New management should take a fresh look at the NHS

Today the new Health Secretary will seek to focus the NHS on a new alphabet. A is for ambulance use, B is for backlogs or waiting lists, C is for transfers to care and recovery homes and D is for doctors and dentists. I wish her well in getting ambulance waiting times down , treatment waiting lists down, transfers from hospitals up and numbers of medical professionals up.

None of this can be done without learning from the mistakes of the last two years. Huge sums have been thrown at the NHS but the  non covid services have suffered, with unhappy staff and too many patients in an ever growing queue. So where has all the money gone and why didn’t it buy success? Just throwing more at it will not solve the problems.

Let me begin by repeating that I like many am grateful for the hard work and risks run by the teams that responded to covid before medical science knew which medicines helped and before there was a vaccine.
Unfortunately the senior management refused to use the Nightingale capacity to create covid specialist hospitals. That meant many non covid wards in general hospitals were unable to work fully, leading to many other untreated conditions. Money spent on the Nightingales was written off. Large sums were also spent on taking over the capacity of private hospitals to do non covid work, only for that capacity to be too little used.

The NHS then spent a fortune on a Test and trace scheme of very variable quality which some people gamed to carry on their normal lives. This spending  has now rightly been wound down.

The management needs to share its manpower plan and detailed budget with Ministers and Parliament. Ministers who take the blame need to be more engaged with the use of all the cash.

174 Comments

  1. DOM
    September 22, 2022

    ‘Let me begin by repeating that I like many am grateful for the hard work’.

    I gave up reading the rest of the article after I saw this. This is classic Tory party capture in action. Fearful of being seen to be criticising Labour’s medical arm of their unionised client State that is the NHS Tory MPs try to pacify any potential accusation that they abhor the collectivist NHS. It cannot be emphasised just how much we have lost and what will continue to lose due to the Tory party refusing to condemn the rise of collectivist and Socialist ideology since 1997.

    John knows full well that the NHS is utterly dysfunctional (Tavistock) unionised to the core, politicised to the core and is now run not by the SOS for Health but by union leaders and employee vested interests like the BMA etc..

    Cameron’s cultural shift imposed upon the party when he declared ‘we will go with narrative’ has caused untold damage as he gave a green-light to the Maoist and Marxist left who now control many areas of life in the UK

    I see no point in discussing this issue when the party in government is more aligned with Labour and the unions rather than governing on behalf of the taxpayer, the patient and morality rather than trying to appease the unions, the Guardian, the BBC and Labour

    Just give it up Tory party and declare your true colours because this tightrope you’re walking will at some point snap and cause the nation real harm.

    Reply
    1. John Hatfield
      September 22, 2022

      Indeed, I doubt that any NHS staff work as hard as the staff in (say) a fast food outlet.

      Reply
    2. Mickey Taking
      September 22, 2022

      Certainly the NHS sits firmly on the pedestal established over so many years, religion-like from early beginnings as the health service provided out of general taxation – free at he point of need to the Empire of the regions, the quangos, the research councils, the pharma investments and handsome payouts to 5 day ‘service’ not 7 day week delivered from post-code luck and queues never ending with the annual £billions disappearing into the country’s largest employer, finally delivered by ad-hoc judgements and marie -celeste surgeries.
      Is the challenge never going to be tackled? It requires something of revolution, and rejecting the furious outcry needs a level of mandate. So, what does a party do with an 80 seat majority facing down quite strong odds of being rejected within 2 years by the electorate? Is this exactly the sort of rescue, reorganisation that could secure election success much more than promises certain to reneged on as they always are!

      Reply
  2. Wanderer
    September 22, 2022

    Instead of a vague aim to improve certain services, maybe there should be some guidance as to what a good service would do, so the public get to see what the service ought to be like?

    For example, I’m in Vienna and don’t use private medical services. I can always see my doctor when the practice is open, either phone for a specific appointment time that day or simply turn up and wait. The doctor gives me a referral for any tests I need, then I arrange them with any supplier of those services. Waiting times I have regularly experienced: blood test 24hrs (+ 24 hrs for results), x-ray 1 week, CT scan 3 weeks (I got lucky once and had a next-day), consultants a few days if urgent (2-4 weeks otherwise, depending on specialty), surgery outpatient appointment 2 weeks.

    At hospital as an outpatient, you do wait for up to 2hrs for the first consultation, but then any further tests (additional x-rays, scans etc) are usually done that day, so you can wander back to the consultant again with all the information he/she needs.

