Reform of the NHS

I was surprised to read of possible plans to undertake another reorganisation of the NHS. Apparently the government is thinking of reversing some of the changes introduced by the Lib/Con coalition government when Messrs Cameron and Clegg launched a joint document proposing giving GPs the power to procure services from hospitals and others through Clinical Commissioning Groups. There was some resistance to these changes which prompted a  review led by Oliver Letwin which concluded by  continuing the policy with some alterations to the detail. This system has been in place for a short decade now, and has just been tested by the pandemic. Reponses to the virus have greatly strengthened central decision making and resource allocation.

Ministers have become more involved in issues like protective clothing, capacity and medical priorities, listening to the advice of their national Scientific and Medical advisers on these matters and then making decisions based on that advice. As Health is a devolved matter the Chief advisers to Scotland, Wales and Northern Ireland have also had bigger roles, and there has been some effort to get agreement between the four parts of the UK. Usually there has been high level agreement about the overall priority of fighting the virus, sharing of approaches and data, but detailed differences in timing and magnitude of lock down responses. There have also been some differences in success with obtaining a range of supplies and in the pace of vaccinating. The roles of the NHS country Chief Executives and of national quangos and advisory committees have also been tested in public debate about their quality and wisdom.

The pandemic does provide an opportunity to review the system, though it would be wise for the crisis to be past before rushing to conclusions about what worked and what needs improving. During the phase of seeking to scale up the provision and future supply of protective equipment there was a danger of competing initiatives bidding against each other, and making it complex for local care homes and hospitals to know how best to secure the needs they had. There needs to be some review of how big are the benefits from central purchasing, how central purchases are  best distributed, and what are the continuing  benefits of local determination of need and procurement of supplies.

I see there is also discussion of rolling into the agenda possible changes to the financing and access to care homes. This is a perennial topic which we can debate again another day in the context of intergenerational fairness and fairness between elderly people with different ailments and needs. Any change to the approach which states that if an elderly person needs care home accommodation and hotel service they should pay for it out of capital until they hit a minimum when they can qualify for state payment of the fees could be an expensive new commitment for taxpayers, though popular with those who might then inherit the housing wealth of the elderly person. I think the urgent priority is to see government thoughts on how the central and the local management of the NHS has worked during the pandemic, and what can be done to improve it for the future.


  1. Mark B
    February 10, 2021

    Good morning.

    The problem are numerous. Reform is not the answer, it just creates more bureaucracy, an opportunity for the opposition to say that is underfunded and the unions to grab more power.

    I have said it before. Let companies offer Private Health Insurance and let be a tax break. Grow the Private Medical side. Someone I know need a scan and paid privately. It was done very quickly. Yes it cost him a lot of money but he needed to have it done. If others want nose jobs or gender reassignment then let them pay for it.

    1. Dave Andrews
      February 10, 2021

      I’d also like people to pay for fertility treatment. Add to the list treatment for obesity, alcohol abuse, drug abuse and smoking. Then, when anyone with good intentions signs up to work for the NHS, they are met with abusive and threatening behaviour from the people they wanted to serve.
      It’s not the NHS that needs reform, more the British public.

    2. Narrow Shoulders
      February 10, 2021

      Private is indeed the way to reduce the burden on the NHS and increase capacity. This would allow the NHS to concentrate on core services (not gender reassignment nor fertility) and give an outlet for tourists to attend at their own cost without doctors having to worry whether or not they will be treated. Private Health insurance should not attract IPT nor should it be taxed as a benefit when provided by employers. It is not a benefit it is now a necessity.

      Central buying is cumbersome, but there should be prices agreed centrally to leverage the size of the NHS purchasing power. NHS outlets can then buy from that list (or not if they can procure cheaper themselves but if they can procure cheaper themselves this should be referred to the central buying team).

      Finally patients need skin in the game, free appointments are not valued so there needs to be a deposit system whereby on no show the deposit is forfeit. No appointment is confirmed without a deposit to prevent appointments being booked and deposits taken but notices sent to the wrong contact details.

    3. MiC
      February 10, 2021

      Everything attempted by this government re the pandemic has been a near-complete failure and disaster, leaving us with upwards of 120,000 dead according to ONS.

      The only thing which has worked well is the vaccination programme organised and implemented by the NHS.

      Yes, it is far from perfect.

      Oh, they’d replace it all right, but would anyone be mad enough to trust the Tories to replace it with something BETTER rather than by something WORSE?

      Compare occupational pensions in this country with those across the Channel for instance.

    4. jerry
      February 10, 2021

      @Mark B; So who would over-see this US style privatised health care system, to ensure it provides both personal and public health needs, no doubt there would be arms length oversight by an ‘Office of health’ of some sort, and what of the A&E system? Far from reducing bureaucracy your idea would likely increase it!

      The answer is to actually implement the cradle to grave NHS as envisaged in the Beveridge Report and endorsed by the war-time coalition, that all three of the main parties put into their 1945 manifestos but have never delivered due to the stance taken by some within the medical profession at the time and since – hence why we are stuck with the inefficiencies of the GP style referral system.

      1. SM
        February 11, 2021

        Jerry, the cradle-to-grave NHS system was based on the innocent belief that given free treatment, the population as a whole would become healthier and therefore the call for Health Services would LESSEN over time. This overlooked the fact that making people healthier (and taking into account medical advances) would allow them to live longer and so build up a very significant older-to-very elderly sector that would require MORE healthcare in far greater numbers.

        It also did not foresee that medical advances would mean a significant drop in infant mortality and therefore create a significant increase in the cost of both medical and social care for the severely handicapped sector.

        1. jerry
          February 11, 2021

          ; What a load of hyperbolic anti NHS nonsense! The Beveridge Report predicted all you claim it did not, and was the rational behind the need for the NHS, medical science in the 1930/40s wasn’t in the dark ages you appear to believe, penicillin for example was a product of research in the 1920s and its first use was in 1930, its benefits were being well documented during the early 1940s.

          1. SM
            February 11, 2021

            I suggest you try reading the official history of the NHS, as I did some years ago. I am also well aware of the history of antibiotics. Are you aware, however, that although one of the initial and fully justifiable aims of the NHS was to build new hospitals and redistribute the allocation of medical services fairly across the country, various vested interests stopped that happening – hence the unjust number of hospitals in London as opposed to other areas. (You may not recall that Virginia Bottomley, SoS for Health, attempted to do just that by closing Barts in 1994/5, which fought back in ways that seriously hurt other needy East London hospitals).

            The foolish claim that costs would fall as the population got better health care was made by Aneurin Bevan (then eager to win the leadership of the Labour Party); it was opposed by Ernest Bevin, who was proved right by 1951, when the NHS was first fell deeply into the red financially and charges had to be introduced.

          2. jerry
            February 11, 2021

            @SM; Your dislike of the NHS appears idealistic, certainly not rational, even less so if you have actually read an unbiased history of the NHS.

            You really do not have a first clue as to why the Beveridge Report was never implemented as envisaged, just who do you think those “vested interests” you mention were [1], clue were not the trade unionists working as porters etc. in the existing hospitals, nor the nursing staff, could it have been Surgeons, the existing hospital boards and in the community, GPs…

            The “unjust” number of London Hospitals was/is due to past historical fragmentation, preserved and maintained by those same vested interests you mention, within the settlement that created the NHS by way of the Public Health Services Act 1947, thus the NHS inherited the bloated system of (University) Teaching Hospitals, private General Hospitals and the voluntary & charitable ‘cottage’ hospitals. As for foolish claims, if the NHS could/can not save money (given its massive procurement power), the same must be true of much smaller private hospitals, even insurance companies to some extent (might exp-lain why health care is so expensive in the USA), or are you suggesting medical advancement would not have occurred without the NHS.

            The NHS had not fallen into the red by 1951, (prescription) charges had to be introduced to help fund the UK involvement in the Korean war!

            [1] many of the vested forces that existed in 1945-7 remain to this day

    5. Lifelogic
      February 10, 2021

      Exactly also pay people on the waiting list circa half of the cost to go privately if they can afford to do so. A win, win as NHS pays half price, the recipients get the op earlier and the wait for others on the list is reduced as these people drop off the list. The tax payer wins again as they perhaps get back to work earlier too.

    6. Hope
      February 10, 2021

      JR, again more specious rot. Final paragraph not accurate!

