NHS reorganisation

I read little about the wide ranging management reorganisation of the NHS underway as the institution wrestles with recovery from the pandemic and continues to fight the continuing virus. The reorganisation is one sought by the management rather than being a political blueprint, which may account for the absence of debate.

The NHS in England has been recruiting Boards to run 42 Integrated Care Systems. These in turn work with Integrated Care Partnerships. They are designed to promote collaboration and common working between GPs, Councils, providers of community and mental health services and Healthwatch. In parallel all the provider trusts – hospitals and other institutions providing healthcare and treatment- are to join provider networks, to work with others and to increase their scale of activity.

The Integrated Care Boards will be responsible for finance. They will procure the health services their area needs from a range of providers. Their budget will include “community commissioning money, GP budgets, specialised commissioning spend, budgets for certain other directly commissioned services, central support and national transformation funding.” They can delegate funds to the Partnerships based on their area.

The boundaries of these new bodies create bodies of different sizes and often combine several Council areas. Wokingham for example will come under Buckinghamshire, Oxfordshire and Berkshire West. Its eastern neighbour will be Frimley.

It has proved difficult to get much background information about the costs and benefits of these changes. It is important the new bodies are well primed to procure the services we need to cut the waiting lists and to maintain or  improve the range and quality of services on offer so that all are of a good standard.


  1. Everhopeful
    November 17, 2021

    Are they going to get GPs back?
    Whatever the plan.
    It won’t work!

    1. Ian Wragg
      November 17, 2021

      Another layer of useless management to waste the extra £36 billion given by staffer.
      There’s no end to the waste in this black hole money pit.
      I hope the price of Shell moving to London is permission to start drilling again, another bout of high pressure heading our way at much lower ambient so power grid will be un crisis. Pretty much like the NHS.

      1. Everhopeful
        November 17, 2021


    2. Sir Joe Soap
      November 17, 2021

      Hopefully not. Definitely time to pay for face to face hours only and sub-contract the online guesswork out to India for those who want it.

      1. Everhopeful
        November 17, 2021


    3. Hope
      November 17, 2021

      Not recovery from pandemic JR. They should have planned, tested and trained for it! Required under Civil Contingency Act! They even have operational departments dedicated to these sort of incidents! They did but ignored their own plans!! Hancock telling everyone about how good he is! The same man who broke All his own rules with an arrogant this is not advice comment to the nation!

      The NHS failed the nation. The govt. failed the nation. The leaders failed to prepare, plan and test for it. They had a plan as did the WHO and the Govt. and NHS ignored their own planning! Who is going to accept responsibility for the deaths, and wrecked economy? Handcock? Johnson? Simon Stevens? Whitty ?Valance? Who? Will Johnson blame it on world events?

      All the current shortages, rise in prices, inflation and tax increases are the govt.’s own making. Not an inanimate virus. These were choices made by and sanctioned by Johnson. Your party and govt. are responsible for making us all the outcomes: traduced our democracy, politicised the police, made us all poorer. As we recently saw this does not matter as long as you look after your own to prevent punishment and ensure one rule for yourselves and the rich and another for the masses. Like Johnson promising not to cancel Christmas, but did so and still invited his wife’s best friend to Christmas lunch! Masses not allowed to see their loved ones die or get buried. He has no morals or values whatsoever.

      Total radical change required for the left wing socialist NHS.

      1. Everhopeful
        November 17, 2021


      2. Donna
        November 18, 2021

        Well said. Unfortunately you left Prof Ferguson (always wrong; always massively over-predicts) from your list of The Guilty Men.

    4. Nottingham Lad Himself
      November 18, 2021

      I do agree with the commenters here, who say that if people want a right to free and to freely available healthcare, then they also have a responsibility to take what care of themselves they reasonably can.

      That would be:

      Not to smoke.
      Not to drink excessively nor to use drugs.
      Not to allow oneself to become dangerously fat.
      Not to be promiscuous.
      To take some exercise – even a little such as walking to the shops rather than none.
      To wear a mask on public transport, etc.

  2. David Peddy
    November 17, 2021

    NHS reform is urgently required, starting with Trust Boards.At any one time at least 20 Trusts are in Special Measures(SM) including three of our most prestigious teaching hospitals – Barts, Kings and St Georges . Kings has been in SM 3 times !
    Very few Trusts work well : there are only two that I know of Salford and Norfolk & Norwich.
    Many Trust Boards have meaningless structures and are packed with jobsworth , career public sector aparatchiks ,employing the infamous ‘Revolving Door’ . One trust that I know of has a CEO, Deputy CEO and COO ! What are these people supposed to be doing ?
    Others that I am aware of have Directors of Transformation ? Another has a Director of Strategy : I thought that was the CEO’s job ?
    The DoH needs to profile the successful CEOs and use that for recruiting replacements in poorly functioning Trusts
    It needs to create a Template Trust Board structure

    1. SM
      November 17, 2021


    2. Sir Joe Soap
      November 17, 2021

      No chance.
      CEO is too busy hiring Directors of Strategy, Diversity, HR, Transformation.

    3. Peter
      November 17, 2021

      David Peddy,

      Trusts are another vehicle for political patronage. Failure is never punished, the culprits simply move to another trust.

      Nothing is added to the efficient running of the NHS. It’s another expensive overhead with little transparency or accountability.

  3. lifelogic
    November 17, 2021

    Does not sound like the sort of reform that is needed to me at all. We need freedom and fair choice for customers & not a take it or leave mate it monopoly) you have to pay for it anyway so tough approach. People who choose not to use the NHS should not have to pay and those that do use it should pay for it if they can afford to. Get the power to the customers not the dire state monopoly NHS. Get more money into health care not more money into the NHS.

    1. Garry Y
      November 17, 2021


    2. Bill B.
      November 17, 2021

      I agree, Lifelogic. Last year the NHS mainly turned itself into a Covid service, not a health service. It’s reported in the Telegraph that 46,000 people now have undiagnosed lung disease after the NHS suspended diagnostic tests ‘due to the fear it would spread Covid’. How much clearer do we want it to get?

    3. a-tracy
      November 17, 2021

      Lifelogic – the whole purpose of socialised medicine is those that can afford to pay – pay a bit more to help support the many that can’t afford to pay. No one wants a selfish everyone just for themselves health system like the States, even the States are trying to change it.