    I pay about 6 euros for each prescription, otherwise I pay nothing for any of these services at the point of use.

    How costly this is to me via taxation I don’t know. But it’s a pretty good system for patients. Could the NHS aim for this? Is it affordable?

    Reply
    1. formula57
      September 22, 2022

      @ Wanderer ” I can always see my doctor …” – that is a relief to those of us sick with worry that you might perish before removing the RNLI taxi service from your will.

      Reply
  3. Wanderer
    September 22, 2022

    I forgot to add you must be working, officially unemployed or retired to use the health services. Otherwise private insurance is needed, costing 700 euros per month. I don’t know what they provide for illegals.

    Reply
    1. Bloke
      September 22, 2022

      Instead of Govt running the NHS like a communist system, voters should each be allocated an equal share of its budget to spend on their own healthcare. The supply side would then compete on quality and value with the patient free to choose the best service. Their personal unused funds could build their pensions, or be allocated to family members or others in need.

      Reply
      1. jerry
        September 22, 2022

        @Bloke; How is the NHS “like a communist system”, unless you mean those in the most need are given priority over those in less need. But then even private medicine prioritize, I know someone who has been waiting for a knee replacement for months now, he understand he’ll never get it on the NHS as his need is in a very low priority group, so is prepared to be a private cash (not private insurance) paying customer to a large private group within your beloved private medical industry, yet dates keeps getting pushed back.

        “The supply side would then compete on quality and value with the patient free to choose the best service.”

        These supply side companies should be just that, and indeed they already are, in the same way as deference contractors simply supply the MOD -not stand their own armies!

        Anyway, this multi level service you suggest, just how would any ‘customer’ make informed choices, who would give them unbiased EXPERT opinion, on-line (perhaps paid or fake) reviews perhaps, someone who is perhaps on commission, or a specialist Consultant who earns no more nor less whatever the final outcome might be. Also how would your suggested such health care system be regulated, for example in stopping unnecessary procedures, simply because such procedures make additional profits for the supply side companies, in the same way as any ‘up-selling’ does.

        Even in the USA, those who do not object to the cost of necessary private health insurance all to often complain about the ‘market’, and they have good reason, given the level of medial negligence and malpractice claims.

        “Their personal unused funds could build their pensions, or be allocated to family members or others in need.”

        That sounds somewhat like “National Insurance”…

        Reply
        1. Narrow Shoulders
          September 22, 2022

          @jerry I really don’t think you can argue that those in most need are given priority when looking at the waiting lists. I appreciate what you are trying to argue but it is so broken tha t we need solutions not platitudes.

          Reply
          1. jerry
            September 23, 2022

            @NS; Both the public and private health care systems are are broken, neither system need platitudes. But I take your point, and agree, yes perhaps I was presenting a somewhat over simplified argument -in reply to an ever more simplified suggestion!

        2. Bloke
          September 23, 2022

          @jerry:
          Every patient would be free to buy the best.
          The present NHS invoice arrives as a heavy tax bill muddling everybody.
          Join the queue. Your call is important to us.
          Efficient regulation is a simpler task for Govt than running the entire business.
          Whatever so-called ‘deference contractors’ might do is a matter for them.

          Reply
          1. jerry
            September 23, 2022

            @Bloke; Nice rant, but perhaps you could actually try answering the questions I asked above!

            “The present NHS invoice arrives as a heavy tax bill muddling everybody.”

            You point being what. Surely no different from any other public spending etc, but then perhaps you think CND had a point back in the 1980s when they demanded tax-rebates for anyone who didn’t want their taxes spent on ICBMs?…

            “Join the queue. Your call is important to us.”

            Is that an echo I hear?… I could swear I was being told just that this afternoon, whilst in an automated-telephone customer service queue, waiting to speak to a privatized utility company; I gave up after 45 minutes.

            “Efficient regulation is a simpler task for Govt than running the entire business.”

            Nonsense, otherwise why do some private industries and services demand self-regulation, given it’s always easier to be both Judge and Jury as to what is acceptable or not!

          2. Bloke
            September 24, 2022

            (Waiting in a queue and giving up doesn’t reach).

