Managing the NHS

Many MPs raised issues with Ministers about how they will ensure that the extra money voted by Parliament in principle this week to bring down waiting lists will  be spent to achieve this end.  I myself asked the Minister proposing the NIC rise followed by a  new levy what reduction in waiting lists could be secured for the sum in question. Like the Health Ministers themselves he would give no commitment to specific reductions.

The quest for this extra money seems to have come from the new Secretary of State for Health following briefings from the senior management of his department and the NHS. They conjured forecasts of large increases in waiting lists from current levels unless a major  new funding package was put in place. I understand the difficulty of making these forecasts, but surely barring a major outbreak of a new virus variant that defeats the vaccinations the  waiting lists should be falling as the NHS returns to a more normal working pattern, with the number of serious covid cases well down on the peak before mass vaccination.

Government forecasters seem to specialise in gloom, and have put out some very pessimistic estimates of the spread of the virus which did not come true. This issue of waiting lists should be easier to predict as much of it is in their control.

It is also important to understand why managers and officials think there could be a further surge in waiting list cases if we rely on the £230bn agreed health spend, and then to probe how an extra 4% would make all the difference. If there was more visibility of exactly what the new money would be spent on there could also be a better debate about budget priorities within the existing large agreed totals. We could for example examine the big budget for test and trace and see how that could be reduced as we move to a world where  most people are vaccinated and where compliance with it is now low. We could examine the profusion of managers and policy people, of structures and offices that hang heavily above the work of the surgeries and hospitals.

This new team of Health Ministers needs to go through a thorough review of costs and priorities to ensure more money goes to the good medical teams doing the work, and more is spent on acquiring in house additional capacity. The current dependence on locums and temporary medical staff is very expensive.

The NHS also needs to clarify what future use of the private sector it intends to make. Mr Blair started the idea that the NHS would buy capacity in areas like cataract removal from specialist units in the private sector that could achieve good results at affordable prices, leaving NHS main hospitals for more complex tasks. During lockdown the NHS paid to block book a lot of the private capacity to keep some non COVID activities going. How did that work out? Are reports of underuse true?

114 Comments

  1. DOM
    September 13, 2021

    What we are seeing is Labour’s Socialist public sector (BBC, NHS, Education etc) holding a weak Tory government to ransom who now fear any issue and any confrontation with the public sector that could damage their carefully constructed PR veneer that they are not the ‘nasty party’.

    This is now not about the NHS. This is about the political fortunes of the Tory party and a political organisation that is the NHS who now they can now scam anything they want from weak Tory Ministers who know in their hearts their being scammed and held to ransom

    Tory party weakness, their now lack of values and principles could drag this nation into bankruptcy if they refuse to confront the Socialist left that now rule the roost.

    Your party is destroying all that we are for one simply reason. Tory party leaders refuse to confront the enemy and therefore have decided to join them in a silent war against the moral majority.

    That free-lunch ‘get out of jail card’ can only be played a limited number of times. It is now time for your party to stop capitulating to the Marxists and return to the true values of an apolitical, moral world in which WE are the master not the STATE

    Reply
    1. Lifelogic
      September 13, 2021

      Exactly and it will damage the economy hugely, will not work and will not even raise more tax as it will diminish the wealth creating sector. The Conservative party are ruling in the interests of the largely parasitic 20% state sector and ignoring (and extorting from) the 80% of workers in the private sector to pay for this. Worse still many in the private sector are misdirected into essentially parasitic jobs in compliance with daft gov. regulations, tax compliance and tax planning, HR compliance, diversity, unconscious bias training …

      If you follow the logic of this governments idiotic tax to death & net zero CO2 policies then the delightful Emma Raducanu (and other sports stars) would clearly have to be banned from flying round the world to just to play games and she will almost certainly leave the UK to become a tax exile limiting her to about 90 UK days – possibly even less in the first years. Best get her Queen Honour to her in the new year honours list before she becomes a tax exile from April 6th.

      Might be nice if people like Emma could stay in the UK or flood back here. A personal tax cap in the UK of say £250k PA would make this possible or restoration of the old Non Dom rules (idiotically destroyed by the Tories and Osborne) would also allow this for her.

      Why should anyone have to pay more than that for dire pathetic public services they receive or often do not receive?

      Reply
      1. Everhopeful
        September 13, 2021

        +1
        The lovely sanity of your words.
        Soothing!

        Reply
      2. Mitchel
        September 13, 2021

        End of year school report for the UK:

        “Good at sports.”

        Reply
        1. Narrow Shoulders
          September 13, 2021

          (:

          Reply
    2. Sir Joe Soap
      September 13, 2021

      So true.
      My only hope with this is that the further this government goes down the road to capitulation to the “big-mouth” NHS/left wing people, the nearer we are to a counter reaction by us, the silent-so-far majority.

      Reply
    3. Everhopeful
      September 13, 2021

      +1
      Yep…and now (as predicted) the Left has prodded and egged on the Tories into a situation where they are losing core support and have nowhere to go to regain it.
      If you pretend to be pleasing everyone you end up pleasing no one!

      Reply
    4. Donna
      September 13, 2021

      Correct analysis Dom.

      We desperately need a genuinely conservative Prime Minister – with a backbone – to take on the Public Sector Unions.

      Unfortunately, our only hope for a spine being forcibly inserted into the current CON-TRICK Prime Minister was Cummings and he was forced out by ‘er indoors.

      Reply
    5. MiC
      September 13, 2021

      This country is falling behind most large European Union countries now, with only about 66% of the people having had two shots of covid19 vaccine.

      This is mainly due to their vaccination of 12-15 year olds and a lower incidence of obscurantist superstition.

      However, it appears that the Tories depend, at least to a degree, on the latter in order to get some of their votes.

      Reply
      1. Peter2
        September 13, 2021

        Would you make it compulsory MiC?
        Because it is becoming obvious that there are a few million people in the UK who are unwilling to be vaccinated.

        Reply
        1. MiC
          September 14, 2021

          No.