      May nearly lost her election to,Corbyn on her “nothing has changed!” lie. People did not believe her.

      Cameron and your wretched govt promised changes to adult social care to get elected. It repeatedly broke its promises. Not the perennial debate you claim. Or leave to another day.

      Your govt decided to move vulnerable elderly people known to be at serious risk from hospital to care homes without testing which directly resulted in their deaths! Care homes deaths equated to 40% of total deaths last year. How dare you dismiss this issue with such triviality. Had your govt acted on its promises some of those might be alive! Perhaps we could equally suspect this disgraceful policy was a deliberate act to get rid of your perennial adult social care problem?

      Suggest you apologise to those who lost loved ones because of your govt decision and failure to,act on its repeated promises.

  2. Lifelogic
    February 10, 2021

    The NHS is a dire state monopoly & rationing system. It kills thousands and fails millions. Being free at the point of use (or delay or rationing) kills nearly all fair competition and innovation too. The reform needed is to have free and fair competition and to give power and choice to the currently powerless patients. It is one of the worst system around for a developed nation, measured on outcomes. Some safety net is needed to pay for medical care for the few that really cannot afford it. Anyone who doubts this should read all the reports into its many appalling failures and scandals. There are no shortage of them.

    It also needs a proper and open reporting of errors system rather than the endless secrecy, lies and cover ups.

    If you put the federal government in charge of the Sahara Desert, in 5 years there’d be a shortage of sand.
    Milton Friedman. In the case of the NHS you get a pile of bodies and a vast tax bill.

    The only person I know who has died of Covid went into hospital with a minor stroke, was infected with covid in hospital, dumped out (untested) into a care home (to infect others) then send home and back to hospital tested positive and then died the next day. Thanks very much NHS! Desperately incompetent pandemic planning too.

    The governments agenda is almost the complete opposite of what is needed.

    1. Cynic
      February 10, 2021

      Would it not be more correct, and less confusing, to talk about the English Health Service, the Scottish Health Service etc.?
      Perhaps it would make it more obvious where blame and responsibility lay.

    2. Ed M
      February 10, 2021


      You’re going to carry on getting incompetent government (and many times worse if Labour or Liberal Democrat) until politicians, and in particular, those in government and the PM, get paid more and you attract higher quality people for government – people with experience in business, who have put together a business plan, who have set up their own brands, exported abroad, in a leadership role over many different people with high skills etc ..

      So PM should be on about x 3 times what the PM currently receives.

      Until that changes, then it’s Groundhog Day, same old, same old, from Westminster. If you agree, why not organise some kind of group to try and raise the wages of politicians in government. And also that does something to stop politicians being so negatively targetted by the media, another reason which puts higher-calibre from entering Parliament.


      1. dixie
        February 11, 2021

        All paying more will get is the same politicians and failures except they will be more expensive.

        Part of the problem is reward for failure is endemic in government whether it is the politicians or the civil servants. It does not help that the common “qualifactions” appear to be lawyer/journalist + Oxford PPE.

        1. Ed M
          February 11, 2021

          I agree about lawyers etc. Need more successful people from business (people who have done a business plan, set up something like a tech brand, exported abroad, in charge of various people with high skills).

          But how do you get these people into government. Certainly:

          1) Increasing pay is going to make things easier (not harder)
          2) Do something about the press that puts many high-calibre people off joining Parliament.

          What else can you do?

          1. Ed M
            February 12, 2021

            Doing some research on this, looks like pay isn’t as influential as I thought on this subject.

            And how do you challenge media to be less hostile to politicians? I can understand Satire – it’s part of our national life going back to Hogarth and before. But media that delves into politicians private lives, things like that, that’s a different matter.

            Personally, I’d love to see Parliament put a great, big statue up of Cyrus the Great, to inspire politicians more about how politics can be a truly great and rewarding thing as long as approached with the kind of benevolence, wisdom and courage of Cyrus the Great (a hero of the ancient Greeks, Romans, Persians, Jews and Christians).

    3. Ian Wragg
      February 10, 2021

      Not only are we here to save the NHS, Hancock is determined to stop us going abroad on holiday.
      This smells of Agenda 21 and mass reduction of flying for the steeples. Of course the great and good will be jetting in from all over the world to discuss reductions in plant food.
      We’re being had for mugs and Boris seems to have lost control.

      1. Secretaria
        February 10, 2021

        Ian, there is a simple answer to travel at home and abroad, returning to gainful employment, or visiting a restaurant, theatre etc; post COVID injection ,a health passport in the form of a plastic card that can be shown when asked and electronically interrogated. Don’t anyone give me any nonsense about privacy. Facebook, your bank, where you shop, your driving licence, passport , and mobile phone already know more about you than you do yourself. Government needs to bite the bullet that is necessary for a return to normality.

      2. Hope
        February 10, 2021


        Shapps thinks the U.K. should wait until EU countries catch up! Then what third world countries etc etc? Handcock relishes making teenagers criminals by giving them ten year prison sentences with his authoritarian view to control where they go on holiday!

        There must be another agenda for the green blob or something because this makes no sense whatsoever when NHS sends a letter to govt today saying it will take many years to catch up for non Covid treatments! Let alone the economic disaster Johnson is causing!

    4. DavidJ
      February 10, 2021


    5. Dennis
      February 10, 2021

      ‘The only person I know who has died of Covid went into hospital …’

      Why wouldn’t that happen in a paying private hospital? Get rid of difficult patients or keep them ticking over to get more fees. Competition can mean cutting corners in care, no?

      1. Dennis
        February 10, 2021

        In the NHS using all facilities, drugs, surgeons etc. without thought of the bottom line means, or should mean that all will be done that can be done – I don’t think that will happen in private hospitals if the money is not forthcoming. In the USA they insist of you having all the tests that are available so racking up the fees – it’s a racket.

        1. Lifelogic
          February 10, 2021

          You really think that? You must lifecin a dream world. “Without thought of the bottom line” then why such huge and long waiting lists even for urgent operations? Why is so much of the NHS is current just shut?

          1. Dennis
            February 11, 2021

            Think what? I made a few points – you mean ‘the bottom line..? Does the NHS surgeon think how much the operation is costing? Will you give evidence. I should think in a private hospital this could be on a surgeon’s mind as mentioned by his boss. I don’t know but I would not ne surprised. Do you know better?

    6. M Davis
      February 10, 2021

      Lifelogic, I would vote for you!

  3. DOM
    February 10, 2021

    A once provider of medical services to the public that has morphed into an activist and political animal. With a Socialist government in power under Johnson don’t expect the NHS to be reformed and depoliticised. Expect more of the same Tory capitulation to NHS union demands and further demands upon the taxpayer to finance the bottomless pit of waste

    The patient like the pupil is now an inconvenience to the Marxist unions who rule health and education and Tory ministers desperate not to trigger negative headlines in the media will simply cave in to their demands

    Call it reform or reorganisation, it’s all meaningless rhetoric. The NHS is simply unfit for purpose and has become a threat to liberty with its demands to download its tracking and monitoring app (as advertised by Google today)

    And its tv adverts have become threatening in nature which most find offensive

    When will this organisation start cutting off access to these services to keep people in line and force them to act in a manner to conform with State diktat?

    1. Everhopeful
      February 10, 2021

      Yes. Yes. YES!

    2. Caterpillar
      February 10, 2021


      + 0.9

      “capitulation”, “negative headlines”

      No, they are actually on the same side, it is not just capitulation.

    3. Paul Cuthbertson
      February 10, 2021

      DOM – a perfect summation.

    4. Hope
      February 10, 2021


      Reported in the press, £275-300 million (our taxes) spent on govt scary advertising. Hence why MSM do not ask difficult questions to their largest customer! Other businesses giving up on advertising as they are closed!

  4. Sea_Warrior
    February 10, 2021

    Job One: ensuring national self-sufficiency in PPE and drug/vaccine production. (Some good progress has been made here.)
    Job Two: an inquiry into the earnings of GPs during this crisis. (I’m appalled to see that we might have to hand over £30 for a certificate to GPs already earning a packet from the vaccination programme.)
    I’m disappointed to learn, in the past few days, that the government is thinking of moving away from involving the private sector in the provision of services. This non-clapper believes the NHS to be woefully inefficient. If Boris insulates the NHS from competition that that’s just another example of his being a closet-socialist.