    2. ukretired123
      September 22, 2022

      @wanderer So true and basic stuff.
      One basic problem with free NHS care is that people choose to ignore their own health by default, often unthinking either poorly educated, lazy or both and rationalise the NHS will solve it anyway and if they don’t can make legal and financial claims on the system funded by the taxpayer.
      If they had to pay before any visit as in other countries or pay upfront for health insurance they would have to seriously consider having a more proactive lifestyle and not couch potatoes by default.
      Simple risk / reward economics would work wonders.
      I appreciate that some people cannot deal with this due to being disabled but I know that even when NHS advise individuals with pre-diabetes they excuse themselves and have no appetite for that but the reverse and can invoke, nay demand EU human rights as in the extreme cases!

      Reply
      1. jerry
        September 22, 2022

        @ukretired123; “One basic problem with free NHS care is that people choose to ignore their own health by default”

        Oh you mean like so many do in the USA, because they can’t afford health care, so they ignore the first symptoms, then the secondary symptoms, thus by the time they finally do seek medical help their condition is well advanced, what ever the end outcome it is often the tax payer via medicare etc who foots the cost, and those costs are often far higher than they should have been had health care been free at the point of need to begin with.

        I also suggest the average person in the UK does have a perception of UK health care costs, you might have ignored the deductions listed on your wage slips but I suspect most do not, hence why so many people complain about the level of NI etc!

        “they would have to seriously consider having a more proactive lifestyle and not couch potatoes by default.”

        As if all illness is caused just by a sedentary lifestyle and/or diet, much illness is either age or work related, other illnesses would have happened anyway, family genetics being a bigger issue than any other.

        Reply
        1. ukretired123
          September 23, 2022

          Reply to Jerry
          Obesity and overweight is rampant in USA and UK with overweight kids copying overweight parents because you don’t need to walk, work, cook or break sweat by default and can rationalise it by excusing yourself with plausible denial. The trend has been accelerating and snowballed to be a major problem for the NHS.
          We are part of the ageing population and we minimize our demand for the NHS for obvious reasons stated as we have real NHS feedback from family and friends. We don’t use our age to excuse ourselves. Read Dr Moseley for some inspiration. We walk the talk, run, ride and train with kettle bell weights and shrug off lots of health and economic problems by doing so, smiling generating the precious endorphins (invisible and which you cannot buy or get on the NHS!).

          Reply
          1. ukretired123
            September 23, 2022

            Our bodies are designed for work not benefits! Surprise surprise!
            Something you will never hear from the Labour party…..
            Mental health relied on physical activity. Basic stuff.

          2. jerry
            September 23, 2022

            @ukretired123; Unlike you, I’m not in denial at all, were did I suggest obesity isn’t also a problem, all I’m commenting on is your rather quack-like one size fits all “remedies”, and your wish that everyone who doesn’t fit your ideas should be tared with the same broad brush.

            “generating the precious endorphins”

            Natures natural pain inhibitor in other words, natures way of allowing for the flight reflex even whilst injured, when ignoring damage to the body is less important than not being killed! Hence why some ‘keep-fit’ (haha) fanatics end up doing real harm to their own bodies, when they ignore both the bodies own natural signals to stop and the advice of a professional trainer, often just to get that feel good ‘high’ caused by the release of endorphins.

            “Our bodies are designed for work not benefits!”

            Nonsense, our bodies are designed for neither. Our closest relatives, the ape, spend most of their time either sleeping, resting or socializing/playing, work is limited to hunting for food…

  4. Mark B
    September 22, 2022

    Good morning.

    Perhaps it is time to think differently. Unless the new Minister has workable plans and a grasp of many of the problems facing healthcare they doomed to fail like the rest.

    One area they can make a start on is health tourism. This consumes both money and resources which adds to waiting times. I have suggested possible solutions, many which are in practice in other countries, but there is that typical bureaucratic head in the sand mentality to overcome.

    The NHS is highly unionised and the unions fund the Labour Party. Whilst that is still the case you can kiss goodbye to any hope of reforms as Labour will mobilise to protect its Cash Cow.

    With the GE so close I think it best not to rock the boat and further add to your parties woes.

    Reply
    1. jerry
      September 22, 2022

      @Mark B; The NHS was not failing 50+ years ago, mostly because of the post war consensus, whilst I’m not suggesting it was perfect its only real hiccup had been due to the cost of the war in Korea, back in 1950/1, when Attlee imposed prescription charges etc. and then paid the price in votes.

      As for health tourism, that problem is due to the inability of NHS Trust’s back offices to actually process and seek repayment. Anyway, many of those so treated would have been treated regardless of their travel insurance status, or the likelihood of repayment, either for our own public health protection or simply out of compassion.