      1. Lifelogic
        November 17, 2021

        I am not suggesting that anyone who genuinely cannot pay should not get treated. Currently loads of people do not get treatment due to the dire NHS rationing and delay system.

      2. Micky Taking
        November 18, 2021

        Then why allow key staff to work part-time which is designed to facilitate the payment privately for better-class attention?

    4. ukretired123
      November 17, 2021

      +1 You cannot reform a mega money pit. Needs a revolution…

    5. graham1946
      November 17, 2021

      Don’t worry LL. When this fails it will be privatised or sold to the foreign money men, like much of our industry.

      1. Lifelogic
        November 17, 2021

        Who on earth would buy it?

      2. Micky Taking
        November 18, 2021

        It will have to be asset stripped – – you know £15k per knee, £3k per cataract, £20k per baby delivery.
        Somebody will figure out how to make a tidy profit.. what did you say ‘somebody already has!’ really ?

  4. Sea_Warrior
    November 17, 2021

    Has an experiment been run? If not, why not? Perhaps you should be asking a question at the next Health Questions, Sir John.

    1. SM
      November 17, 2021

      If an experiment were to be run, it would certainly need another, but independent, Board, with its own team of advisers, auditors, HR personnel, Diversity coaches, communications Director and a Medical Advisory Panel –

      for starters.

  5. DOM
    November 17, 2021

    Yawn. We’ve been here before, many times.

    If John will not or indeed cannot tell it as it is as per his position as a party MP then it must fall to his readers to do so

    The NHS is financially and ethically bankrupt. It is political in nature. It has achieved its goal, to insulate itself from reform and neutralise those who seek to reform it. As we can see with today’s article that neutralisation of its foes has been highly successful

    There is now no opposition to the autocratic unionised public sector. The Tories have simply thrown in the towel and thrown us to the wolves

    I’m struggling to understand how it is that the voter cannot see that voting Labour, Tory and SNP is an act of self-sabotage. All the main parties are now wedded towards State authoritarianism. We have been skewered by those we placed our faith in. That skewering will continue until the people wake up when the free-lunch comes to an end

    1. Everhopeful
      November 17, 2021

      I reckon that most of the world leaders, past and present attended the same global kindergarten where they hatched their plans. And like a fraternity movie they are still tied together by various old shades and whispers. Thus we are now governed solely for/by their long held affinities.
      Liblabconkip is a reality.
      They have no loyalty or care for us.
      But continue to trade on our sheep-like tribalism.
      Labour surges ahead in the polls and the old, old tragedy plays out yet again!

      NONE of them can fix what they have done.

  6. Iain Gill
    November 17, 2021

    for many patients being able to get referred “out of area” is the only thing keeping them alive. so bad are local diabetes services, for instance, in some places that more complex cases depend on being referred into London or other big centres away from their “home” laughable centre of excellence.

    power needs handing to individual patients.

  7. Everhopeful
    November 17, 2021

    Before launching into some woke reorganisation maybe the NHS should address the apparently unfathomable reality that 10,000 more people have died in the past four months than is normal. (The New Normal?).
    These deaths are not covid related but deaths stemming from the inaccessibility of healthcare over the past two years.
    What IS the purpose of the NHS?
    Maybe get that question answered before taking any action?

  8. Shirley M
    November 17, 2021

    The NHS priority should be to train more UK nurses and doctors. This has been neglected for years as it is quicker and cheaper to steal foreign nurses and doctors and now we pay the price of this shortsightedness. Not only do we deny UK citizens an opportunity of a ‘job for life’ but we damage other countries by taking their medics.

    1. No Longer Anonymous
      November 17, 2021

      Sadly Remainers are addicted to cheap labour.

    2. Lifelogic
      November 17, 2021

      Only about 50% of UK trained doctors go on to work for the NHS as it is such an unattractive employer!

      1. Micky Taking
        November 18, 2021

        I sympathise, it must be awful going to work everyday having to deal with ill people, constantly moaning and needing your attention.

    3. a-tracy
      November 17, 2021

      Shirley, I wonder do foreign nurses do the same three year university degree at the same level?

      I would train double the male nurses that we do, I’d do a recruitment drive in schools and colleges. I’d tell them the basic wage once qualified by degree plus all the overtime available, the extra allowances for nights, weekends, the holiday allowance, the full sick pay for six months to a year, full parental leave allowance, the excellent defined benefit pension.

      I’d explain how they can specialise from their basic nurse training and the full gamut of positions available to the ambitious. When men enter a profession the wages rise, it will improve the situation for female nurses and allow them the part-time working that they want. Too many females trained = too much short staffing.

      1. Shirley M
        November 18, 2021

        Agreed. The ‘perks’ for NHS employees can be very beneficial. I know of several nurses who have retired at 55 on very good pensions. How many jobs allow you to retire at 55, collect your generous pension, and carry on working as an agency nurse as and when you choose? Doctors complain at the £1m pension limit. How many professions offer that level of pension contributions, mostly paid by the taxpayer? A job with the NHS is a job for life (if they want it). That security is a massive bonus not available to the majority of UK employees.

  9. Donna
    November 17, 2021

    Difficult to get information about the costs and benefits of the changes?

    Have you tried asking the Sec of State for Health. The clue is in the name ……. or is he clueless, which is what I suspect?

    After all, it’s only taxpayers’ money and when it comes to the NHS, that appears to be an unlimited amount.

  10. turboterrier
    November 17, 2021

    How much is this going to cost?
    Great big organisations with layers of administration from the front line to the top of the pile. Sounds like another costly exercise in how to further waste the taxpayers money. Would it not have been sensible to set up half a dozen trials across the country and try and identify best practice. Will government’s ever get away from knee jerk reactions to applying solutions without aďressing the real problems?

  11. Hat man
    November 17, 2021

    These newly appointed managers have to do something for their £270,000 salaries, I suppose.

    It’s a pity you can’t get information about costs and benefits, Sir John. Perhaps that’s because since the Covid crisis the government has stopped thinking in those terms. If you don’t need a cost/benefit analysis before you shut down a whole country, you don’t need one for a bit of NHS reorganisation either.

  12. Enigma
    November 17, 2021


  13. Narrow Shoulders
    November 17, 2021

    The most needed reform the NHS needs is to be paid for what it does. A motor garage style fee structure for procedures and consultations (much like the private sector) which the trust then invoices the DoH for when performed.