          Reply
        2. hefner
          September 14, 2021

          Obviously not, people should all be free to compete for Darwin Awards, shouldn’t they?
          And given the pressure of population on this planet, it should even be encouraged.

          Reply
    6. MiC
      September 13, 2021

      The people have never been the master in the UK.

      It was always the monarch, and then the Crown, through its Parliament.

      So there is nothing to which to return in that regard.

      Reply
      1. Peter2
        September 13, 2021

        What a strange post MiC
        Three paragraphs yet only one topic.

        Reply
        1. MiC
          September 14, 2021

          You missed a full stop at the end of your first sentence, Pete.

          Reply
          1. Peter2
            September 14, 2021

            You could have put a comma after “stop”
            Your original post still is very strange.

    7. Jim Whitehead
      September 13, 2021

      DOM, +1

      Reply
    8. Dunedin
      September 13, 2021

      As I understand it, the NHS will be getting a large chunk of the extra money for the first 2-3 years, then more will be spent on social care.

      In that case, will Boris be removing cash from the NHS just ahead of the next election?

      If the PM does not make it clear now, he is setting himself up for a pre-election showdown with Labour, NHS, and unions over “nasty tory” cuts.

      Reply
  2. Oldtimer
    September 13, 2021

    It seems to me that there needs to be a close examination, test and evaluation of which business model (or models) is (or are) appropriate for this monster organisation. One size unit may not fit all needs. Health technology and business process technology are evolving rapidly. How does the NHS identify or recognise and respond to these changes, some of them revolutionary, without the market pressures faced by private sector businesses? Even in the private sector companies fail to respond to such imperatives; the failure of Kodak to respond to the digital revolution is but one example of customers deserting it for a better mouse trap. What pressure or mechanism is there in the NHS to become more efficient as opposed to simply asking for more money to do its job?

    Reply
    1. IanT
      September 13, 2021

      It’s nearly 20 years since I had commercial dealings with the NHS but I very much doubt anything has changed. Central NHS Managers who set policy (more like loose high level guidance), Trust Managers who ignored or avoided those policies and NHS Purchasing managers who had no idea what other commercial organisations (or even individual NHS Trusts) were paying and who seemed to think that every detail of every deal should be renegotiated or customised (even those already agreed by NHS centrally).

      Attending meetings with committees of 12-20 people, most of whom you had no idea what they did (or even why they were there), waiting weeks for any kind of feedback and more months (if you were lucky) for any kind of decision back. Trying to call to chase progress was an exercise in futility, they were always waiting on someone else.

      Dealing with (at that time) some 150 “NHS” organisations (mostly Trusts) was a time wasting nightmare – and one that frankly I avoided whenever I could. Unfortunately, the NHS had a UK wide agreement with my company and it wasn’t always possible. Other large Enterprise customers were much easier to deal with and had professional purchasing and project management teams. Of course some Trusts were much better than others (by a very, very long way) but there was no sense of commonality. They might as well have been completely unrelated businesses, which in fact they effectively were.

      Good luck with sorting them out, the management live in their own private world, no doubt generating vast amounts of data and finding reasons to expand their empires. No shareholders, no P&L (well no Profit – just Loss), no Customers – only Patients, No fear of ever getting fired.

      Why will they ever willingly give that up?

      Reply
    2. SM
      September 13, 2021

      +1

      Reply
    3. Jim Whitehead
      September 13, 2021

      Oldtimer, +1 , excellent comment.

      Reply
  3. turboterrier
    September 13, 2021

    Since its formation the NHS has undergone many changes but from its inception I do not think it was every formatted to be able to manage the rapid expansion of population and the increase in life expectancy due to medical science. Dispite the billions poured into it the whole enterprise has never really been in front of the game always playing catch up. Not only all the staff within the NHS itself but in all the support departments that have grown beyond recognition to try and control such a monolithic organisation.
    The NHS has to take a leaf out of some of our most successful companies in that department have to be run along the lines of self direction business type centres where everybody in the team focuses on their catchment area in the controlling of the purchasing of supplies and day to day running materials. Not answerable to ivory towers full of managers and their back up staff, only to the consultant or senior medical officer of their unit. Staff are not interested in the politics only their patients and they are the best if not only people who really know where the money will be best spent. Self controlled departments would form much closer ties with there external suppliers the GP practices and other critical areas central to their area of expertise.
    If nothing changes government’s will throw more money into the NHS black hole and nothing will be achieved.
    Trust the frontline staff they are the real and onl experts on how to best spend the funding to the betterment of their patients.

    Reply
    1. Sharon
      September 13, 2021

      Turbo terrier

      Good post!

      Reply
    2. Nota#
      September 13, 2021

      @turboterrier – The real problem is the politicizing the NHS to be an ‘I am better than you’ metaphor of politicians, it was never about the customer, the countries health or delivery of service. The Patient is punished, those actually involved in delivery of the service are the managements and governments political point scoring footballs

      Reply
  4. Ian Wragg
    September 13, 2021

    Until they utilise the private hospitals they sequestered at £400,000 per month, they don’t deserve any extra funds.
    It’s a black hole.

    Reply
    1. SM
      September 13, 2021

      A friend has needed regular surgical attention for a severe renal condition during the past 5 years. EVERY time she has needed this operation, there are administrative delays resulting in infection, pain and deterioration . Earlier this year, she was actually sent to a private hospital and dealt with rapidly and efficiently. When her next surgery was due, she was told that her NHS hospital was no longer using the private contract.

      Her next operation was therefore delayed, and delayed, and …. until she twice had to be admitted as an emergency patient. Finally, instead of being in and out in 36 hrs, she took up nearly 4 weeks of NHS in-hospital (indifferent quality) care, both for the necessary surgery and treatment for sepsis (which can be fatal) and e-Coli. I will not detail her immense physical pain and distress.

      And now the whole cycle of broken promises for appointments has begun again ….