    1. Longinus
      February 10, 2021

      £10 per vaccination will barely cover the associated costs of staff overtime, travelling to/from housebound patients, PPE and reduced income from other sources. Why shouldn’t a professional be paid an appropriate fee for non-NHS work? Does your accountant, dentist or solicitor work for nothing?

      1. Qubus
        February 10, 2021

        In that case why not cut-out them GPS entirely. Then they can get back to what they are supposed to do. There are more than enough volunteers.

    2. jerry
      February 10, 2021

      @SW; It has been private involvement in the NHS that has always, and historically, been the cause of front line inefficiencies, many do not realise that GPs are part of the private sector you crave, contracted to the NHS… There is plenty of opportunity for private sector involvement health care, no one (pother than perhaps the very radical left) is suggesting the nationalisation of PPE equipment or pharmaceuticals

    3. Dennis
      February 10, 2021

      Isn’t the family unit a socialist state? They run pretty well and honestly. If socialist states are run badly then that indicates that people who run them are crooks, greedy, dishonest, rapacious etc., etc. , but that’s not news. So it seems we must put up with whatever we get from whatever system.

  5. Iain gill
    February 10, 2021

    John, are you aware British gas services are currently running waits of over 4 weeks for boiler repairs? People pay in about 400 quid a year for a maintenance contract. Here we are with snow on the ground, children stuck at home not going to school, and they have over 4 weeks wait for repair appointments. No heating or hot water. Their service is basically fraudulent because they take the payments but don’t deliver the important repair service when you need it most.
    Just like the NHS.

    1. Andy
      February 10, 2021

      British Gas was privatised by the Conservatives. There are plenty of other providers out there you can use to fix your boiler if you are unhappy with the service.

      1. Caterpillar
        February 10, 2021


        So you recommend privatising the NHS, because even if it continues to fail to deliver on its service agreements then competition will provide alternatives. The logic to that position no longer exists, it requires a Govt not a dictatorship. The current dictatorship acted to switch off private health provision last year, and it continues to switch off other private businesses now. As long as we permit ourselves to be ruled by dictators then any organisation, public or private, can be made to fail at the whim of the dictator. One’s political or operational efficiency position is irrelevant, a dictatorship can and does destroy whatever it chooses, whenever it chooses.

      2. Iain Gill
        February 10, 2021

        its a bit late after you have already paid your premium

        but yes that will happen after the terrible performance this winter

        sadly nhs customers cannot do the same

        both need strong action by those in power

        1. Iain Gill
          February 10, 2021

          rather hilariously British Gas want full medical details of everyone in the house, and are rationing appointments based on how vulnerable they think you are. those medical expert receptionists like the nhs use in action again, rationing access to services. funny they dont mention that you will be at the back of the queue if you are healthy when they take their rather large payments.

          its a scam out and out, just like the nhs.

      3. Roy Grainger
        February 10, 2021

        But if we’ve paid £400 for a service contract (I was lucky and got a 3 week appointmernt from BG) why should we pay extra money to another provider to do the work BG contracted to do ? We’re not all as rich as you Andy.

        Just off out to the supermarket – I hope those Brexit food riots you predicted aren’t ongoing.

      4. a-tracy
        February 10, 2021

        You are not understanding Andy, he pays an insurance policy for his boiler to British Gas. This insurance policy is now not providing the service.

        The Labour party privatised Dentists, they also started the ball rolling on privatising the Royal Mail – what is your point? It seems to show no matter which political party is in charge they march to the beat of someone else’s drum.

      5. graham1946
        February 10, 2021

        For once, I agree. I would not touch British Gas with a bargepole or the ‘insurance’ companies – I’ve had bad service from both. I use a ‘little’ man who advertises in our church magazine and he ALWAYS turns out same day whatever the weather and usually manages a fix same day even if he has to go for parts and prices are very reasonable and certainly not £400 per year. The big boys don’t want to take any risks either so they will most likely not cover a boiler over 8 years old. Stay local, use a tradesman not someone you don’t know and may never see again and whose training you have no idea about.

      6. Robert Mcdonald
        February 10, 2021

        Once a bureaucracy always a bureaucracy.

    2. Lifelogic
      February 10, 2021

      They also, in my experience of using such boilers cover, have a habit of saying they cannot fix the boiler as ‘it is too old’ and or the system needs ‘flushing’ and this is not covered. They then give you a new boiler quote that costs about double the going rate. If you find a competent and honest boiler chap they then fix it easily for less than the contract costs.

      Very similar to the NHS problem pay up front and you get very little of value in return when you need it.

    3. hefner
      February 10, 2021

      Since 1986 British Gas has been a private company. I can only concur with Andy: for more than fifteen years I have been relying on the services of an independent engineer with Gas Safe Registration (please check that the independent plumbers have this certification if you decide to go that way).

      This guy replaced and installed a new boiler in one day about ten years ago (£1,000). He comes back every spring for the 90 mn annual check-up of the boiler and gas cooker for what seems to have been a standard price of £75 now £85.

    4. a-tracy
      February 10, 2021

      Same here Iain, water spewing out can’t come out until 17th February, we had to use an emergency plumber. Thermostat they fitted leaking water couldn’t fix it a month ago when they came out because it has a case around the radiator, they fitted the thermostat in that case!

      They are blaming covid but that can’t be right the plumber that came out said he was quiet and he’d heard they were on strike.

    5. steve
      February 10, 2021

      Iain Gill

      “Their service is basically fraudulent because they take the payments but don’t deliver”

      …..So simply stop paying, Iain. A point of law is that you do not have to fund a service you are not receiving.

      I did this successful with water. Stopped paying and pointed out their breach of contract, that worked.

    6. M Davis
      February 10, 2021

      My Son, who is disabled, according to the DWP, was left with no Gas in November because he was just over £4 in arrears. Not his own fault but the Meter/Card fault. His Brother and I have had great difficulty in getting my Son back on with Gas, at least twice now, within the last six months. He has been having problems for quite some time. Goodness knows how he will cope after I have left this so-called mortal coil! They seem to be anxious to get him on to a Smart Meter which, he does not want, for various reasons. When it is obligatory in 2025? then he will have no option but until then the Gas/Electricity people should treat him with more respect.

    7. ChrisS
      February 10, 2021

      Anyone who has their boiler serviced by British Gas needs their head examined. To sign up for their insurance backed service agreement you first have to have your installation inspected. A perfectly functioning system will certainly be found wanting, not meeting British Gas’ “high standards.”
      You are then presented with a big bill which might include a boiler change which will rarely cost less than £3,000 and take a day and a half for a man and apprentice to install. The cost of the boiler and other bits will be no more than a third of the total. You can do the sums !

  6. Lifelogic
    February 10, 2021

    The fools in government and even it seems at JCVI (unless they were overruled in which case a sensible JCVI member should honourable have resigned) cannot even see they are killing hundreds more people than needed by not vaccinating men (who are at a much higher risk for a given age) earlier in priority. Risk suggests about five years younger for men than women. Also it would save thousands of NHS admissions.

    The NHS, NHS England, Hancock & Zahawi cannot even get basics like this this right. Hundreds of lived could have be saved (many still could be) by this change. But they do not want to admit their error so these people will have to die it seems.

    1. Everhopeful
      February 10, 2021

      10years for lying about a ridiculous “red card” thingy. ( 0 years for crossing channel illegally. @4* welcome).
      How many years for blood on government hands?

    2. Lifelogic
      February 10, 2021

      I have finally had a reply from Public Heath England to my several emails pointing out that many extra deaths and hospital admissions are being caused by the anti-male discrimination in JCVI vaccine priority order and its failure to adjust it to real gender risks.

      Needless to say they ignore the issue I raised (I assume they did not even bother to read it) and give some standard reply that fails totally to address the issue. It takes them about a month to do this. Their gross negligence and the many extra deaths (certainly more than Genville Tower) and all easily avoidable will thus continue.

    3. IanT
      February 10, 2021

      With the current rate of vaccination I’m not sure it makes that much real difference frankly – but you’ve made your point (about a dozen times now) – so perhaps time to give it a rest?

      1. Lifelogic
        February 10, 2021

        It seems rather a shame for hundreds of people to die just because the dopes at JCVI, Hancock and the vaccine Tzar got this basic decision wrong. For a given number of vaccines shots is could easily have made them about 10% more effective. Even now many lives could be saved by changing.