    The accounting required is then invoicing, general ledger and wages so swathes of accounting managers can be let go and each trust receives money for productivity. Workflow planning provides the staffing requirement and the patient becomes the focus.

    1. a-tracy
      November 17, 2021

      NS I used to think that but how would you stop them recommending tests and extra procedures to bump up their earnings on a slow month?

      1. Narrow Shoulders
        November 18, 2021

        a-tracy – I am over 50, in my lifetime NHS waiting lists have always been news. I don’t think the “free at the point of service” NHS should ever have a slow month.

  14. Polly Ticks
    November 17, 2021

    I would like to see a severe reduction in non medical managerial positions such as:

    – ‘Sustainability manager’ and ‘net zero intern’ both of which I have seen advertised. The tax payer were paying their salaries and benefits at £46k and £24k. No doubt there will be opportunities for promotion etc, as departments are created and ‘little empire building’ begins.

    – Diversity and Inclusion managers, taxpayer funded salary again of £46k, but various news reports of them earning £70k or more.

    – Marketing managers, again paid at similar levels to above.

    Positions like this cost the tax payer a fortune and add nothing to quality of care. If the government does not have the courage to axe these jobs, then trusts should be forced to share them, after all they are probably working from home anyway.

    It would also be interesting to have an update on government success in reducing health tourism. At the beginning of the pandemic whilst we were strictly locked down, flights in to the UK continued, and I often wondered how many were health tourists. This failure to stop flights in, especially from high infection countries, such as Italy at that time, whilst we were restricted severely, angered me greatly. Apparently, I think it was around April, more flights were scheduled in from Pakistan ahead of the travel ban. I wonder how many people flying in were actually British citizens.

    1. a-tracy
      November 18, 2021

      That’s what happened at the Royal Mail Polly after privatisation 1/5 of the management were reduced, retirees not replaced, leavers not replaced, some early retirement 10,000 management roles, this won’t happen whilst it is public run.

  15. Sam
    November 17, 2021

    It’s the same individuals doing the same job just under a different board.

    The provider landscape, where care actually happens, remains unchanged.

    Whether two commissioning boards work together to solve problems or whether two commissioning boards become one commissioning board makes little difference if their is no transformation of providers.

    There have been dozens of commissioner reforms since I joined General Practice in 2002.

    The problem is, the only thing commissioners can actually change is themselves because they do not run the delivery organisations.

  16. Micky Taking
    November 17, 2021

    First question: Will the staffing of the new Boards each have the same structure and level of employees?
    Next: Will a Board outsource services formerly within NHS organisation?
    Directors: Will all people hired for Boards have previous management experience of NHS, or is it intended that other business background is a prerequisite?
    Which major Management Consulting busines is being used to draft the terms of transition to this model?
    What budget is allocated to this reorganisation, from within NHS funding, or new Government spending?

  17. Narrow Shoulders
    November 17, 2021

    From a capacity perspective it would be interesting to discover how often the failed asylum seeker (who may have converted to Christianity to bolster his claim for asylum) and others like him used our NHS services in the period since 2014 when his asylum claim was refused.

    To create extra capacity in our NATIONAL Health Service maybe we could remove those who have been refused permission to remain here.

    The hoops I had to jump through and expense incurred in order to first get my wife to this country and then to remain are (rightly) onerous, in part for capacity and cost reasons, play fair to those who follow the system and stop the illegals bypassing procedures to which law abiding citizens must adhere.

  18. Sir Joe Soap
    November 17, 2021

    So if we look at this in the usual sense of customer and supplier it has become incredibly complicated.

    If I put in a new bathroom, I have the choice of going to one provider to buy in the different parts and fit it, or I can go to the market myself for the different parts and get a fitter to quote. Likewise many other things in life where a conglomeration of different components are required. Why do I now need to rely on a mixture of Boards choosing where to spend my money, Partnerships which sound like a rationing system with multipe opportunities for buck passing and all accountable to whom? Certainly not me as the customer.

    Restore the customer-supplier link and competition, not a huddle of providers who “know best”.

  19. Nig l
    November 17, 2021

    NHS tick box culture causes ambulance road block. Excellent article in DT. If the kind of coordination between services organised by the writer and the claimed benefits are what we can expect more of, this looks positive.

    The problem I have is that with such a centralised command and control mentality this will be just another ‘deck chair changing’ exercise.

    Organisational change should be driven by customer needs. I look forward to what you find in that respect.

    In other news. Now no doubt, driven by Boris, the government ‘lied’ over the Owen Paterson affair. I note JRM holding his hand up. Anything to protect the boss. The letter I received from my MP early on, no doubt written by No 10 now looks ridiculous.

    ‘Ministers have lost control of the benefits system’ as fraud doubles.

    ‘Broken asylum system results in Liverpool bombing’

    Kier Starmer doesn’t need to do anything. Your incompetents are doing it all for him.

  20. Nottingham Lad Himself
    November 17, 2021

    The idea, that something as fundamental as the way that the UK’s sole supplier of healthcare to most of the population works is not the business of Parliament is the biggest cop-out that I have heard in ages.

    Parliament is supreme and its business is whatever it wants that to be.

    Sir John would appear to be content to wash his hands of any responsibility for the NHS, and I can only assume that so are the rest of his party.

    Reply On the contrary I am trying to persuade Ministers to engage to correct the problems

    1. Nottingham Lad Himself
      November 17, 2021

      Thank you Sir John.

    2. Micky Taking
      November 18, 2021

      reply to reply…Good luck Sir John. I doubt your efforts will be rewarded. Reforming NHS is a rotating project that never produces results, so the next one is proposed to hope to silence concerned voices!

  21. Oldtimer
    November 17, 2021

    It sounds odd that, as an MP, you are unaware of what may turn out to be profound changes that affect the delivery of healthcare in your constituency. Is the NHS setting up a fait accompli restructuring? What does the Sec of State have to say about it? What are the objectives? What is the driving principle behind the change?

    Reply I not only know about them but have just written again about them

  22. Giles Brennand
    November 17, 2021

    There are two ways to run an efficient health service.

    Administrator run. They control the budgets and have total, total authority over the medical staff, including the hours they work, the patients they prioritise and the types of treatments available.

    Doctor run. They have complete authority and are fully accountable for remaking within budget.

    Either way can work extremely well for the patients, the staff and the finders, such as taxpayers.

    Anything in between is a complete dog’s breakfast and a guarantee of enormous inefficiency, poor service, unattractive careers and prioritisation based on who you are and who you know.