      Reply
      1. SM
        September 13, 2021

        Forgive me, may I add that the condition detailed above requires attention from both a renal and a urology department, and from two hospitals within the same NHS Trust. There appears to be NO concept of co-operation between departments or hospitals – anyone like me, with ample experience of the NHS, will sadly find that this is considered normal and acceptable.

        Reply
    2. J Bush
      September 13, 2021

      +1

      Reply
    3. miami.mode
      September 13, 2021

      IW, numerous reports state it was £400 million per month although this was during mid 2020 and the cost now may be a lot lower or indeed the deal may have finished.

      Reply
    4. glen cullen
      September 13, 2021

      The NHS senior consultants have been unable to do their second job at private hospitals due to convid-19 restrictions…..normal service will resume shortly (and the private wards in NHS hospitals have been closed)

      Reply
  5. Nig l
    September 13, 2021

    Insist the NHS business case is made public. It would set out reasons, promised outcomes/targets etc.

    Then you wouldn’t have to ask these questions and could challenge the thinking. Let’s us see the Ministers assessment/challenges to their assumptions and KPIs.

    We know their performance in many areas has been reduced. Presumably that meant cost savings. Where are those and how much and with them, why is new money needed.

    Or as I suspect with Ministers etc not having the analytical/financial skills etc it was a ‘back of a fag packet’ process.

    Zero confidence from me.

    Reply
    1. Ian Wragg
      September 13, 2021

      Private hospitals have remained open with very few referrals from the NHS. Despite being g paid for.

      Reply
  6. Sea_Warrior
    September 13, 2021

    I see that the NHS is kicking-off a large-scale trial to detect early stage (1 or 2) cancers by means of a blood test. So, what are the resource implications? Would such a capability enable long-term savings in cancer-treatment costs? And if so, would the savings be taken – thereby slowing, halting or reversing the inexorable rise in overall NHS spending – or would the money be left in that big NHS cauldron? Perhaps a question – about benefits realisation rather than trials results – could be asked of Javid at a future Department Questions.

    Reply
    1. SM
      September 13, 2021

      Some years ago, I participated for 5 years in a huge international trial whose goal was to identify early detection markers for ovarian cancer. The NHS certainly participated in the trial by providing premises, technicians and patients’ information so volunteers could be recruited, but it did NOT initiate the research. I would be surprised to learn that it is different now.

      It was recently declared, as a result of that trial, that it is not possible to predict ovarian cancer, unfortunately.

      Reply
    2. Sir Joe Soap
      September 13, 2021

      Don’t worry, they will run out of vials if this ever gets off the ground.

      Reply
    3. bigneil - newer comp
      September 13, 2021

      SW – The ” cancer tests” – I find it odd that they want old people – who were also the first to be “vaccinated” with a fluid the manufacturers appear to have no “responsibility” for- and as people who have been jabbed – can STILL get and die from Covid -( what the jab was supposed to stop )- I find the whole thing VERY strange.

      Reply
  7. Everhopeful
    September 13, 2021

    Not that I aspire to govern, nor have the hubris to believe that I could….
    But surely since they believed the plague to be one of great devastation…
    A vast budget should have been predicted and put in place two years ago?

    Reply
    1. Everhopeful
      September 13, 2021

      Actually…the NHS should be awash with dosh since the worst predictions certainly did not come true….oh but then…..PPE and nasty swabs must have cost a bit….and of course they came uber expensive. ( mates rates) and then the jab but never the less those expenses should have been factored in the computer model. And since only the plague was recognised as a disease that should have saved some money. Tik Tok …what was all that about??
      And what was that Boy Scout motto?
      “Be Prepared”…..expect in the case of a “Health Service”!

      Reply
      1. glen cullen
        September 13, 2021

        I can’t understand why the NHS needs any extra funds at all with all the savings they’ve made over the last 2 years, empty wards, GPs curtailed, dentists closed, hospital out-patient closed and limited A&E

        Reply
      2. bigneil - newer comp
        September 13, 2021

        EverH – Awash with dosh? – it could be – but while the BBC asks for people with VGC 2nd hand sports eqpt donate them to schoole etc – our govt waves in the world, gives totally unknown people claiming to be???? free lives – TOTALLY FREE – just for getting here illegally – while at the same time welcoming a seemingly EVER increasing number of Afghans ( who ALL apparently worked for us back there ) – and NOW going to build them brand new houses !!! – -NEW eqpt for foreigners – – 2nd hand stuff for us !! – –

        Reply
        1. Everhopeful
          September 13, 2021

          +1

          Reply
  8. Mike Wilson
    September 13, 2021

    My understanding is that before COVID waiting lists had grown. Let’s say that, for the sake of argument, COVID is now over. Why would you expect waiting lists to shorten when, before the virus, they were lengthening? That makes no sense.

    Reply
    1. bigneil - newer comp
      September 13, 2021

      MikeW – – Covid – 150’000 deaths . population – 75million ( AND GROWING WITH EVERY DINGHY !!! )- ONE FIFTH OF ONE PER CENT OF THE POPULATION and we know the 150k has been pushed to include anyone they can.

      Reply
  9. PeteB
    September 13, 2021

    I admire people for commenting but wonder why we waste the time?

    Sir John, you have (I believe) confirmed UK health spending per capita is broadly aligned with levels for other developed countries. The UK outcomes delivered fall well short of other countries. Only when this fact is acknowledged and accepted by the politicians and, more critically, the civil servants + NHS managers will there be change.

    Blindingly obvious the NHS is in a mess and more money will not solve it. No political will to give this message as the socialist BBC continues to convince the masses otherwise. Any PM who resists the NHS will risk losing the next election. And so we see that all those with power fight to keep power.

    Reply
    1. commentator
      September 13, 2021

      A reason for commentating is to put out different views and hope people will wake up.
      It costs nothing.