      “Whilst that is still the case you can kiss goodbye to any hope of reforms”

      That is the case with ANY funding that comes from vestige interests, be they trade unions, employer groups or just wealthy private individuals, it’s a cross party problem and needs a nonpartisan solution.

      Reply
      1. ukretired123
        September 24, 2022

        Jerry – you presume too much from your pedestal view of the NHS .
        Let’s hear your constructive ideas on how to turn this mega cash sink hole around instead of general carping.

        Reply
  5. Cheshire Girl
    September 22, 2022

    It was my understanding that the Nightingale Hospital were not used, because the NHS did not have the staff to man them.
    Was that not the case?

    Reply Not so

    Reply
    1. Ian Wragg
      September 22, 2022

      I see despite whinging for more money the NHS is still advertising for inclusion and diversity managers on £100k annually plus all the fringe benefits.
      My wife has a cataract operation due, over a year wait on NHS, £2k private and being done next week.
      This should be refunded from the NHS budget but it isn’t.

      Reply
      1. DennisA
        September 22, 2022

        Also we have the “Greener NHS”. This is an advert from a few months ago, there will be many such posts and growing.

        Net Zero Programme Manager, London, £54,764–£63,862 a year
        “Full–time – This is an exciting position in the Greener NHS’s Net Zero Operations function, within the wider Greener NHS central programme team. It’s a great time to join the programme, following the commitment by the NHS to become the world’s first Net Zero national health system, alongside the appointment of the NHS’ first Chief Sustainability Officer.

        This commitment and multiyear plan (detailed within ‘Delivering a ‘Net Zero’ National Health Service’) reflects growing evidence of the health impacts of climate change and air pollution, alongside recognition that it is not enough for the NHS to treat the problems caused by air pollution and climate change – from asthma to heart attacks and strokes – it needs to play a part in tackling them at source.”

        These statements regarding asthma, heart attacks and strokes have no evidence to back them up and indeed can be shown to be false. The NHS should focus on front line care, not chase political fads.

        Reply
        1. Narrow Shoulders
          September 22, 2022

          Public service directives require this sh*% from public sector organisations including the NHS.

          Liz Truss’ new government can remove many of these directives and then require that tge public sector stops spending money on these distractions

          Reply
      2. Mickey Taking
        September 22, 2022

        Should have called SpaMedica (not spec*****).

        Reply
      3. jerry
        September 22, 2022

        @Ian Wragg; Yet who has been in govt for the last 13 years! The problems you cite are caused by woke politicos, the NHS is merely having to follow the law or some directive handed down from the DHSC or HMT.

        Reply
    2. Lifelogic
      September 22, 2022

      The Nightingales were surely an expensive PR stunt to show that the government were doing something even if it was expensive and largely totally pointless (rather like test and trace, masks, the largely ineffective and often dangerous vaccines… To reform the NHS 1. Charge everyone who can afford to pay something for every usage, 2. Pay people 50% of the cost of their operation if they go privately rather than use the NHS (this saves 50%, get more money into healthcare and shortens the waiting times for others), income tax breaks for private health care insurance (company or private), abolish Insurance Tax (12%) on medical insurance.

      This would be a good Start. The Thatcher era had most of this. Same applies to schools, universities, the BBC, social housing and transport fair – competition between state and private provision should be the norm.

      Reply
      1. Narrow Shoulders
        September 22, 2022

        Teat and trace really was PR exercise in shutting the stable door after the horse had bolted.

        Reply
    3. agricola
      September 22, 2022

      Reply to reply.
      Not so is an inadequate response. If they had insufficient hospital doctors, nurses, and other medical staff to run the NHS pre Covid where were the staff to run Nightingale going to come from. Perhaps an answer to such a problem in the future would be the creation of a Territorial Medical Service.

      Reply
      1. Barbara
        September 22, 2022

        Many retired medics offered to help, but were told they were unacceptable.

        Reply
    4. No Longer Anonymous
      September 22, 2022

      The Nightingales weren’t used because the majority of Covid patients were seriously ill because they had known Covid-worsening co-morbidities and weren’t set up with the equipment needed to deal with these.

      They were also meant to be Dying Homes. For the mass deaths we were expecting.

      It was clear from early on that mass deaths weren’t going to happen and that vulnerable people could be clearly identified and shielded.