    Which approach will the new structure follow?

  23. majorfrustration
    November 17, 2021

    Sounds rather like the 80s when we had regional Health Authorities who undertook the commissioning.
    No change here then, move on.
    Off topic – given that A&E Departments are supposedly run off their feet is there any data giving a breakdown
    of treatments provided by the Departments that in reality could have been serviced by GPs

  24. forthurst
    November 17, 2021

    It appears that this reorganisation of NHS England was the brainchild of Matt Hancock and Sir Simon Stevens, both PPE ie Politics graduates. Are PPE graduates better than Geography graduates at re-organising the NHS? Why are not medically qualified people in charge of public health care in this country like in Germany? For how much longer do we have to put up with Arts graduates messing up? What is even the use of an Arts degree? In what way does it indicate actual intelligence rather than the ability to induct irrelevant and often deliberate misinformation and regurgitate it to the liking of tutors.

    In the countries which are rapidly overtaking us in wealth, education is about science and engineering which are the basis of creating added value in an economy as against rent seeking which is how things work here to the benefit of a few and the impoverishment of the many.

  25. Nig l
    November 17, 2021

    Ps Audit Office now says HMRC is letting tax owers off the hook as it does not have enough staff to collect the £44 billion outstanding. HMRC say that they are planning to get it down to £35 billion by March.

    Well that’s all right then. Just continue to hammer the rest of us who do pay.

    1. Narrow Shoulders
      November 17, 2021

      Always easier to collect from the captive or honest Nig1

    2. Micky Taking
      November 18, 2021

      Ah.. PAYE the godsend to HMRC. High regulation which forcibly drains the incomes of all lower end earners, while allowing top end to pay clever accountants to avoid PAYE taxation.

  26. alan jutson
    November 17, 2021

    All sounds like a yet a more expensive, dysfunctional, over complicated, and shambolic system to me, where many incompetants can hide, (as they do now) and few will be taken to task or be held to account.

    As I have said before, we need to think again, and right from the very start.
    Surely we would not set up with what we have now, if we were starting a health and social care system from scratch would we ?

  27. Roy Grainger
    November 17, 2021

    “It has proved difficult to get much background information about the costs and benefits of these changes.”

    Past experience tells us the costs will be high and the benefits will be low.

  28. Iago
    November 17, 2021

    Off topic, the government is giving 200 million to the Turks, ie Erdogan, for solar power.
    Part of our economic and cultural suicide.

    1. glen cullen
      November 17, 2021

      Thats just insane

      1. alan jutson
        November 18, 2021


        That is why it should be no real surprise !

    2. Donna
      November 18, 2021

      And the difference between Germany/Nordstream is…….? Another one, like Putin, who will use their power (pun intended) to blackmail us.

    3. Mitchel
      November 18, 2021

      So,JP Morgan picks up a nice arrangement fee while the UK taxpayer takes the guarantee risk.

      No surprise,I think we have long known in whose interests recent governments have been acting.

  29. Bryan Harris
    November 17, 2021

    This sounds like an awful amount of resources is going into the management structure when we need urgently front line staff.
    I’ve never been keen on big bureaucracies, and this will be huge. It seems to have elements of Obama care, whereby certain drugs and options are allocated to certain medical problems, leaving the patient and doctors with no ability to change it to suit the patient. That would make it inflexible and dangerous – we’ve already seen such things going on with doctors forbidden to use ivermectin.

    Too much bureaucracy will be the death of personal care and innovation.

    The NHS has already shown it’s colours with the way it has done nothing suitable about the shortage of GPs, other than to dictate a system for surgeries whereby obtaining treatment is so much harder and complex.

    Will these expensive changes improve anything?

  30. William2nd
    November 17, 2021

    Having worked in the NHS during a time of ‘reform’ I would suspect that all of the large consultancy firms in unison lobbied that this reorganisation was necessary because they saw the £billions being poured in with no government plan and wanted a piece of the action.its how they make money. I suspect (again with direct experience) that they have suggested that only they can provide the business ‘expertise’ for £2000+ per man day to ‘drive through fundamental change’. Contracts have probably been signed by NHS England thus £Billions will go to the external consultants to ‘help’, and lots of change will happen, to ‘structures’. The result will be that the money will then be gone and the NHS will be in ‘melt down’ again next winter.
    My direct experience is that the NHS is too big, too centralised and unmanageable at this size but easy pickings for the likes of Deloitte, KPMG, etc to never actually say what the problem is. I will admit I have no evidence of this, this time, but past experience and common sense tells me the money mangle just keeps turning. The solution is to decentralise, remove the national hierarchy and that will stop the big consultancies from selling £billion ‘solutions’ centrally every few years and creating just more ‘mess’ to come back to ‘fix’ next time. It’s their business model and its proven to work.

    1. SM
      November 17, 2021


    2. alan jutson
      November 18, 2021


      Most people who have ever come into contact with management consultants know that they know the answer is to be found on the shop floor, or the sharp end of any business.

      Thus the first place they usually go is to those on the front line, they interview them. take notes, and bolster it out with a load of other waffle, coloured graphs and charts, and that is what is presented to the Company Directors or CEO’s of this World after a few months of preparation (to justify their fees)

      Thus all they have done is shortened the reporting chain, by cutting out a whole load of internal management structure, and taken the ideas from the front line/shop floor direct to the top level.
      Something any Director or CEO could do themselves if they ever bothered to visit the front line/shop floor on a regular basis.

  31. agricola
    November 17, 2021

    The way it is described equates to a Hampton Court Maze of bureaucracy with no indication of what they all do. I would advocate a single central purchasing organisation divided three ways, capital equipment, consumables, and drugs. I would ask, what is the purpose of any administrative organisation between the Ministry of health and a group of hospitals comprising a Trust, and then get rid of it. I would expect the Trust to organise itself in such a way that it was highly productive compatible with quality, and carried its own administration. I suspect much could be gained in throughput numbers from self contained speciality units. To each Trust I would attach a medical training school/university to cover professional training. The ministry would dictate policy and provide finance, the Trusts would implement it. In implementation I would advocate that they study Japanese systems of industrial management and transplant much of it. Though charity is laudable the bulk of financial responsibility for such as air ambulances, hospices etc should be part of the MOH budget. Post hospital and elderly care, be it in patients homes or dedicated care homes should be part of the Trust and NHS.

