from Calais and the EU.

    1. John
      January 31, 2018

      Correction – Than that we get from Calais and the EU

  53. LenD
    February 1, 2018

    Bring back matrons and sisters in the hospitals and get rid of all of these career minded middle managers.

    Put all high ranking and middle managers on short term contracts and set up a supervisory board made up of lower NHS workers and patients, where they see ongoing waste and nothing is being done to rescue waste then just don,t renew contracts.

  54. Pyramid Scheme NHS
    February 1, 2018

    If politicians of all parties would spend as much time worrying about the performance of major industries in the UK as they do about a non-productive ( directly ) entity like the NHS we may be in better health and not requiring such a growing NHS sucking in like a cosmic black hole massive amounts of intelligent labour who require annual technological updates enabling their work by even more intelligent labour as trainers. We shall have to suck them in from elsewhere…leaving?

  55. margaret
    February 1, 2018

    I know more about the NHS than most yet moderation is always stopping the truth getting through !

  56. nigel seymour
    February 1, 2018

    All EU and other foreign nationals should have insurance by law until they have paid in 10yrs of NIC’s. This insurance should have 25% tax levied on it that could be invested back into NHS England. Any of the above immigrants who can’t meet the requirements should be referred to NHS Scotland or Wales for treatment. All ‘healthcare tourism’ immigrants who cant meet the requirements i.e. childbirth should also be referred to NHS Scotland or Wales. They should be deported with immediate effect if they refuse. All NHS patients should be required to help pay for food during their hospital stay, otherwise get their family or friends to bring in packed lunches or re-heatable food. Pizza and other delivery providers could also be used.

  57. Yossarion
    February 1, 2018

    Surprised this is News, after all the BBC led with this in previous years, however now seems to be well down the order of march.

  58. Original Richard
    February 1, 2018

    Our politicians are moving towards extending the NHS into a total social care system which will include all forms of mental health care such as dementia, although no way has yet been found or agreed as to how this will all be funded.

    If this extension takes place, and we are still in the EU, or have negotiated a Mr. Hammond type deal with the EU, we will see “granny dumping” from across the whole of the EU.

    If these elderly EU citizens are found places close to the UK’s airports it will not even be expensive for their relatives to visit them.

    Our country will be bankrupted.

  59. mancunius
    February 2, 2018

    Even the very largest of hospitals appear to have only one pharmacist, and it can take a long time to issue a prescription and also to get it to the ward – in-patients can often be kept waiting up to five hours for their discharge, because of a ‘busy’ pharmacy and/or a dilatory trolley delivery. This holds up bed re-use. Perhaps the delivery can be speeded up somehow? Pneumatic tube systems, for example? And re-design hospital pharmacies to process more speedily.

    1. mancunius
      February 2, 2018

      I meant ‘only one pharmacy’, of course, not only one pharmacist.

  60. Dennis Zoff
    February 2, 2018

    All good ideas John and will add a band-aid to the problem?

    …….but Politicians, as non-healthcare (NHS) professionals, are far removed from the real issue, namely one of Hospital management. Many problems are not addressed competently by Trust management or indeed do they address the overburdening, costly and unnecessary Hospital administration.

    Never a truer saying can be said “competent professionals lead by unknowing donkeys” Many Hospital Trusts are strikingly similar to the House of Lords; wholly out of touch with reality, with their private healthcare……and frankly have no professional concept or real-life experience of the costly mismanagement and waste!

    Using band-aids to cover the cracks in the NHS, though commendable, is not going to suffice John. We urgently need an NHS overhaul, and in my opinion, should adopt a French, Scandinavian, Dutch, Danish, Swiss, Austrian or German Healthcare system (having seen them first hand) that currently makes many NHS management/facilities/Buildings seem amateurish….and as for the cheaply constructed Hospital infrastructures and their medical equipment, let’s not even go there!

    The underfunding and maladministration diminishes the NHS as a world-class leader in healthcare, however, the UK medical research establishments, Doctors and Nursing professionals that work in the NHS are world class…..the management and general hospital infrastructures, sadly are not!

  61. Adam
    February 2, 2018

    Our health service is still run by a medieval guild called the BMA.

    As far as I can tell, GPS are not regulated. When I go there there doesn’t seem to be any paperwork, unlike other parts of the govt. who is responsible of GPs miss something ? It really needs to modernise and they don’t require 100,000 a year.

    We need to get scientists together, physicists chemists, biologists and mathematicians rebound medicine on scientific grounding instead of the nonsense much of it I say based on today. Medicine should rely on the authority of science to the authority granted to it by politicians and BBC lobbying.

    If you know any science and read medicinal journals the standards allowed in there are horrifying. It’s led to all sorts of junk science pervading the media because newspapers think medical studies are synonymous with science.

    We need to start towards making it all scientific and removing anything which cannot be proven through science.

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