      Reply
    2. Nota#
      September 13, 2021

      @PeteB – got it in one, no accountability, no responsibility and no care. Just empire building by wanabee rulers. – disrespect the customer and under this Government you win every time

      Reply
    3. member of the public
      September 14, 2021

      Why post ? It’s interesting to observe.
      From those chortling into their fists at their imagined powers of manipulation
      to earnest and honest ordinary people.
      It’s all laid out to see.

      Reply
  10. Enigma
    September 13, 2021

    The NHS was set up as a National HEALTH Service but is now a National SICKNESS Service. People have handed over responsibility for their health to the doctor. The government and NHS encourage a poor diet with their Eatwell (Eatbadly) Plate, which has led to a tsunami of obesity and chronic illness which has swamped the NHS. We need to go back to basics and thankfully Dr Aseem Malhotra has grasped the nettle. He is being heard at last on GB News, but the BBC still silence him. phcuk.org

    Reply
    1. Sir Joe Soap
      September 13, 2021

      National Death Service in so many cases.

      Reply
    2. MiC
      September 13, 2021

      Yes, your main point is quite valid.

      However, many people have handed over their responsibilities for everything that that they possibly can to others.

      For instance, Leave voters often handed over that to keep themselves reasonably informed to the likes of the Daily Mail, the Daily Express, the Sun, and so on, and the result is the calamity that we see unfolding every day.

      Reply
      1. Peter2
        September 13, 2021

        Isn’t that exactly what socialism is MiC?
        Handing over your responsibilities to the State.

        PS
        We have a choice as to what media we decide to watch and read.
        Strangely only media sources you don’t like are mentioned.
        No bias in your Guardian Observer Mirror BBC etc

        Reply
        1. MiC
          September 14, 2021

          Absolutely the reverse.

          It is the duty of the State to protect people from the power of the totalitarian entities which would otherwise enslave them, that is, from private employers, by passing civilised laws to do that.

          Only then do people reasonably have the freedom to make the decisions about what to do with that freedom.

          Reply
          1. Peter2
            September 14, 2021

            You have a choice of hundreds of thousands of employers in a capitalist society.
            Once state socialism is in charge your choice of employer is just one.
            Some freedom.

    3. Fedupsoutherner
      September 13, 2021

      Enigma. I fear you are correct. My husband attended a diabetic advisory meeting and much of the diet they were promoting consisted of foods with high carbs. Carbs are the enemy of a diabetic. They seemed to be more interested in low fat and 10000 steps a day. Nobody mentioned the fact that a low carb diet was the most important thing along with healthy fats.

      Reply
      1. No Longer Anonymous
        September 13, 2021

        Indeed

        Low carbs, extra protein and fibre and short, high intensity bursts of exercise rather than counted steps at an easy pace (waste of time.)

        Reply
      2. Lifelogic
        September 14, 2021

        The most important thing for many type II diabetics seems to be significant weight loss around the abdominal organs as soon as possible – Prof. Roy Taylor has demonstrated clearly in his research.

        Reply
    4. turboterrier
      September 13, 2021

      Enigma
      Well said. Had to attend a NHS diabetic class as I was considered to be getting too close to borderline. Run by a contractor but reading the script. No consideration what so ever given to the impact of carbohydrates on the body. When questioned about this, I was informed this is what we are contracted to deliver and we cannot deviate from it.
      Right hand not knowing left hand comes to mind.

      Reply
    5. Fedupsoutherner
      September 13, 2021

      Enigma
      I have just downloaded the link you provided and found it very helpful. I firmly believe this is the way to go after seeing the change for the better after my brother followed this type of diet. The diet the NHS promotes is actually very unhealthy and the tips and advice given here is very good. There is a lot of evidence which shows us change is very much needed and the NHS needs to get up to date.

      Reply
    6. bigneil - newer comp
      September 13, 2021

      Enigma – The BBC don’t want to hear – or broadcast – ANYONE who disagrees with what THEY have been told to say. Send a text they don’t like? – they will alter/cut out a few words to completely alter the original meaning of the original text. Sometimes even adding a small insult to the sender. And people are getting wise to it.

      Reply
    7. Ian Wragg
      September 13, 2021

      International health service. We are increasing the population by approx 1000 per day and none are paying taxes but all are accessing public funds in one way or another.
      We have a vast rump of people with underlying health conditions especially diabetes who don’t and never have worked. They also tend to have more children thus taking a disproportionate amount of taxpayers money.

      Reply
    8. MickN
      September 13, 2021

      My problem is that it has become the International health service.
      It was never designed to give free treatment to anyone in the world that wants
      to turn up and demand it.

      Reply
      1. glen cullen
        September 13, 2021

        A bit like the BBC world service

        Reply
    9. No Longer Anonymous
      September 13, 2021

      +1

      Joe Wicks diet and exercise plans. They are excellent for good health.

      Reply
  11. Mike Wilson
    September 13, 2021

    Given that government cannot run an efficient, effective health service and that, eventually, it will consume all public spending – all any of us can do is try to look after our own health by eating healthy food, maintaining a healthy body weight and doing some exercise.

    Reply
    1. bigneil - newer comp
      September 13, 2021

      MW – We now also have to pay for anyone from anywhere, who turns up, needing translators too. We get a 10 min appt – they can have an hour, meaning 5 of us CANNOT get an appointment. Would you buy a car – then have every one else drive it, while YOU have to pay for it?

      Reply
  12. Sir Joe Soap
    September 13, 2021

    You need to secure this bridgehead in this battle more than anything else.
    Ahead of green world, ahead of silly political correctness, immigration, where the government is failing and important though all those are. This one is so obvious.
    There is an opportunity here to prise open the can of worms that is the NHS in full public vision using this tax increase to expose its proponents as money wasters. Graduates being taxed 52% to pay for this false religion need to be brought onside.

    Reply
  13. Maylor
    September 13, 2021

    What will be done to weed out wastage and increase efficiency ?

    We cannot afford to keep throwing £££s at the NHS without any accountability.

    Whenever there is a problem nowadays, the answer is always appoint more administrators who in turn begin to build up their army of underlings. How about a team of Time & Motion experts backed by senior nursing and medical staff ?