  32. No Longer Anonymous
    November 17, 2021

    So when does the Government campaign “Eat less, move more, save the NHS” start ?

    Around a million hospital admissions a year are because of obesity and £6 bn a year is spent by the NHS on obesity related illnesses.

    The UK and US were hit hard by CV-19 because of obesity.

    Nearly all of it avoidable.

    For balance we also need private insurance for those who participate in high risk sports. I include in that marathon running which (as a fitness fanatic myself) I find idiotic. It is asking for long term joint injury among those who aren’t naturally built for it yet is promoted every year by TV events and NGOs.

    1. No Longer Anonymous
      November 17, 2021

      Any alcohol/drug related A&E treatment needs to be penalised too. Just like being sick in the back of a cab, which doesn’t seem to be a problem, so why not the NHS ?

      This as a deterrent rather than just being about the money.

    2. Micky Taking
      November 17, 2021

      Do elderly people need private insurance against treatment for slipping on icy pavements, roads or stairs.
      Also tripping up on uneven pavements and kerbs?

      1. graham1946
        November 18, 2021

        Tongue in cheek no doubt. Do youngsters need insurance against getting drunk and ending up in A & E?

        Elderly people cannot get insurance, let alone affordable ones. As you get older and the payout day nears, insurance companies reduce your cover or increase premiums, or both. Similar to the vets insurance – fine when a young animal, but as they get older the premiums become unaffordable and people go without. Insurance does not work in healthcare and insurance companies only like premiums, not claims. Try getting affordable insurance for your holiday in later years.

        1. Micky Taking
          November 18, 2021

          Graham -(not tongue in cheek this time) yes drunks dropped off at A&E should pay towards the triage, the ‘treatment’, the possible abuse and any damage caused. Lets start at £50 or not treated? I understand most young ‘night out’ types only carry a credit card….’that will do nicely’.

    3. Fedupsoutherner
      November 17, 2021

      NLA. We now have 2 and 3 year olds that are obese. As was said on GB News yesterday, it’s about time we laid the responsibility of children’s health at the feet of parents. It is nobody else fault if your child is overweight. It amounts to cruelty if your child is overweight.

  33. The PrangWizard of England
    November 17, 2021

    Off-Topic, but more important than the NHS.

    It seems pressure and sanctions have been brought against the leader of Belarus to stop his contrivances and those of others to get illegal migrants over the border into Poland. The Polish PM has been absolutely firm and admirable in protecting his borders and it seems the plan to break through has been curtailed.

    Here of course our situation is completely different. Our PM is weak and unprincipled, dangerously so for us, and we are totally incapable of stopping the French from helping illegals by careful actions or lack of actions to get here, as they have an economic hold over us. We cannot and indeed dare not threaten sanctions or any other consequences to deter the French. We through Tory weakness in managing our economy and our sovereignty and with hopeless PM, our borders are non existent and we are being endangered. The Border Force and the RNLI help the illegals over the Channel.

    What kind of government and administration do we have?

    1. Bill B.
      November 17, 2021

      What kind of government do we have, Prangwizard? I’d say the kind that does what it likes.
      A.k.a. tyranny.

    2. No Longer Anonymous
      November 17, 2021

      With a news blackout from the BBC.

  34. Original Richard
    November 17, 2021

    This will be a reorganisation driven by our Marxist fifth column to weed out any non-believers and expand their number and grip on the NHS.

    The Government should request each Trust Board to publish detailed lists of admin (not patient-facing) and clinical (patient-facing with health skills training) staff positions and salaries together with totals.

    I would do this to be able to compare Trust Boards and then I would ask them to reduce their admin costs by 10% each year.

    To clear the back-log I would be issuing patients with vouchers to spend on private care, not pouring more money into the NHS to expand their admin.

    PS :
    I would also instruct the Trust Boards to ensure that patient-facing clinical staff and patients are given priority for hospital on-site car parking spaces as opposed to the 9-5 admin staff which is often the case at present.

  35. a-tracy
    November 17, 2021

    Oh dear, this just sounds like layer after layer of people to make excuses.

    Can you show the structure in a table if the NHS have an organisation chart?

    How do you control the funding and how do you know the productivity of each trust? Who checks wage bill -v- treatments given?

    Does every A&E have a doctor’s surgery attached? “As of March 2020, there were 132 NHS trusts operating type 1 A&E departments. Each trust may operate more than one type 1 A&E department, and, based on audit data from the Royal College of Emergency Medicine, there are approximately 180 individual type 1 emergency departments in England.25 Mar 2020” source kingsfund

    Who monitors what A&E’s are being used for? How many day appointments could be dealt with at local GP/community nurse level, why was it necessary for the person to go to A&E?

    Who monitors how many procedures are done in each trust to compare to the rest of the trusts?

    If trust areas are unbalanced with levels of deprivation and need then this is the levelling up you need to start to address. Don’t keep building social and affordable housing all in the same towns year after year, decade after decade in the areas with the poorest schools and other provisions. That is what levelling down does, it creates to much burden on services in some areas.

    1. Narrow Shoulders
      November 17, 2021

      Does anyone ever get turned away from A & E

      1. a-tracy
        November 17, 2021

        NS – they are doing recently yes. I know a chap who has nearly lost his eyesight through it, he sat up all night in a chair scared to death because he was told not to lie down in case the blood clotted behind his eye!

        I know people where a distressed doctor came out into A&E and told everyone there was at least a four hour wait before they would be seen so if their problem could wait for the following day please leave.

      2. SM
        November 18, 2021

        Don’t know if the rules have changed now, but in my day, once someone had entered they could not be turned away without being checked.

        What is needed is a very firm and permanent triage system – some hospitals have them, many wouldn’t recognise how to even start one.

  36. Original Richard
    November 17, 2021

    We appear to have a GP shortage when in fact we have a shortage of GP hours worked.

    The base problem is that GP surgeries are private businesses paid by the number of patients on their list, as opposed to work done, and because they are well paid, 90% of GPs can afford to work part time.

    The Government needs to change this model and I would suggest starting salaried NHS GP posts working in surgeries attached to hospitals. One advantage would be that if a patient arrives with a serious condition they could be sent immediately to the relevant hospital department without all the letter writing referral time wasting.

  37. acorn
    November 17, 2021

    For those who don’t know their “Network Contract Directed Enhanced Service (DES) 2020/21”, from their Integrated Care Systems (ICSs) part of the NHS Long Term Plan; read on.