        But they would of course have to admit their error so I assume these people will just have to die! I tried my best for them.

    4. Helen Smith
      February 10, 2021

      You may be right but no government would dare to do this, cue outrage from the feminists.

  7. Lifelogic
    February 10, 2021

    The free at the point of use NHS also gives little incentive to look after yourself. So people drink and eat too much, take drugs and fail to exercise and call the free ambulance. If nothing else them charging them for this would at least give them less to spend on drink or drugs for the next weekend!

    Private medical care should be encouraged with tax breaks, encouraging company schemes, and NHS charging. People on waiting list should be given part of the cash costs to go privately. So as to lift the load on the NHS.

    Projections by the NHS Confederation show that the NHS waiting list is expected to rise from about 4.2 million currently to about 10 million by Christmas. This assumes (optimistically) that the health service will make a steady return to full capacity within the next 12 months.

  8. Everhopeful
    February 10, 2021

    Those who….um….care about our health🤕, held a big online conference on 24th November 2020 stating the following intention ….
    “It will examine what needs to be done to ‘lock-in’ the positive changes and innovations we have seen during the pandemic for the long-term benefit of patients, staff and local communities.”.
    Strange navel gazing in the face of a totally unpredictable pandemic? I mean, we are still in it aren’t we? Would have been more to the point to discuss how to deliver a health service AS WELL AS a COVID Service!
    Actually I wondered if we were being denied paid-for healthcare so a reorganisation could take place? Let the sick go hang!
    If Labour’s ghastly policies could all be reversed that would be great…but where to find a grain of sense in this government?
    Boris however is apparently looking forward to using a newer, shinier NHS as a commie style slimming club.

  9. DOM
    February 10, 2021

    Your government is sinister in intent and practice. Hancock’s new law on foreign travel is so repugnant and Putinesque that even I cannot believe your government could try and create an equivalence between CV19 transmission and murder. SAGE and the NHS and other dark forces are creating a most terrible environment designed to incite and dread

    Utterly vile and repellent in the extreme

  10. Newmania
    February 10, 2021

    As new variants sweeps away the idea of a return to “normal” its not a bad idea to start thinking of what normal really is . Is it normal to be blasting around the world in planes , eating as much as we feel like eating , assuming we can pack people into the world like farmed salmon ? Is it normal for the old to parasitize the young for ever longer stretches of time spending half their lives supine. Is it normal for those who create wealth, and work, to be treated like mendicants . Is it normal to expect to live past 100 at all and to have lost all sense of the value and briefness of life ?
    None of this was normal until recently. I find myself thinking we may be living through a period in which we rediscover certain verities such as the value of the young and vigorous .

  11. Old Albion
    February 10, 2021

    A good reform would be to end the practice of free treatment for health tourists and illegal immigrants.

    1. Lifelogic
      February 11, 2021

      No I do not forget this. We would get far more money into healthcare if the state monopoly NHS did not kill nearly all private competition. It should charge all who can afford to pay and give tax breaks for private care. Why should someone using private care have to pay four times over? Once for others NHS in taxes, then taxes on the money they earn for their medical cover, the the medical cover premium and than 12% IPT tax on top of this too.

  12. jerry
    February 10, 2021

    “though it would be wise for the crisis to be past before rushing to conclusions about what worked and what needs improving.”

    No, we are approaching 12 months since the (pre) Covid crisis first hit, more than enough time to realise what works and what does not when it comes to how the service is managed and run etc, what our host suggests is like waiting until victory before learning the lessons of war and the battlefield…

    As for care homes, perhaps the real issue is the lack of DHSC/NHS community care provision, support for both families who do the right thing and have their elderly relative live with them, and for those elderly who wish to live in their own homes, either alone or with their spouse. The failings go back 33+ years, the DHSS should never have been split up and reorganised.

  13. Jim
    February 10, 2021

    Leave well enough alone, if it ain’t broke don’t fix it.

    I am afraid the UK government is at a low ebb competence wise. You have made a mess of Brexit, poor quality legislation gave us Grenfell and heaven knows what else – Smart Motorways?. Please, just leave the machinery alone. All of you need to go on a long training course for professionalism and competence and thinking things through. Many of you need making redundant. No more fancy grand schemes please – you don’t have the skills. Until you do – leave things alone.

  14. ian@Barkham
    February 10, 2021

    The monolithic version of a Health System we have is flawed in many ways. In part the last set of reforms were just partial tinkering, I would guess due to the resistance of the establishment and their desire to build a protective domain for themselves. Doing only part of what was needed was never going to solve anything other than the entrenchment of the establishment to cause a crisis so they can sit back and say they told you so.

    The instant flaw is that we have a Secretary of State for Health, which is just a glorified handle as he has finished up with the pseudo responsibility but no authority to manage the system.

    The Government never caused Covid-19 but are responsible for it. The Government never caused the shortages in protective clothing, it was the ‘Trust’s’ own highly paid procurement officers that failed but somehow it is the Government getting the blame for something they had control over.

    The Governments biggest mistake in all this Pandemic is to infer that it is they alone without help and support of the people paid to do the work can solve everything- are they just looking for ‘Glory’?

    To illustrate how flawed the NHS is, the role out of the vaccine is a virtual volunteer operation. The higher echelons of the NHS are hiding away protecting themselves and their domains. Those close to the ground with a passion are the ones getting on with it and enabling the country to get some semblance of life back.

    The lesson is it is not a centralised system one size fits all that works, its the enabling those that can do to do what is needed that actually fulfills the needs of the frontline.

  15. Roy Grainger
    February 10, 2021

    I think the problem is that when the NHS plainly fails (PPE purchasing, mass testing failure in Spring, abandonment of cancer patients, inability to stop Covid transmission in hospitals, discharge of Covid patients into care homes) then the Government get blamed. So there is a clear incentive for the government to take back control of those decisions again.

    People who claim the NHS is the envy of the world are not only wrong but are perpetuating an absurd jingoistic Little Englander fantasy of British exceptionalism. The NHS is an average health service and there are many better (Germany for example).

    1. Qubus
      February 11, 2021


  16. SM
    February 10, 2021

    I experienced the debate about the (dire) Lansley NHS reforms from the inside, as a senior member of a local Patient Representative committee, and my view both then and now is that we absolutely do NOT need yet another load of fiddling with the NHS – we need a Royal Commission of Enquiry, with a very fixed end-date, to consider a total reformation of the system’s objectives, management, actual practices and financing.

    The NHS currently has 28 Hospital Trusts under special measures, in some cases lasting for several years. Ambulance services are creaking, and the GP system is cracking up and very inefficient in many areas. This was all evident long before the pandemic.

  17. Sakara Gold
    February 10, 2021

    To protect the NHS, the government now says it is taking a tough line on borders. But what it seems poised to deliver is characteristic of much of it’s pandemic response – an uneasy compromise between ministers prioritising health outcomes and those concerned about the effect on the economy, but which risks achieving the objectives of neither. Ultimately, government must decide whether it actually wants to keep variants of concern out of the UK – or just give the impression that it is trying to do so.

  18. Peter
    February 10, 2021

    “…. there is also discussion of rolling into the agenda possible changes to the financing and access to care homes. ”

    An increase in inheritance tax rates to 80% has also been mentioned to cover the cost of the virus. The claim is this rate was previously applied shortly after the World War Two.

    If this were to be introduced, elites with trusts and lawyers would not be paying it. Though it would chime with the first part of Klaus Schwab’s statement ‘You will own nothing and you will be happy.’

    1. anon
      February 10, 2021

      Perhaps reform trust law to ensure inheritance taxes are actually paid. By capping or limiting the assets put into a trust/s to say £1m. Or just abolish them particularly offshore ones.

      Reform the NHS! Good grief we are not yet free of the EU and its tentacles. The new association treaty which the EU has not yet approved needs to be revoked so we can move to WTO.

      Concentrate on our future non eu supply chains and business trade. We need the EU like a hole in the head.

  19. None of the Above
    February 10, 2021

    I am sure, just like any other organisation, that the NHS could improve it’s efficiency but I believe it is best left alone until the pandemic is reduced to manageable levels.
    Some of the more enthusiastic and ideological contributors to this post would benefit from a little historical research. Some have suggested that the NHS spends too much and allows too many to die. They should try to find out just how many people, especially children and pregnant women who died because they couldn’t afford a Doctor before the NHS started up.
    For those who can afford to pay not to wait, I say “I’m glad that you can afford that choice and good luck to you”.
    To those who would prefer medical insurance schemes, I ask “What is the difference between the insurance premium and a tax bill”?