    Reply
  14. Roy Grainger
    September 13, 2021

    “We could for example examine the big budget for test and trace and see how that could be reduced as we move to a world where most people are vaccinated and where compliance with it is now low”

    Test and Trace is not a single item. The amount spent on Test has always been overwhelminly higher than the amount spent on Trace. I assume the non-compliance you talk about is mostly in response to the Trace part (self-isilation instrauctions) so savings as a result of that would be modest. With twice-weekly testing of schools, a battery of travel-related testing, and generalised free workplace testing and testing of those with symptoms the testing budget can’t be reduced much can it ? How much do those tests cost the government ? £10-£20 each for LFD and much more for PCR ?

    Reply
  15. Alan Holmes
    September 13, 2021

    I’ll tell you how the money will be spent.
    More managers.
    More dodgy contracts for people with the right friends.
    More ludicrous and wasteful covid gimicks.

    Reply
  16. Sharon
    September 13, 2021

    Private hospital block booking at our local private hospital did not work out at all well. I know this because a family member works there.

    Nearly every week they were told to expect, say 30 Covid patients, 4 would come, or none! The hospital was empty for quite a while, then they got tired of waiting and started seeing private patients again! And quite likely received NHS!

    Reply
  17. alan jutson
    September 13, 2021

    I thought the so called policy and vote was all about improving Social Care, it now seems to have morphed into saving the NHS again.
    Seems to me the left hand does not know what the Right hand is doing, planning, or thinking.
    This is all now rapidly becoming an absolute farce.

    The Country and Mp’s were fed and voted on a lie, you were one of the few who spotted it, you actually asked the simple question, so how is the money going to be spent, you failed to get any answer, so sensibly you voted against it, so thank you again.
    Time now for the others in your Party to wise up and get real !

    Reply
  18. Donna
    September 13, 2021

    Sir John has confirmed that no sooner was Javid’s backside installed in the Sec of State for Health’s seat then he was demanding even more money for the bloated, inefficient, over-bureaucratised, sick joke that is the NHS.

    If so that’s the second time he’s demonstrated that what he says and what he does are diametrically opposed. Remember, he was supposedly an EU-sceptic, who was expected to side with the Leave Campaign….. until he didn’t.

    And he was expected to be fiscally conservative …… until he was in a position to demand money via tax increases to shovel into the bottomless pit of NHS funding.

    There is nothing conservative about this Government-of-Fools. They’re terrified of the Public Sector Unions and the BBC ….. and haven’t got the principles, guts or basic nous to do anything about them.

    Reply
  19. Iain Gill
    September 13, 2021

    the blood tube shortage, and the obvious failures in NHS procurement that demonstrates clearly need a full and frank review too.

    Reply
  20. Bryan Harris
    September 13, 2021

    We can’t just let these high taxing ministers be so glib.
    It shouldn’t be outside their capabilities to show exactly where the money is being spent, and what the resulting effects were.
    Once everything is in place we can hold ministers accountable for making sure the waiting lists are massively reduced.

    There should, however, be no breathing space for complacency – The NHS badly need to be made more effective, in so many ways. WHAT are they doing about that?

    And, Yes, let’s see exactly what ministers are doing to ‘save the NHS’ themselves – A monthly report, that we can all see, would be appropriate.

    Reply
  21. rick hamilton
    September 13, 2021

    The whole concept of an essential service being run by civil servants and doled out free of charge to all comers is a guarantee of massive waste and inefficiency. The socialist dream of no competition and equal misery for all could not be better demonstrated. On the other hand there is obviously some world-class medical treatment being provided inside this shambles if only people can actually get into it.

    The local GP partnership that we are obliged to use appears determined to stop patients getting any attention, let alone encouraging them to report symptoms at an early stage. In any sensible system with choice you would go somewhere else: the failed clinics would go bust and the good ones would get more funding. Just imagine a National Food Service and the appalling garbage that we would all have to eat, except for a lucky few who somehow contrive to get caviar and fillet steak.

    As the Japanese say, “There’s nothing so expensive as something that’s free”. What on earth is so bad about paying a modest fee for a doctor’s consultation exactly when you need it ? When there are better systems with better outcomes in other countries why on earth do British governments refuse to learn from them ?

    Reply
  22. majorfrustration
    September 13, 2021

    Contract for the new money to be streamed to the pirvate sector against an agree number of episodes – body swerve the NHS. It should not be that difficult to withdraw from the commissioning contracts work that can be done by the private sector and the related money.

    Reply
    1. MiC
      September 14, 2021

      Has not even the egregious behaviour of the private water and sewage companies, cladding manufacturers, track-and-trace system “designers”, and the like not snapped you out of your trance-like, utterly unconditional enthralment to the private sector?

      Yes, it works fine for pubs, restaurants, bars and clubs, and for manufacturing of consumer goods, that is for all things where the quality delivered is self-evident and there is plenty of competition. Anywhere else, and anyone with half a brain can see that it is a recipe for disaster.

      Reply
  23. Nota#
    September 13, 2021

    What the Minister appears to be saying “following briefings from the senior management of his department and the NHS” the 38% extra funding awarded to the NHS in the last 2 years has now all gone all absorbed into the daily routine and the mangers now want more to feather their nests.

    More and more money from the taxpayer no accountability, no responsibility, just more and more management, more diversity officers. More new titled mangers to add to the tiers of managers already doing the job.

    Already pointed out in the MsM of the £15 billion extra spend used just for Covid £12.3 billion hasn’t arrived were it was intended and is unaccountable for.

    If the new Minister cant get a focus on the real spending he needs replacing. Simply question how much of the money is getting to the functioning front end and how much is going to the back room save my position chums?

    We must never loose sight this Health Minister is a fully paid up member of the UK Governments Cabinet, yet is only permitted to talk for England

    Reply
  24. Everhopeful
    September 13, 2021

    I see that the “good news” re papiere and incarcerations has predictably turned out to be more lies.
    Don’t expect a Tory poll surge any time soon!
    So after all the slash and burn, that leaves us with Starmer, the other assorted loons and a nascent party that has already been stitched up by the establishment. No bank account!
    And we will probably get dragged back into the EU ( not that we left) as penniless supplicants.