    In one universe exists General Practice and its Primary Care Network These are responsible for over severn out of ten jabs in the arm over the last eighteen months.

    https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/30-september-2021 Notice the level of part-time working that has crept in. That is FTE hours against Headcount.

    In a separate universe exists the NHS Hospital & Community Health Service, which headlines that Professionally qualified clinical staff, make up over half (52.5%) of the FTE HCHS workforce. (I would replace the word “over” with “only”. Remember, this system doesn’t send out any invoices to its customers.)


  38. Ed Hoskins
    November 17, 2021

    Why the health service works in France

    As an Englishman living in France who worked in the NHS some long time ago, it is of great sadness to me that political dogma and the refusal to accept criticism of what has become a national icon manages to blank out any consideration that methods and experience from elsewhere could ever be applicable in the UK.
    This is particularly so in the NHS, where the dogma that the government has to be directly responsible from taxation for the supply of health care have been inbuilt for so long. This combined with “free at the point of use” is particularly damaging. (What is even more amazing is the fact that so little in the NHS is actually free at the point of use, prescription charges, dental costs and the endemic rationing, which itself translates into huge costs for the individual patient.)

    So why are things so different here in France.

    These are my simple conclusions:
    A. The system is run on an insurance basis based on income supervised by the state but with no direct participation by the state. The system has state protection for the low paid, the chronically ill, pensioners, children, etc.
    B. “Free at the point of use” in the UK is a fallacy and only encourages people to use UK medical services unnecessarily and to regard the access to such services as being as of right.
    C. Here the modest fee ~€20 payable to the GP, most of which reimbursed later, is a disincentive to time wasters and malingerers, even in France, a country of hypochondriacs. It is amazing how effective the cash flow consequences of having to pay the doctor his €20 fee, even though it can be claimed back later, is in making sure that patients really need to be there. Of course, anyone with a noted chronic condition or socially disadvantaged will be reimbursed 100% and if he has a Carte Vitale the GP is credited automatically without money changing hands.
    D. The Pharmacist will provide over the counter advice and drugs for almost any common aliment. He will also provide prescription drugs (un-reimbursed), if needed at his discretion. Thus the load on the GP is much reduced.
    E. All the providers in the system, the GPs, consultants, diagnostic labs, district nurses, etc. are self-employed private contractors within the system. But they normally work at Nationally proscribed fee scales.
    F. The contractors in the system choose their mode of working from the point of view of their own businesses, within those fee scales. This results in the outcomes most of which would be remarkable in the UK except in the costly private sector:
    • The GP has no secretary and no appointment system. Turn up when you need and wait perhaps 20 minutes on a busy day.
    • GPs are not paid by a capitation fee based on registered patient numbers but on their actual patient appointments. And only recently a system of affiliating patients to GP’s has been introduced, before that it was totally open to the choice of the patient on any particular occasion
    • The patient also has the choice of which consultant to see and can contact his office without consultation, but the GP will always recommend the one he considers suitable.
    • The GP will also be happy to make home visits: the reimbursed charge is rather more.
    • The dentist has no dental nurse and runs the practice single handed. A large proportion of his fees are reimbursed to the patient.
    • The busy cardiology practice with three consultants has just one administrative assistant.
    • The district nurse will turn up at on the doorstep to take a blood sample at 7.00 am in the morning for a fee of €6.35 (reimbursed).
    • The consultant dermatologist answers his own phone and makes his own appointments without any need for administrative help.
    • As well as doing major surgery, the consultant orthopaedic surgeon does his own minor splint work on the spot.
    • Etc. etc.

    Thus, the administrative load created by centralised control and rationing of access to consultants, treatments and hospital appointments does not exist.
    G. As separate private contractors, all health professionals work as if “their time was their money”. Most UK hospital consultants are already private contractors as well as being well-paid part-time government employees. A piece-work remuneration system has been working for dentists in the NHS for many years.
    H. There is a real emphasis on preventative medicine and prompt treatment is considered to be economically worthwhile. Thus, certainly in my experience waiting lists just do not exist. In addition, speaking as a pensioner, practitioners do not seem to think that age is an impediment to treatment.
    I. There is certainly an abundance of medically qualified people in the system and indeed there is a real degree of competition between them. According to OECD figures, there are almost twice as many medically qualified professionals per head of population as in the UK health service. They are not rewarded with the high salaries received in the UK.
    K. The medics seem to control the running of the hospitals and other facilities not the government. They see the benefit of having an absolute minimum of administrative overheads. Those that exist are mainly involved with the ensuing that the various state mandated Insurance organisations are charged correctly. This also means that there are no artificial limits placed on maximizing the use of expensive capital equipment and the hospital installations.
    L. Also, crucially, as the government is not supplying the service, the state does not own the product of the service nor most importantly the patients’ medical records.
    Patients have bought the service either directly or via their insurance: they are therefore the owners of the results. Responsibility for the ownership of such records is reasonably unloaded on to the patient. This eliminates another whole swathe of administrative costs. As there is no government duty of care with regard to patient records, there is no demand to create an expensive nationwide database of everyone’s medical records, as was tried and failed in the UK.
    Any minimal useful information is retained on the chip of my Carte Vitale. The Carte Vitale is a type of credit card with a chip, that is used to organise the data required for my insurer to pay the sums necessary to the whichever part of the health system I have used. The Carte Vital can be updated on the terminal at any pharmacy. This seems to be a truly efficient use of Information Technology as applied to the health service.
    And in France there is a much simpler health IT system. It has been working for decades and it is visibly successful just across the channel.

    The Nation’s Health not the National Health Service should be the priority of government.

    The NHS is certainly not the only way to organize a Health Service and the clear evidence is just across the channel. But dogma means that the Brits would never want to learn from foreigners.

    1. a-tracy
      November 17, 2021

      Ed thank you for taking the time to write this. Very interesting.

    2. SM
      November 18, 2021

      That is extremely helpful, Ed.

    3. Micky Taking
      November 18, 2021

      EXCELLENT, thank you!

    4. acorn
      November 18, 2021

      Agree with you Ed H. I mentioned a month back that the French system is one of the best. Sadly, there is no possibility of introducing such a system in the UK. Sclerotic atrophy of the UK economy; in the last decade particularly, has left its citizenry voting for a clueless, incompetent, self-serving government and a joke Punch and Judy parliament.