  20. Brian Tomkinson
    February 10, 2021

    When are you Conservative MPs going to take action and remove Johnson and Hancock from office before they wreak even more harm on a beleaguered nation?

  21. J Bush
    February 10, 2021

    The NHS and GP service used to work quite well, until Blair decided to change it all. Apart from all the points by others of its politicisation, its top heavy management and multiple structures with job descriptions that have no place in hospitals and nothing to do with medical care. There are far too many people employed there who view their work as not so much a vocation, but a career and that is clearly reflected in the large hospitals who claim ‘centres of excellence’. There is little or no empathy or consideration of the PATIENTS needs, not customers.

    Previous to Blairs’ interference, the matron ensured cleanliness, there were no bugs infecting inpatients then. There was on-site training for nurses (no need for degrees etc) and GP’s were not self-employed, with many now with not viewing the patient care as top of the list.

    1. SM
      February 11, 2021

      I’m no fan of Mr Blair, but long before 1997 hospitals could be dirty and inefficient, microbial mass infections started mainly because of over-use of antibiotics throughout the medical services, Mr Major introduced the foolish nursing degree requirement and GPs have always been self-employed.

  22. majorfrustration
    February 10, 2021

    I doubt if our political class is up to it both in real intent and ability. No political upside. Perhaps the way forward is along the “BBC route” – the market place hosts the likes of Amazon Prime, Netflix and the like and the natural effect is that the BBC will have to change and be more accountable. OK change takes time but it will happen.

  23. William Long
    February 10, 2021

    This smacks to me of tinkering with the symptoms, rather than taking the trouble to dig deep and address the causes. This can only be done if there is real determination to deal with the socialist monolith that is the NHS. It should only be started when there is full understanding of the approach to the pandemic: what went right and what went wrong, and above all, why it went wrong, because a lot of this was clearly the result of the underlying structure and history of the NHS. The person who was in charge through the pandemic is conflicted and therefor cannot be the right person to lead the reform process, just as the person who was in charge for much of the preceding period is, in my view, an extraordinary choice for chairing the Health select committee.

    1. SM
      February 11, 2021


  24. J Bush
    February 10, 2021

    Apologies for the length of this, but I think this exemplifies one of the problems that nurses no longer have on-the-job training, but are expected to keep taking courses up to and including, academic degrees that are not necessarily nursing specific.

    About 5 years ago my brother had a serious traffic accident, his bike was hit by a tractor. The police at the scene believed he was a goner, but he was air lifted to Newcastle RVI. The surgeons did an excellent job, they saved his life and did some amazing surgery to save his arm and leg. Once they were satisfied with the results of the surgery, he was transferred to a local hospital in Cumbria. (he was in hospital for approx 5 months and bedridden most of that time)

    My brother, quite rightly, has nothing but praise for these surgeons, but on one of my visits he noted a difference in the day-to-day care between the hospitals and found the local hospital nurses were far more caring and considerate in allowing him to retain his dignity. I suggested that was perhaps because the local nurses were called to a vocation, whereas the nurses in the large training ‘centres of excellence’ were there to further their careers, and that basic caring and having to clean patients was beneath them. The local nurses treated him as a person, whereas the nurses on a career path viewed him as more of an inconvenience.

    And therein lies one of the problems of today’s NHS.

    1. Barbara Bebbington
      February 11, 2021


  25. Bryan Harris
    February 10, 2021

    Clearly the link between government and quangos/NHS management is more of a curly line than a straight one.
    Forward planning associated with the virus was severely lacking even though many knew it was coming. Then the NHS management were left in a fog with no direction from them on what should happen next.

    The major failing with the running of the NHS is probably that of accountability — Lack of beds and staff should see ministers and managers sacked, and we still do not have isolation hospitals.
    While the government must take it’s fair share of criticism, for the way the ‘managed’ the effects of the virus, it was their adherence to ‘medical advice’ to destroy the economy rather than overload the NHS which was their most serious error.
    Then we have medical drugs taken off the list of solutions because of a fake article – Once it had been shown to be fake news tests should have resumed with these other drugs.

    The majority of the population still have no confidence in the way that death numbers and test numbers were obtained or extrapolated — Tests were especially suspect.

    Let’s not wait for the virus to blow over – that could take many years, and far too many ruined lives. WHAT we need immediately is a thorough review of what has been going on, the way evidence was arrived at, as well as effectiveness of restrictions. Actions of government must be included as well as how effective/realistic/properly informed their advisors were.

    The only difficulty with this will be to find a team whose ethics are top rate, who are not part of the current effort, but who understand both the medical as well as the economic angles, and will not just give us a whitewashed report to tell us that everything possible was done in the right way.

    The NHS could be run much better, but clearly at arms length by government who only add to the difficulties.

  26. Ian Kaye
    February 10, 2021

    I wonder if the NHS would benefit from being reformed vertically ie creating silos.given the army are experts in logistics how about creating and agency within the NHS called supply, this would be distinct from a silo called care, for example. No doubt the supply silo could be divided into clinical and non-clinical, each subdivision implying individuals with expertise in their particular field. I am thinking mainly of how hospitals are organised

  27. David Peddy
    February 10, 2021

    I worked with the NHS for 45 years so I am aware of some of its shortcomings
    I am in favour of it working in conjunction, if not in partnership with the private sector . This is not just because of capacity issues but the NHS can learn from private sector practise
    I am in favour of paying for GP & OP appointments;penalties for no shows; for hotel costs of a hospital stay .It would make people more responsible before they involve the system.It works elsewhere and there is no reason why it should not do so here
    Stevens and Hunt had long enough at the helm to make a real difference : they did not and they have failed
    They could have taken as models the few well run trusts; identified the characteristics of their CEOs, Directors, managers and cloned that into a recruitment system for other Trusts
    They could have created a template for Trust Boards instead of allowing them to fill jobsworth roles with time serving ,public sector apparatchiks utilising the infamous ‘Revolving Door’
    They could have improved recruitment procedures for management
    They could have introduced professionalism ,training and experienced purchasers into Procurement
    They could have reformed the Terms & Conditions of Employment and the Contracts for non Clinical staff which are excessively generous ,open to and overtly abused
    The IT systems are poor for procurement and patient management

    1. SM
      February 11, 2021

      You are 100% correct, Mr Peddy.

  28. No Longer Anonymous
    February 10, 2021

    I know it’s very tricky ground but it needs to be covered. We face an ageing crisis. I witnessed my own father endure a long and gruelling death which lasted six months longer than was natural. This was caused by six months of highly expensive medications and treatments to keep him alive in a pitiful and agonising condition. He was so fearful of death that he took this path – there was no peaceful way out.

    I would not want this for myself. Alas the choice of painless assisted dying is not available in the UK. And so very many people at the end of their lives are put through mental and physical torture in their dying days and I’m sure many – if not most – who were in exactly this condition have been reported as CV-19 deaths over the last year.

    Assisted dying (monitored legally in some way) would alleviate the NHS of a huge amount of pressure which is known to be built up towards end of life. My own father lived largely independently of the NHS until the day he became bed bound.

    The carers (all British as it happens, Andy) were great, as were the St Barnabas nurses. The NHS was not always so good, obviously the District Nurse was very busy – the GP had misdiagnosed the cancer which was treatable. When he was ambulanced to hospital we could not seem to get through to the staff that it was bone cancer and not a normal broken arm and so the poor fella had to suffer being treated for a day as an accident patient rather than someone who was sick.

    Assisted dying. Surely the time for the debate is upon us.

    And also charging patients for treatment if they are found to be intoxicated at the time of injury.

  29. BJC
    February 10, 2021

    Management/administration in any organisation is only necessary to provide a slick support mechanism to ensure the highly skilled specialists at the coalface can hit the ground running, productive and delivering the very best outcomes. In the NHS and, indeed all public services, the administration works as a separate grinding, job-creating business, unconnected to the actual and ever-changing needs of their specialists or overall objectives of the organisation. Clinical staff must waste a huge amount of time and energy triple-checking untrusted procedures, or simply doing the work themselves; no wonder they’re exhausted. Amazon can distribute to the world, but the NHS can’t even distribute around a hospital.