    Reply
    1. Everhopeful
      September 13, 2021

      Oh and if they think this diversion will act as a jab the kids smokescreen
      It won’t.

      Reply
  25. paul
    September 13, 2021

    Your wasting your time, the gov is as much to blame as the NHS is, the gov uses the NHS to hide unemployment numbers and to show that tax income is going up, there were under 1 million people working for NHS in 2019 now there is 1.2 million people working for the NHS today, it more than likely that the gov went to NHS with a offer of more money to take on more staff to show in charts and numbers on the BBC that things are better than they were before, next year you see that 1.3 million people are working for NHS, that’s the gov, no expends spared to make themselves look good for the voters.

    Reply
  26. paul
    September 13, 2021

    With new 42 people the NHS is taking on at 270,000 pounds a pop would need at least 200 staff each to justify high wage.

    Reply
  27. Chris S
    September 13, 2021

    Following on from my comment of yesterday, I have today sent the following email to the Health Secretary in the hope that we can get some answers :

    Dear Secretary of State
    As of Saturday, September 11th, the Govt website showed that there were 8,098 patients with Covid in English hospitals.
    NHS Data shows that as of June 2021 there were 123,707 beds available for use in England and the occupancy rate was 83.8%, hardly that busy when in mid-winter the rate is supposed to rise to 95%.
    Source : https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/
    Using these figures, there are probably around 103,666 patients occupying beds so Covid patients make up just 7.8% of this total and there are more than 20,000 available beds that are not occupied.
    It’s clear that the NHS is hardly running flat out is it ? Why therefore are waiting lists increasing and, why, as you told the Andrew Marr programme on Sunday, is that number going to rise before it falls ?
    Perhaps you could explain why this is ?

    For example :
    1. What percentage of the total number of Doctors and Nurses employed in England are treating these 8,098 Covid patients ?

    2. How many trained Doctors and Nurses are currently working for the NHS compared with the same period in 2018 and 2019, before the pandemic.
    Raw numbers can be misleading with many female staff working part time, particularly GPs so perhaps the figures are best expressed in manhours or perhaps that should be person hours to be PC ?

    3. What proportion of the available hours are being lost because expensively trained doctors and nurses are being diverted to management roles rather than treating patients ?

    4. Your department took up block bookings with private hospitals in England to counter increased demand. Can you please tell me the cost of this, the number of bed days purchased, and the percentage of bed days when these beds have actually been occupied ?

    As you have been unable to tell Parliament how many extra patients on the waiting list will be treated and there appears to be no measurable target to reduce waiting lists, there is clearly going to be no way of holding the NHS to account for the vast sum of extra money you are providing.
    This is a recipe for waste and inefficiency.

    I await clear and unambiguous answers to questions 1-4 above and your reasons for not setting targets for a return on the additional investment with great interest.

    I have copied this email to my own MP, Christopher Chope, in the hope that he can ensure I get a substantive response from your department.

    Yours Sincerely

    CHS

    Reply
  28. Nota#
    September 13, 2021

    From the MsM “The Health Secretary said that cuts to public spending should be considered before any new tax increases if more money had to be found in the coming years.” Sajid Javid said on Sunday

    He misses the point – the reason taxes don’t go down well beside the obvious, the bulk of taxpayer money goes ‘unaccounted for’. It goes on schemes to keep ‘chums in work’. In the ministers own department it appears to be just absorbed into administration and not actual service provision.

    While the ‘Inland Revenue’ is more than quick at collecting and holding none-payers responsible and accountable. No one in Government that dishes out the money is held responsible or even cares about the efficiency and value for money returned to the ‘customer'(the taxpayer).

    Empire building just goes unchecked. Simply one, and their are many more, ‘Diversity Officers’ why? these are political appointments to establish a polarising political view. Why are taxpayers paying to have some one preach the political stand point of a taxpayer funded organisation, when in fact that direction is already voiced by their masters, those that award them with taxpayer funds the Government. That is just bad sloppy lazy ‘grand standing’ of senior management. As it now works each an everyone of these ‘Diversity officers’ ‘political appointments’ will in turn create internal costly empires to justify their existence. They need an office, computer equipment their own administration staff, their runners their own coffee machine – the large salary and benefits is probably just 10% of the total extra costs. That is 100% demonstration of government allowed waste of taxpayer money. Then to cap it all the only obvious qualification to fill this well paid job is that you are a ‘chum’, friend and someone that will cover the backs of ineptitude of senior management and the political class.

    No ‘taxpayer’ anywhere should be funding political statements from anyone other than their elected representatives. Otherwise what is the point of the HoC

    Reply
  29. X-Tory
    September 13, 2021

    I have always said that the problem with the NHS is not underfunding but overspending. it is unacceptable, for instance, for executives to be paid more than the PM. In fact, there should be a new law that NOBODY who is paid from public money can earn more than 90% of the PM’s salary. And take waste in procurement. A report recently estimated this at some £5 billion/yr. I suspect it is much greater. Again, a new law is required making it a criminal offence for any company to make more than a 5% profit on anything sold to the NHS. This is greater than the level of inflation so represents a real, net profit, and it is unacceptable for companies to make excessive profits from the public purse, especially on matters of health.

    Then let’s look at staffing levels. I have been treated as an in-patient in both UK and Italian hospitals, and the excessive number of nurses in Britain is staggering. Nurses should not do *anything* that does not require medical expertise. In Italy most tasks are undertaken by auxiliaries, who can obviously be paid a lot less than medical staff (and cost much less to train). And, of course, we can save BILLIONS by eliminating nonsense like ‘Track & Trace’, and Covid testing (other than to those requiring hospital treatment), and non-essential operations (like sex changes), diversity training, or providing medical treatment to anybody who is not a UK citizen.