      1. Peter2
        November 18, 2021

        Have Labour ever proposed anything other than ever more funding acorn?
        You ridiculously try to blame the current Government but it doesn’t work.

    5. alan jutson
      November 18, 2021

      Many thanks for the lengthy and detailed posting.
      Yes aware of the system, which seems from my limited knowledge to work well, hence the reason I have suggested many times on here that we should look to other Countries and make a proper comparison, unfortunately those who do not want the NHS to change at all, keep on wanting only to compare our system with the USA model, which is probably the worst system in the World if you are not wealthy, instead of opening their eyes and minds to other systems that exist.

  39. Mark J
    November 17, 2021

    The NHS is much like the Railways – a seven day a week essential service. Yet just like the Railways staffed with outdated contracts, whereby the weekends (Sunday for the Railways) aren’t considered part of the normal working week.

    The NHS seems to be very much Mon-Fri and the Railways Mon-Sat.

    Why is it that all these specialist departments within Hospitals do not tend to see patients on a Saturday, or even a Sunday? Why is it if you are admitted to Hospital late on a Friday, it is not until Monday that you finally get to see someone whom can properly deal with your case?

    For those that say GPs are doing a wonderful job. They really aren’t. There are people I know whom are still struggling to get a face to face appointment with a GP.

    Too much of our money is wasted within the NHS. The solution is to reform to ensure the massive amount already given is used to its full potential. However, the easy option (as always) is to just tax us more to pay for a bureaucratic and failing system.

    The Conservatives (a word i use loosely), need to stop worrying about the hard left and their luddite attitudes to public sector reform and get on with doing it.

    If it was down to the hard left. The NHS would still need three people to change a light bulb.

    1. Micky Taking
      November 17, 2021

      ‘three people to change a light bulb.’ – all employed by a contractor and the cost of the light bulbs might be 10x local store cost.

  40. Mark J
    November 17, 2021

    As I mentioned previously I now support an ‘Entitlement Card’ that grants access to UK services and benefits.

    Lax immigration and checks on entitlement have now pushed me to supporting such an idea.

    It is now the only way to ensure that those that have contributed and are entitled, are the ones to use these ‘free’ services.

    The ROI have such a card in operation, why not us?

    The NHS is a national health service, not an international one – open to the whole world to use and abuse at will.

    I also don’t agree with Emergency care continuing to be free to visitors. If I go elsewhere in the world I am expected to pay, even for emergency services, or have the relevant insurance in place to cover emergency medical treatment.

    Why is it the UK Government still feels it has to provide emergency treatment for free, that UK taxpayers have to pay for?

  41. graham1946
    November 17, 2021

    ‘The Integrated Boards will be responsible for Finance’

    Pet projects will get funding, essentials will be cut. Stand by for more ‘Wokery’ treatments. Senior executives will get more money and posher sounding titles and more administration. We had a major Tory re-organisation in 2012 which has been a disaster, together with Labour’s idea of making nursing a degree post.
    GP’s to be included – they can’t (or won’t) handle what they already have. There are far too many ‘Trusts’, all with their own directors, finance, buying et al. Looks like another ‘jobs for the boys’ stunt to look as though something is being done but this time with the government being able to deny involvement when it fails, so I see the advantage for the politicos. Politics needs to be taken out of this and education altogether and the departments folded up – they do a poor job, but of course this would result in less jobs for the chumocracy. I despair.

  42. glen cullen
    November 17, 2021

    The BMA is to powerful an union for any government to change
    While senior consultant doctors & GPs remain self employment and yet are allowed to be the decision makers they’ll ensure that the shape and funding is to their advantage
    This government hasn’t the bottle to go head to head with the BMA

  43. Julian Flood
    November 17, 2021

    Sir John,

    Reform of the NHS is impossible to achieve if taken head on as there are too many vested interests and too much history. There are (reputedly) better systems used around the world. but we have no way of getting to them.

    Remember VW when it was producing the Beetle? The world was moving on, but they were committed to the one product and so were their customers . They solved the problem by trying other models on a small scale, slowly upping production of those which proved acceptable and dropping those that weren’t. Eventually the Beetle was hived off and the successful substitutes took over. My inclination is for drop-in centres where, for example, recently qualified doctors and health workers build their expertise before becoming very well paid GPs etc. Insurance schemes are another way, with individuals taking their taxpayer funding with them.

    AS a councillor I watched the CCG struggle to provide services for a town with health problems caused by the ageing generation that had moved to the promised land of Suffolk in the 70s. I managed to get a briefing from a Cambridge academic who specialised in such matters, and he explained how a displaced population brings with it the medical history of its origin, a history that takes two generations to discard. My ex-East End residents were displaying the profile of their past and were, in the words of the CCG, ‘getting old early’. Cigarettes, diet, exercise were all factors, but this demographic problem was ignored by the CCG funding model. Health expenditure is weighted to the end of life and that time is calculated on a model of ageing that is inflexible. Get that wrong and local services are overwhelmed.

    This, Sir John, is going to be very relevant as the Blair Major immigration boom begins to age, something which will happen after two generation if the deracinated populations change their behaviour to match the local population. If. So until 2040-ish the funding algebra must match the reality of historical health deficiencies and things in our inner cities could then begin to improve. Good luck selling this policy to the voters, but that’s what you are paid for.


  44. DOM
    November 17, 2021

    The NHS serves itself and only itself and has become a useful political tool for the Socialist political grifters that now infect our nation .

    John knows this nation’s public sector, its institutions and its politics has been infected and taken over by dark forces and yet for reasons I understand he and other decent MPs cannot expose the poison that is destroying all that we are

  45. Micky Taking
    November 17, 2021

    off topic.
    BBC website:
    Nine Insulate Britain protesters have been jailed for breaching an injunction designed to prevent road blockades. Activists began a wave of protests two months ago, blocking the M25, roads in London and elsewhere in the UK.
    Ana Heyatawin, 58, and Louis McKechnie, 20, were jailed for three months while Dr Ben Buse, 36, Roman Paluch-Machnik, 28, Oliver Rock, 41, Emma Smart, 44, Tim Speers, 36, and James Thomas, 47, all received four-month sentences. The group vowed to continue protesting.
    The submissions made by Ben Taylor, 37, to the court on Tuesday were described by Dame Victoria Sharp as “inflammatory” and a “call to arms”, and he was therefore given a longer sentence of six months “to deter (him) from committing further breaches”.