    Meanwhile, NHS management in my own area are putting their energies into trans sensitivities. In what way does this support the productivity of clinical staff? Like I say, unconnected and job creating activities.

  30. Walt
    February 10, 2021

    No worries, Sir John. Today the press tells us that the NHS is already on the job, at least in Brighton and Sussex University Hospitals NHS Trust, where the words ‘breastmilk’ and ‘mothers’ are to be replaced by words currently considered to be more trans-friendly and gender-inclusive, e.g. ‘chestmilk’ and ‘birthing parents’.

    1. Sea_Warrior
      February 10, 2021

      ‘Chest is Best!’ to follow, in short-order. Many of us can remember being fearful of the lunacy that a Michael Foot government might bring in; now we know.

    2. Fedupsoutherner
      February 10, 2021

      Walt. Yes I saw this. What a load of utter crap. I wonder how long and how much financial resource that took up. My God, don’t they know how to waste money and test our patience?

    3. Hope
      February 10, 2021

      Govt Maternity Bill with Marxist language in it being presented to parliament to help AG not leaving Govt. when she goes on maternity leave! I wonder if the govt would make legislation for my personal circumstance?

  31. ian@Barkham
    February 10, 2021

    Off Topic

    We learn today from the MsM that the Government is in discussions about using £5 billion of UK ‘taxpayer’ money to bail out Private landlords over the cladding debacle.

    This cladding was deemed unfit for purpose long before these outfits chose it because it was ‘cheap’. Most Countries had an outright ban because of the dangers in its use. So the Landlords, the Specifiers and the Contractors knew what they were getting into long before they got started. It was a case we can get away with it. – Now it is the UK taxpayer handed the Bill!

    If the Landlords cant sort it without charge to their tenants, let them hand the ownership rights to the tenants on a ‘condominium’ type cooperative basis. My understanding is that most landlords don’t provide basic fire precautions to their properties unless the tenants pay. Getting the taxpayer to fund their profit is not sensible.

    The tenants don’t deserve that abuse and neither does the taxpayer. At this moment it stinks of let the taxpayer bail out my friends.

  32. turboterrier
    February 10, 2021

    The front line of the NHS is not A&E it has to be the GP surgery.
    If a payment by results and not patient numbers was introduced that would change the mindset of the GPs. They are part of a 24/7 operation but most surgeries run from 0830 to 1800 hours. One surgery I belonged to did three early openings to accommodate the workers.
    All surgeries should be operating on a shift pattern throughout the day, who knows their patients best? Some doctors with young families would welcome split shifts to have more time of early morning late afternoon school runs. Doctors onthe back or dead shifts can utilise their time dealing with the endless administration and box ticking.
    To combat self inflicted illness each surgery should have a nurse on triage duty as in A&E. Weight , blood pressure, temperature and BMI. Then the right questions are asked. Over a very short period the wasters can be identified and presented with all the facts and figures correlated over any given period that gives the doctor the opportunity to lay down some ground rules. Fact when working with a GP a number of surveys proved that 80% of their workload came from 20% of their patients. Those who have no wish to help themselves should be identified, redirected to specialist courses for their self inflicted lifestyle.
    When living in Spain the medical centre was a 24/7 operation with a paramedic technician and a doctor on duty throughout the night. Everything that could be done was done before sending patients to hospital. Those that were sent had all the time wasting checks all completed . The hospital then knew exactly what was needed on the patients arrival. The NHS has to adapt to a work smarter not harder ethos.

  33. glen cullen
    February 10, 2021

    NHS consultant doctors – self employed
    NHS nurse bank staff – self employed
    NHS dentists – self employed
    NHS GP doctors – self employed

    The why in which we employ and manage NHS staff needs reform, than the so call local community trusts, everything else is just tinkering

    1. Lop
      February 10, 2021

      NHS Consultants are not self-employed for contracted work.

      1. glen cullen
        February 10, 2021

        A consultant can be contracted for work in many different trusts at the same time – thats a structural problem

  34. Caterpillar
    February 10, 2021

    (Aside or not)

    Grant Shapps confirming himself on the list of dictators today – so few Conservative MPs believe in, let alone support, human rights, liberty and individual responsibility.

    Every life is a tragedy, what a core belief.

    1. No Longer Anonymous
      February 10, 2021

      I was willing to take the vaccine into my healthy and low risk body on one proviso. That it got me and my fellow countryfolk out of lockdown.

      Mr Shapps and many ‘experts’ are making it clear that there is little point in it.

      There really is no point in having a Prime Minister, is there !

  35. Elizabeth Spooner
    February 10, 2021

    The main reform that the NHS needs is to undo the last 30 years or so, of hospital and bed reductions that have left us with a situation where we have one of the lowest numbers if beds per head population in the civilised world. That is the main reason we have had to “protect” the NHS and the decanting of elderly, probably, infectious patients from hospitals into care homes – with catastrophic results. Many of the beds have been replaced by a greatly increased number of administrators’ desks.

    1. Fred.H
      February 11, 2021

      The NHS seems to have become a second Civil Service, occupied by sinecure driven medical politicians on corporation management salaries making uninformed decisions about ever-increasing funding of inadequate health provision. Can nobody in Government see through this stumbling archaic robot?

  36. Derek
    February 10, 2021

    The NHS reforms. Certainly a case to be investigated but given the success of the Vaccine Task Force, set up by professionals using professionals from the Private Sector and the Army, they swept aside antiquated public sector methodology and rapidly proceeded, doing it their way. They achieved marvels so much so that little UK jumped to number three in the World table of vaccinations per 100 people.
    I suggest the NHS reforms require their own specialist Task Force, filled with professionals, to review and improve, everything, if necessary and without any antiquated ideas from the ‘old crew’!

  37. Old person
    February 10, 2021

    The problems in the NHS are not from one single issue, but the result of ineffective governments more interested in their next term of office and stitching up the next political party (aircraft carriers, HS2?).

    Look at what has been lost: pension increased to 70; free university education; infrastructure investment replaced with PFI contracts; reasonable probate fees; cuts to council services … And the list goes on. More tax is paid than ever before with less returned to the citizen.

    The NHS is overloaded with administrators with no medical qualifications – more concerned with finance than patient care. Just look at the initial PPE shortages with the government having to avoid telling the truth that lower quality face masks would be less effective. NHS trusts stymied with ongoing PFI liabilities.

    Illnesses are more likely to be monitored now, treatments offered a lifetime course of medication.

    And the damage to the economy unbelievable. Little school education and normal healthcare.

    The reform to the NHS will come swiftly. There is no way they can stop a zoom consultation with a doctor anywhere in the world, and a person seeking treatment privately or abroad. People are well aware of all the issues with covid and the treatments in other countries. This pandemic has morphed into a religion with experimental vaccines replacing Holy Communion.

    If there is to be reform with the NHS unable to deliver timely treatment, why not give the money for the full cost of this NHS treatment as an incentive to the person seeking treatment outside of the NHS. Extra support can be given to help the lower paid/non-working directly to gain private healthcare.

  38. London Nick
    February 10, 2021

    Given the overall size of the NHS, central purchasing would give it enormous power. It should use that not only to cut prices, but also to force all suppliers to manufacture 100% in the UK.

    On the subject of devolution to Scotland, I have no problem with health being devolved, but I think that all thee restrictions imposed because of Covid are really policing issues. And when it comes to policing, and law, it is utter MADNESS to devolve this. How can one country – which is what the UK is (or should be!) – have different laws in different areas? No. Law and policing must NOT be devolved. These should be returned to exclusive Westminster control. This would also help to stop the SNP administration in Holyrood from going rogue!!!

  39. formula57
    February 10, 2021

    Fair enough but had Ministers not decided some while ago to scrap the reprehensibly deficient Public Health England?

    A lesson that might be learned is to opt for consistency so as to avoid minor differences in rules between regions, thereby facilitating understanding and compliance. (I do not overlook how important it was for people in North Britain to be taught the great importance and benefit of minor differences so that the SNP could prove the case for exit from the Union.)

  40. DavidJ
    February 10, 2021

    The NHS is beyond reform. We need a fresh start rather then endless tinkering which puts taxpayers’ money in the pockets of government cronies.

  41. Christine
    February 10, 2021

    Clear out all the unnecessary management jobs like those relating to diversity.

    Stop health tourism.