    The government can cut tens of billions of waste from NHS spending. And with new technology which will detect diseases quicker and earlier (making them easier and cheaper to treat) I think NHS spending should be going DOWN, not up!

    Reply
  30. glen cullen
    September 13, 2021

    ‘’managing the NHS’’
    The NHS is split into NHS England, Scotland, Wales & NI all with differing political priorities, budgets, costs and resources
    They’re further split into 223 NHS Trusts (England) and into 191 Clinical Commissioning Groups (England)
    The following are private companies providing an NHS service e.g NHS Dentist, NHS social care, NHS GPs, NHS consultant doctors and NHS bank nurses etc etc

    In its current form its impossible to achieve effectiveness across the whole function – its need total reform

    Reply
  31. Original Richard
    September 13, 2021

    The NHS administration, as for the Civil Service, MSM, Education, Quangos and monopoly services, is run by a small clique of Marxists.

    Evidenced by the fact that no-one is ever sacked for incompetence, malfeasance, corruption or misbehaviour and CEs who fail their Trust badly are given handsome ‘pay-offs’ only to be re-employed shortly afterwards by another Health Trust.

    Reply
  32. turboterrier
    September 13, 2021

    Enigma
    Well said. Had to attend a NHS diabetic class as I was considered to be getting too close to borderline. Run by a contractor but reading the script. No consideration what so ever given to the impact of carbohydrates on the body. When questioned about this, I was informed this is what we are contracted to deliver and we cannot deviate from it.
    Right hand not knowing left hand comes to mind.

    Reply
  33. Richard II
    September 13, 2021

    Yes indeed – Test and Trace must be critically reviewed and probably retired. At the beginning of an epidemic it can be a big help, as South Korea showed, I believe. Not now. Time to spend that money more wisely. Goodness knows there are better things to spend it on now, after all those postponed operations!

    Reply
  34. Narrow Shoulders
    September 13, 2021

    It’s time the NHS was paid by results and claimed for procedures delivered rather than being handed lump sums per trust.

    Run it like a garage with fixed fees for each procedure. That might concentrate minds on administrative fees.

    Reply
  35. John Mcdonald
    September 13, 2021

    How to manage the NHS 1) Reduce the number of managers especially if they have no medical training.
    2) pay more for the service, and bring out as a specific tax item and not buried in National Insurance contribution. 3) People to take more care of their own health – exercise and healthy diet

    Reply
    1. glen cullen
      September 13, 2021

      Why would you want a manager in charge of buying toilet rolls to be clinically/medically trained

      Reply
      1. John McDonald
        September 15, 2021

        Hi Glen,
        If you need a manager to buy toilet rolls then I think you have justified by comment.
        I did not say you do not need admin assistance to run things. This is admin not management.
        John

        Reply
  36. rose
    September 13, 2021

    I’m worried by the talk of yet more devolution. It means another expensive and wasteful layer of government, and it has so far tended to tear the country apart. Furthermore, the Blairites smuggled in a manipulative form of voting so a left wing candidate is usually returned, despite our having voted for FPTP under the Coalition. This means left wing fiefdoms, possibly corrupt, all over the country, ganging up on HMG and defying the voters.

    Reply
  37. NickC
    September 13, 2021

    The NHS is structured to fail. NHS management has no incentive to produce better results. Quite the reverse. Every failure is used as an excuse for more management and more money. The NHS is a ghastly combination of top-down 1950s soviet-style organisation and modern managerialism.

    Reply
  38. Nota#
    September 13, 2021

    Elsewhere – given the Governments support and stance with the so-called authorities, its no longer a criminal act, a crime or illegal to act outside the laws of the Land if you claim to be protesting.

    Causing grief, harm, damage, inflicting costs on others going about their legitimate law abiding life. Is all ‘OK’ according to Government as long as you can claim it is a protest.

    its a nutty country, with a weird political leader who has lost all sense of purpose and responsibility to those pay his wages.

    Reply
  39. a-tracy
    September 13, 2021

    Is the health service in Spain having all the problems that the NHS in the UK is having? Do they also have no spare medical capacity, are they also not seeing patients face to face?

    They have a whole private health sector that bills back procedures to the UK and they treat people from the UK with travel insurance covering all their costs and even have been reported to bill Brits privately rather than treating them on their ECIH card or the new replacement card GHIC (Global Health Insurance Card). The UK Health service needs to get its act together, no national health contribution, treat but rebill back to the Countries on the agreed GHIC recharge system.

    If there is a big reduction in tourism to Spain especially in the winter do they have the capacity that we could purchase at a lower cost than it would cost the government to treat the UK patients waiting for treatment in NHS hospitals for certain procedures i.e. hip, knee and other joint replacements – low-cost Ryan Air flights there and back – treatment short rehabilitation then home. I read once that Spanish healthcare costs less than British healthcare and if they have the capacity to do a planeload full of cataracts patients or other specialities we should consider all options to reduce the waiting lists now they’re having all this money pumped in. How much have the UK saved in the past 18 months with Brits not travelling into the EU and having medical treatments that are rebilled to the UK State?

    Reply
  40. DavidJ
    September 13, 2021

    Managing the NHS. That is it in a nutshell; it is utterly incapable of managing itself and more money will only make it worse. No doubt those to be appointed by Boris on extravagant salaries will only make it worse.

    Reply
  41. Nota#
    September 13, 2021

    Sir John

    In todays Telegraph Norman Tebbit may be one of the few Conservative left in this Country but his observation appear more valid than those now in Government. “There are it seems, more than 400 NHS managers who are paid more than the Prime Minister (and less likely to lose their jobs in the next five years) and less than half of NHS staff are medically qualified. “

    https://www.telegraph.co.uk/news/2021/09/13/extinction-rebellion-must-stopped/

    The Country is suffering purgatory under this Socialist Government and appears led by those they respond to from the left, willing them to go further and further in their extremist doctrine of control and punish

    Reply
  42. Andy
    September 13, 2021

    There is mounting speculation that the Brexitists are going to delay introducing checks on imports from the EU.