    At last the Law of the land being seen to be applied.

  46. X-Tory
    November 17, 2021

    On today’s topic of the NHS, I know that you have advocated the introduction of UV Air Purifiers in hospitals, a stance which I have strongly supported in these pages, even giving you details of a couple of British manufacturers of these devices. You will therefore have no doubt been pleased to note the reports that a UK trial of these air filters has been a resounding success – see here: https://www.forbes.com/sites/victoriaforster/2021/11/16/portable-air-filters-in-hospital-wards-remove-airborne-covid-19-virus/ (As an aside, it is amazing that I have only seen reports of this in the foreign media, and not our own!).

    As the report says: “An air filtration machine placed on a Covid-19 hospital ward removed almost all traces of the SARS-CoV2 coronavirus, according to a new study by researchers at the University of Cambridge in the U.K.” The report goes on to explain that “On the surge ward with patients requiring moderate support such as oxygen, the SARS-CoV2 virus could be detected consistently before the air filtration unit was switched on, but not on any of five testing days afterwards. After switching off the machine, the researchers once again were able to detect airborne virus. ” Indeed, the filtration was not only effective against covid: “the team also found that the air filters reduced levels of fungal and bacterial bioaerosols as well as those of other viruses on both wards tested, reducing the overall number of pathogens in the air.”

    In view of this, will you now be asking the SoS to give a firm timetable for the installation of *British-made* High Efficiency Particulate Air (HEPA) devices with UV sterilization in every ward of every hospital in the country? After that we can think about making these devices compulsory in other public settings, like restaurants, pubs, cinemas, theatres, supermarkets etc. After all, these venues all need to meet safety requirements in other areas (fire, food, etc), so why not air?

    Reply I regularly follow up on this matter and am grateful to you for the report.

    1. Fedupsoutherner
      November 17, 2021

      Well done X-Tory. British made. Great news.

  47. Nota#
    November 17, 2021

    As was stated yesterday NO amount of money and within that you could add the shuffling of the pack, will mend a top down broken system. The people at the top, the Empire builders are their own arbiters of what is ‘right’

    As these entities and individuals are taxpayer funded, employees of the taxpayer, as such should be directly held responsible for the direction they take by the taxpayer. We have a wacky system in the UK in that the UK Health Minister( A false title) is only allowed to pontificate of English matters but has no authority.

    Realistically Health Authorities should be brought under political control, therefore also taxpayer control via the use of the Local Authorities. The concept of overlapping regions, counties etc is a fudge by those that wish to ‘hide’, escape scrutiny and maintain their Empires.

    As with everything in our disjointed society, everything that is in receipt of taxpayer money no matter how small should be subjected to full, proper and formal accounting and overseen by an elected individual that stands to loose their jobs if any neglect is found.

  48. glen cullen
    November 17, 2021

    Very disappointed with the eton college 6th form debate today….can’t believe these people are running our country
    Forget NHS reorganisation we need urgent parliamentary reorganisation

  49. Denis Cooper
    November 17, 2021

    Off topic, it seems that Lord Frost has forgotten that some of the goods crossing the Irish land border into the Republic have been produced in Northern Ireland and so could not be caught by import checks at the ports in Northern Ireland. They could be caught by checks on goods exported to the Republic, alongside any goods brought into the province from outside which were destined for onward carriage to the Republic, but by sticking with this illogical system of import controls rather than a rational system of export controls he will make sure that Northern Ireland has to remain under EU Single Market rules, and therefore under the jurisdiction of the EU court. Eventually that will split the province off from the UK.


    “David Frost: UK wants a ‘reasonable’ Irish Sea border”

    “Britain’s top Brexit negotiator rejected Democratic Unionist calls for an end to checks at Northern Ireland ports.”

    “Britain accepts the treaty requirement for an Irish Sea trade border as “perfectly reasonable” as long as EU checks can be confined to British goods bound for the Republic of Ireland, the U.K.’s Brexit minister said Wednesday.”

    1. X-Tory
      November 17, 2021

      You’re right – Lord Frost’s words are shameful and disgraceful and demonstrate that he is just another traitor, no better than any of the other members of the government.

      A border down the Irish Sea divides our country (to say nothing of the fact that we are doing the EU’s work without being paid – what are we, their serfs???). It is completely unacceptable. The solution we wanted was for there to be NO CHECKS of any kind, as UK standards and EU standards should be considered EQUIVALENT. Different, yes, but equivalent. And having an open North/South Irish border could be our way of IMPOSING this on the EU. They will be forced to accept it because there is no way they will want to erect a border after all they have said against this.

      But Boris and Frost are too pathetic and cowardly and treacherous to try and impose things on the EU. So instead they allow the EU to impose their vision on us. It makes me sick.

      1. Denis Cooper
        November 18, 2021

        The Maidenhead Advertiser has printed the letter I sent in, pointing out the absurdity of the position adopted by the Irish government and questioning why both Theresa May and Boris Johnson were so ready to accept it:


        But I wrote that letter before I had seen the book review by Rory Montgomery with the admission:


        “It became our firm position that any checks or controls anywhere on the island would constitute a hard border.”

        According to that there must now be a hard border, with checks and controls across both parts of the island, even though it is constantly pretended that the protocol is necessary to prevent a hard border.

        For example this morning:


        “EU proposes legal footing for 50% cut in formalities”

        “The Northern Ireland Protocol requires checks and controls on goods moving from Great Britain to Northern Ireland so as to avoid the need for a hard border on the island of Ireland.”

  50. Bob Dixon
    November 17, 2021

    The NHS will not meet current challenges with out a major change.
    That change is Privatisation.

  51. John E
    November 17, 2021

    The money would be better spent on nurses salaries. Some hospitals are reaching the tipping point where staff leave and those that are left behind then leave as well because their jobs have become impossible.
    I think a free market would pay nurses 20% or 3o% higher salaries in Wokingham/Reading at least.
    Boris was quick enough to tell the haulage companies that they needed to increase pay and improve conditions to attract more HGV drivers. Somehow this logic doesn’t apply when it comes to NHS clinical staff but all the reorganisation in the world won’t make any difference.

  52. Lindsay McDougall
    November 18, 2021

    It sounds like an unnecessary layer of bureaucracy leading to confusion. The decision to integrate health and social care is a disaster. Far better to put local government and the private sector firmly in charge of social care with options for funding, including charges. Let the NHS get on top of its many problems.

Comments are closed.