    Those people not showing up for their vaccine because they live abroad will provide data on how many people are using the NHS who don’t live here and don’t pay taxes here. Weed them out.

    Sort out the excessive sick leave taken by NHS staff.

    But of course, the Government will do none of this because they are too soft and scared of being labelled the nasty party. They would rather burden the law-abiding, tax-paying citizens living in this country.

  42. ian@Barkham
    February 10, 2021

    From the MsM quoting – Mrs von der Leyen said mistakes were also made leading up to the decision on export curbs.

    “I deeply regret that,” she said, adding that the Commission would do its utmost to protect peace in Northern Ireland. Avoiding a border between EU member Ireland and British-ruled Northern Ireland is seen as key to protecting the peace process there”

    British-ruled Northern Ireland ? NI is not ruled it is part of the UK

    1. Qubus
      February 10, 2021

      Just shows how ignorant she is.

  43. alastair harris
    February 10, 2021

    I have long wondered why government thinks it has a place in clinical decision making. Surely this is one for clinicians?
    The NHS is sorely in need of reform. It is sadly lacking in the ability to innovate, and it seems to put patient demands well down its list of priorities. But we know of a solution to this. One that is known to work. It is called free markets and competition. The NHS has long operated as a Marxist based centrally planned system, to all of our cost. And if anything good is to come out of the mess that is our current covid policy, surely that is a recognition that its decision making and execution needs to be significantly improved.
    The other big issue the NHS faces is one of scope. The boundary between what should properly be free at the point of delivery and what should be a charged for service is one it seems to struggle with on a regular basis

  44. Ignoramus
    February 10, 2021

    It has become increasingly obvious for several years that the Secretary of State for Health and Social Care has far too much on his plate but at the same time is unwilling/unable to delegate within his empire. The management and acquisition of vaccines is a major exception but owes little or nothing to him. Looking back the only really competent one was Alan Johnson (only Health).

    Social care needs its own Sec. of State and Health needs to be broken up under at least two Secs of State (eg Health and Hospitals). It would be marvellous to have a Sec. of State with a medical or scientific background who actually knew what he/she was talking about.

  45. ian@Barkham
    February 10, 2021

    more from the MsM –
    “Waiting more than a YEAR for NHS treatment will become the norm after Covid pandemic”, health service bosses warn!

    There’s the problem the so-called taxpayer funded and extremely well paid bosses are un-able or un-willing to manage and take responsibility. Between them and the NHS Unions they are a disgrace to the dedicated Staff who want to just get on with their jobs. Being in charge is about solving situations and not creating problems.

    More treatment should be supplied by the private sector, they no how to respond.

  46. John McDonald
    February 10, 2021

    Sorry but totally socialist on the NHS , GP’s, and anti- management bureaucracy.
    We have suffered far too long for the capitalist theory on Health Care.
    Just put the clock back to roughly were it was in the 1960’s except we now have the internet to support GP’s and Hospitals to enter-work, self manage and account for costs. Let the Doctors, nurses, and Health Care workers get on with medicine instead of being in the Office to fill in forms which just feed and support Management structures. Not too many managers in Health Care in the 1960’s
    PS do need to pay in a bit more Tax to support the NHS. There should be no need for Private insurance.
    Strange how socialist and recently ex-socialist countries have a higher standard of Health Care for all
    then the UK. If things get difficult off to Cuba or Eastern Europe for treatment. They also have more Doctors and Health Care Workers. The benefits system is probably not as good as here though 🙂

  47. Pieter C
    February 10, 2021

    According to the Beveridge Report published in 1941, 90% of people had insurance to see a GP, and 11 million workers were insured for hospital treatment (but not their families). The sensible solution would have been to build on this and introduce a compulsory insurance scheme, subsidised for those on low incomes. Instead we had the Labour party’s extreme socialist formation of the NHS. A report on health care systems across the European Economic Area in 2013 concluded that “10% of patients admitted to NHS hospitals in the UK are unintentionally harmed”. From the 1970’s the management of the NHS has moved increasingly away from the clinical and nursing “pillars” to more and more managers. It is fair to say that patient outcomes have not improved despite constant increases in funding. A fundamental review of health care is needed to devise a system suitable for the 21st century which the NHS in its present form is not.

  48. Secretaria
    February 10, 2021

    There is a minus gap between the capacity of the NHS in many disciplines and the demand in patient numbers. Orthopaedic surgeons and hip replacements are just one example. Even if you run operating theatres 24/7, there are not the surgeons, anaesthetist, nurses, radiographers, radiologists, lab technicians to staff such a regime. Effectively a lot of very expensive capital equipment is under utilised. A quick check of hospital capacity against patient demand will tell you where the problems are. I suspect that the NHS requires a lot more trained medical staff and I would suggest that this can take from 5 to15 years of training and experience before a impact can be made on the demand side. Yes you can recruit abroad but there are limits, and I do not like the idea of depleting countries whose needs are possibly greater than our own.

    On the admin side my suspicion is that the NHS is top heavy and way before you get to the hospitals and GP medical centres. Are there things from the way GPMC’s are running things during COVID that can be passed on to normal practise.

    Then there is purchasing and waste, areas which could learn much from our car industry and the Japanese system of Kaizen.

    Finally the potential patient should take greater responsibility for what he puts down his / her throat and the physical exercise partaken.

    Government are responsible for the suspected admin overload, but I would listen to the medical staff before imposing any top down changes. Better still, ask them what improvements they want and could make.

  49. glen cullen
    February 10, 2021

    I’m thinking about starting a campaign to rename Prime Ministers Questions (PMQs) time to Member of Parliament Two Minute Statement (MPTMS) to the Prime Minister

    Why does the Speaker and in fact any sensible MP allow this media grabbing debacle of PMQs to continue in its present format

    1. Fred.H
      February 11, 2021

      Prime Minister’s promotional time.

  50. Nig l
    February 10, 2021

    Reform of the NHS, an oxymoron. Worryingly the leaks suggest even less private sector involvement. It is clear you do not have the courage to do what is needed allowing you to be led by the nose by the Labour Party who are controlling the political agenda as they are in the schools and the remainder of the public sector.

    There is an appetite, indeed real demand for reform by many in the private sector who are treated as second class but like Harry Dunns parents, the people of Northern Ireland, shell fisher men, cancer patients etc this is par for this government.

    We now see that lying about travelling from Portugal is considered a worse offence than many sex, violence, drug offences etc.

    If ever we needed evidence of a government that has lost touch with reality, this is it.

  51. forthurst
    February 10, 2021

    How do you re-arrange the Arts graduates running the NHS to create an optimal structure? Answer: you dish out P45s to the Arts graduates running the NHS.

    What is wrong with a health system in which a high proportion of the doctors and nurses are foreign and frequently temporary and frequently provided by for-profit body-shops on a single shift basis hired by administrators who are themselves permanent staff members without medical qualifications and unable to assess the suitability of any candidate for hire?

    Why are English people being turned away from medical school whilst the university system is flooded with people studying PPE, geography and Arts degrees, generally? The answer: because there was a policy objective by a previous administration to achieve this outcome and also because the Arts graduates who run the government and whose skills are based on regurgitation of ‘received wisdom’ frequently have poor problem solving skills because people with good problem solving skills migrate towards numeracy and science.

  52. Helen Smith
    February 10, 2021

    The NHS needs major reform, witness BSUH latest waste of money regarding how pregnant women should be addressed as people and changing breast feeding to chest feeding so as not to alienate the vanishingly small number of women who feel they are men yet somehow still want to have babies, whilst insulting all other women.

    Or the NHS wasting vast sums of money on non jobs.

    Regarding social care the Tories could do worse than revisit Nick Timothy’s reforms in the 2017 manifesto. The idea of a floor for an individual’s contribution to costs of £100,000 as well as a ceiling, was not that bad.

  53. steve
    February 10, 2021

    “….approach which states that if an elderly person needs care home accommodation and hotel service they should pay for it out of capital until they hit a minimum”

    So when they end up without so much as a pot to piss in is when the state provides for them, after a lifetime of paying taxes.

    I intend to sell my property to my Son for a couple of hundred quid, well before I die. Screw the state.

    1. anon
      February 10, 2021

      The state should only require the interest off any savings or assets, except where the assets are over say £1m.
      How about taking a proportion of the capital each year say 5% with a deminimus.