    Their Brexit uplands are so sunny they keep delaying our arrival at them. Clearly the Brexitists are concerned we cannot cope with such sunniness.

    Either that or they are petrified that they accute shortages they have left us with will be worsened when they impose yet more pointless bureaucracy.

    Still – at least you have control of your borders. How are you getting on with your dinghy friends? (This is fun. Comedy Brexit).

    Reply
    1. Peter2
      September 13, 2021

      Why check European imported goods Andy?
      Are you suggesting they are suddenly substandard?
      What after 40 years of satisfactory quality.

      Reply
      1. MiC
        September 14, 2021

        Ask Archie Norman, Pete.

        He seems to be having a problem with it and maybe he will explain it to you?

        Reply
  43. Everhopeful
    September 13, 2021

    About time too!
    Thanks to Sir Christopher Chope for pointing out ( and sounding concerned about) the jab’s adverse reactions. In Parliament.
    No one else knew?
    Give me a break!

    Reply
  44. Bob Dixon
    September 13, 2021

    Those who took their orders from the EU are not prepared to listen to Ministers. If Ministers want to remain in post they must stick to the orders from the EU.
    What to do?

    Reply
    1. Everhopeful
      September 13, 2021

      Purge perhaps?

      Reply
  45. outsider
    September 13, 2021

    Dear Sir John, I make the heroic assumption that NHS hospitals are now geared up for a worse than usual “winter crisis” in respiratory suffering. If so, other hospital departments should be back to normal working and their waiting lists should stabilise at a high level rather than continue to grow. To reduce the waiting list of sufferers, NHS hospitals seem to suggest that they would require more surgeons, consultants, registrars and junior doctors. And they would need lots more beds to be made available by sending long-stay patients to social care settings. Neither of these is feasible over the next three years, not least because there is already a gross shortage of carers and there will be little extra funding for social care. Meanwhile, greater use of private hospitals, both at home and abroad, seems to be the only pragmatic option. Perhaps that is what the emergency funding is really for.

    Reply
  46. Sea_Warrior
    September 13, 2021

    On the way out of my local supermarket this morning I noticed that the council had set up a stall dishing out COVID tests to the asymptomatic. Can’t you give Javid a kick and get him to stop this obscene waste of money? Providing free LF tests to the students about to engage in nightclub tonsil-tickling would make more sense.

    Reply
  47. outsider
    September 13, 2021

    Dear Sir John, You have noted that the central NHS is already trying to hire a bevy or integration managers to mastermind co-ordination of critical and social care. The obvious and efficient point of co-ordination, however, is the family doctor. That is, I think, how the service was originally conceived , the family doctor being most familiar with the patient’s character, history, circumstances and needs. Under Labour, coalition and Conservative governments, the family doctor has effectively been abolished; primary care has been trashed and most GPs downgraded from professional to orders-following staff status. In some places,the service virtually collapsed in the Covid era. Reversing all this is the sine qua non for a better, more cost-effective health service.

    Reply
  48. Pauline Baxter
    September 13, 2021

    It is all very fine Sir John, asking good questions, about how the N.H.S. spends the huge sums allocated to it.
    Are those questions ever answered?
    So far as I am aware the answer is no. THEY ARE NOT ANSWERED.
    Nothing ever happens to remove the huge bureaucratic machine that is the dead weight stifling Health and Care.

    Reply
  49. Geoffrey Berg
    September 13, 2021

    The NHS is so inefficient and in the main systemically so that I favour a different system. While I think it should still be publicly funded it should become privately operated with different commercial concerns running different hospitals etc., and they should bid for treating patients individually in non-emergency cases with some treatments (e.g. hip replacements) open to international competition so as to drive costs down to more reasonable levels. So the public sector would no longer be the operator of health services but the awarder of contracts for most health care.

    Reply
  50. DOM
    September 13, 2021

    It would help if your party’s leaders in government stopped all taxpayer funded spending and repealed barbaric, vulgar, authoritarian laws whose primary aim is to protect and promote the interests of the Tory and Labour parties.

    Two examples. Johnson throwing money at Labour’s health service is political in nature and has nothing to do with the of financing of important health provision to those in need. Hate Crime laws are designed to destroy debate on issues that has the capacity to harm the Tory and Labour parties

    Ancient freedoms destroyed, taxpayer defenestrated and all to protect, promote and expand the two party autocratic State

    The Socialist scam can only continue for a definite period of time. Of course when the shit hits the fan Johnson will have crawled away to another country to spend the hefty proceeds of his new careers

    Reply
    1. Everhopeful
      September 13, 2021

      +1
      Very clever …Labour’s NHS. Hadn’t thought of that!
      Wonder why next Tory govt. didn’t disband it? Vote loser I guess.
      But I never got the impression talking to older relatives ( including a GP) that it was very popular.
      Bevan included private beds in order to destroy other private care …a nasty move IMO.

      Reply
  51. Sakara Gold
    September 14, 2021

    Good Morning
    At the beginning of the Chinese plague virus crisis the government was advised by public health professionals, the BMA, senior NHS managers and many sexual health tracing specialists to expand the existing, highly efficent and effective in-house NHS tracing system to track and organise the isolation of virus contacts.

    Instead the government chose to bring in a totally inexperienced FM company with a chequered history of involvement in government contracts. Serco/Harding/Hancock then wasted millions on £1000/day consultants to set up a completely ineffective system that had no measurable effect on the course of the pandemic.

    This mismanaged rip-off has cost taxpayers £37+billion for very little benefit – one of the worst examples of wasteful government spending in living memory. Had this sum been applied directly to the NHS, the course of the pandemic would have been different with many lives saved. And in all probability the recent manifesto-busting £35billion tax rise would have been unnecessary.

    It is highly unlikely that this new money for the NHS will reduce waiting lists unless specific, measurable, achievable, relevant and time-based targets are applied – with consequences for the management if they fail.

    Reply

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