      Taking relatively small capital sums in entirety , when the capital is life earned savings is sending a very bad signal. Fine if your a champagne socialist taxing the middle class poor on behalf of the rich.

    2. Qubus
      February 10, 2021

      I appreciate your sentiments but don’t think that is allowed. Sorry.

  54. Ian
    February 10, 2021

    That is right
    Call it like it is
    The NHS
    Is almost as bad as this Government

  55. kzb
    February 10, 2021

    Lifelogic and others tend to forget we spend a much lower proportion of GDP on healthcare than virtually all other advanced economies. The US spends almost double per capita, and their life expectancy is one of the lowest, so surely that is not the direction to go. That said, the NHS does need some sorting out. You could start by outlawing the practice of making GP and dental patients phone up at 8.00a.m. on the day they need treatment. This is treating patients with utter contempt. To obtain NHS payment these GPs and dentists must be made to go back to the prior appointment system.

    1. Qubus
      February 10, 2021

      To repeat a previous contribution: why not pay GPS according to the number of consultations that they provide per annum, rather than a blanket payment just because they have a patient on their books?

    2. Lifelogic
      February 11, 2021

      No I do not forget this. We would get far more money into healthcare if the state monopoly NHS did not kill nearly all private competition. It should charge all who can afford to pay and give tax breaks for private care. Why should someone using private care have to pay four times over? Once for others NHS in taxes, then taxes on the money they earn for their medical cover, the the medical cover premium and than 12% IPT tax on top of this too.

    3. Fred.H
      February 11, 2021

      perhaps deny Doctors/Consultants the gravy train of working in both occupations.? Comfortable employment as DR, and superb environment and fees from ever-so-grateful mugs paying through the nose when NHS falls short.

  56. Denis Cooper
    February 10, 2021

    Off-topic, I think that if I hear Boris Johnson say “our EU friends and partners” one more time I may vomit.

    1. Fedupsoutherner
      February 10, 2021

      Dennis you are not the only one. The sick bucket won’t be big enough.

  57. acorn
    February 10, 2021

    It depends if you consider a national health service to be part of the infrastructure that elected governments were created to supply for the common good of that electorate, at regulated universal prices. Or, a private sector, free market supplied and priced, good/service. In a truly free market health service, how much would you be prepared to bid for a deliberately cartel limited, profit maximising, supply of a Covid 19 vaccine?

    The UK currently has a government supplied health service that covers 27 million households for circa £5200 a year each, with no patient “co-payment” or “deductible” requirement (as per UK car insurance) as per a US type, private sector insurance system.

    Recent family experience of the supply and fitting of a heart pacemaker, will have been costed at circa £5,500 internally by the NHS I am advised. It cost the patient nothing, except the one day car park charge at the hospital. I am advised that a similar procedure in a US private hospital, would have cost circa £15,000 with a patient contribution required by the HMO insurance company, unless it was a definite life saving procedure.

  58. jon livesey
    February 10, 2021

    “Reponses to the virus have greatly strengthened central decision making and resource allocation.”

    At the moment, the NHS looks like a service for handling pandemics, but it isn’t. In fact, there are plenty of countries worldwide that are handling covid patients in tents and vaccinating patients on street corners. In general in the UK, we are in the habit of using hugely expensive NHS facilities to distribute pretty mundane services, just because the services look vaguely health-related. In reality, a lot of day to day NHS services could be distributed much cheaper through retail stores.

  59. oldwulf
    February 10, 2021

    Ever since I can remember, the NHS has been a bottomless pit into which successive governments have thrown money, in order to win votes.

    Much has been written about waste, bureaucracy and the resulting shortage of frontline staff and capacity. It may be that there has been insufficient responsibility and accountability at local levels and/or ineffectual monitoring and feedback from on high.

    A top to bottom review may be long overdue.

  60. Yossarion
    February 10, 2021

    “and there has been some effort to get agreement between the four parts of the UK” This from the Man who used to say He protected England, The UK is a Union and England is a Country, just one more Union for the English to get out of, the one run by the Scots for the Scots.

  61. Jackie
    February 10, 2021

    Listening to Sir Charles Walker on Ch4 News tonight i have to say I agree with him absolutely- people live people die and covid should not be the exception

  62. Mike Durrans
    February 10, 2021

    An other subject.

    Matt Hancock has been in that stressful job for too long and is now displaying symptoms of mental disturbance. He should be relieved of his post and moved to a quiet job for his own good

  63. Mike Wilson
    February 10, 2021

    My wife, looking at things on the internet, keeps saying things like; ‘Tory minister gave PPE contract to his mate’ – ‘Head of some recent committee gave contract to her mate’. I tend to go a bit deaf – bored with all your Tory corruption, Mr. Redwood.

    I developed a hernia in October/November. Went to the quack and was given a NHS referral to book an appointment. NHS Referral offered main, local NHS hospital – wait 33 weeks – or a private hospital the NHS buys services from – wait 19 weeks. Of course, I chose the private hospital. Consultation on 21st December. Consultant suggested hernia repair operation. When could it be done, I asked. I can’t give you a date. I am operating on someone in January who has been waiting since last March. ‘Stuff that’, I thought. A hernia, if it strangulates, can be a life-threatening emergency. The next day I asked when he could do it if I went private. 20th January, was the reply. Cost – £2800.

    So, thank you our sainted NHS. When, after a lifetime of paying in, I needed you – you weren’t there.

    Time to get rid and go over to an insurance based model. I am not alone. Millions are now waiting for operations.

    When the NHS outsources work to a private hospital, it pays the private hospital for the operation. Why was it that if the NHS were paying the consultant could not give me a date? When I pay, voila! – an imminent date appears.

    Can I sue someone in the NHS to get the money back that I paid for an operation that should have been paid for by the NHS?

  64. Fred.H
    February 10, 2021

    Reform NHS? Complete root and branch restructure is required- and therefore ain’t gonna happen.
    Far far too many vested interests, incomes, reputations.

    The structures that allow dozens, probably hundreds of vague, niche and archaic organisations – many with identical reporting and specialist staff, need to be grouped then merged into similar or even regional combinations thus removing layers and fiefdoms.

    1. glen cullen
      February 10, 2021

      Concur Fred

  65. Gordon Merrett
    February 10, 2021

    It is not my usual line but I did feel sorry for Matt Hancock when I learnt that PHE is semi autonyms and although he gets all the blame for their stupid attitude to any help being offered by the private sector and the restrictions original placed on volunteer help offered for vaccinating, he has very little control over them. This is a ridiculous situation for a “Manager” to be in.

    1. SM
      February 11, 2021

      Yesterday I received the following message from a cousin who is a senior Physiotherapist at a District General hospital in Bedfordshire:

      “I assumed I would be returning to work following my 21 day post-vaccination quarantine. Then I was told “no, stay at home and we will fast track your 2nd vacc shot. Then PHE made a strange and ridiculous decision that front-line NHS staff still need to wait the full 12 weeks. The NHS Trusts were threatened with a revocation of their vaccination licences and hefty fines if they went against the guidelines. So instead of returning to work, I am one of 123 staff at my hospital – on full pay – sitting at home.”

  66. ChrisS
    February 10, 2021

    It is ludicrous for the NHS to be run by four different quangos. How much does that add to the overall cost ?

    Sturgeon spends £2,000 more per head of population than England yet delivers significantly poorer performance. Ditto Scottish education. Yet the SNP are riding high in the polls. This has to be the fault of Labour, the Lib Dems, and the Conservative party for being totally unable to pin these abject failures on Sturgeon and the SNP.
    Judging by the unseemly infighting within the SNP at Holyrood and the woefully dire performance of the their parliamentary party we witness every week at PMQs, are there no decent Scottish politicians left ?

  67. Mactheknife
    February 10, 2021

    With regards to the last paragraph John. Is it fair that people who have worked all their lives, bought a house, saved for a rainy day are required to use their capital for care purposes, whilst those that have not get everything provided free ?

  68. A.Sedgwick
    February 11, 2021

    talkRADIO 1545 10/2/21 ex non exec chairman health authority of 6 years gives best summation of NHS bureaucracy and shortcomings I have heard.

  69. Qubus
    February 11, 2021

    Could anyone tell me what Simon Stevens studied at Oxford?

    1. Original Chris
      February 11, 2021

      The dreaded PPE, at Balliol.

Comments are closed.