      The Tories were intimidated into lockdown and extended lockdown. And face masks.

      Reply
    5. Hope
      September 22, 2022

      JR,
      So why did your govt make it happen? Are they so weak and pathetic to do their job? So let us get this right. Your govt instructed the hospitals to be built by the military at taxpayers’ expense and were content for them not to be used thereby wasting our money!

      Good grief your govt and party are more useless than I thought.

      Reply
  6. Nottingham Lad Himself
    September 22, 2022

    I suppose that if you’re trying to hoover up the votes of the infantile, then yes, be infantile.

    Reply
    1. Lifelogic
      September 22, 2022

      Well I suppose you should know a lot about “infantile”.

      Reply
    2. agricola
      September 22, 2022

      It takes one to know one.

      Reply
    3. Peter2
      September 22, 2022

      All those really clever Labour supporters….
      Keep insulting the voters NHL

      Reply
    4. Narrow Shoulders
      September 22, 2022

      Who smelt it dealt it

      Reply
  7. Bryan Harris
    September 22, 2022

    Having spent a lot of time in a hospital very recently from A&E to a stay and now as an outpatient, it’s all too easy to see that yes, there are problems.
    One of the problems is not the frontline staff.

    Staff seem to be bombarded with new processes and rules on a regular basis, and when something goes wrong the reaction is slow to get things fixed.

    A lot – an awful lot of things do work very well, but I’d be the first one to agree that the overall way that patients are managed requires a vast overhaul.

    The treatments we receive are often as damaging as the problems we came in with, and it’s all too easy for a person to come out of hospital worse than when they went in. Let’s stop using so many very expensive drugs that cause other issues and seek ways to heal bodies with more moderate means.

    Reply
    1. Fedupsoutherner
      September 22, 2022

      Bryan. I wholeheartedly agree with your post. I’ve had 3 major joint replacements. The first knee replacement was abysmal. It took me a long time to recover because my leg was crooked afterwards. While in hospital I was given opioids for the pain which made me really ill. Because my knee was done so badly my hip became bad on the opposite side and had to be replaced. Again, I was given opiods and again I was very ill. I was also not told to stop taking HRT before the operation. Within a week I had an infection in the joint and was hospitalised for a week on intravenous antibiotics and then a further 6 weeks treatment at home. Unbeknown to me I had a clot on the lung. 12 weeks after I had to have revision surgery on my knee and even though I pleaded with them not to give me opiods they did and I was so sick I had a seizure. It was then that they found the clot on the lung which I was told might have been linked to not stopping the HRT before. I had to gave a blood transfusion also. Because if the seizure I couldn’t drive for 6 months even though the specialist was 99% sure it was because of the medication. The knee was a disaster second time around too. I am very reluctant to place my life in the hands on any surgeon again. The staff in these hospitals think they know best abd don’t listen to the patient.

      Reply
    2. John Hatfield
      September 22, 2022

      More paperwork than treatment in my experience, Bryan.

      Reply
    3. Jim Whitehead
      September 22, 2022

      BH, +1, and we shouldn’t overlook the baleful presence of the CQC who terrorise the individual GP and Dental practices with arrogant and intimidatory ever-extended lists of tick box compliance items. Ask your GP who’s looking for early retirement from his or her ‘vocation’ what has been so demoralising about their career choice? The ‘Bureaucracy’ they cite means multiple recordings of trivia as well as ‘audits’ of the obvious when there are pressing needs of real patients to be attended to.
      Even the admin staff of large hospitals and clinics are subjected to such impediments to smooth working practice and are always looking over their shoulder for fear that any move or initiative will be viewed critically by the CQC.
      Masks in hospital or in the GP’s clinic? You can be sure that fear of the CQC’s judgement will be the over-riding factor, not actual health concern.

      Reply
  8. turboterrier
    September 22, 2022

    It is quite obvious that the existing processes applied to the operating of the NHS are totally not fit for purpose.
    Millions thrown at the organisation was just wasted on solution management and not addressing the ingrained problems that have existed for years and just ignored .
    It has become a monolithic entity where big management structures, woke departments, with little or no communication from the bottom to the top as the signals and messages get diluted at every layer of management.
    The Trusts each have their executive departments each one fighting for their share of the financial pot. In some cases in a detrimental way to other sections. Waste oozes from every grain of the organisation. Nobody is happy and it shows in the performance figures.
    It will take one Trust, one minister to be brave enough in their beliefs to find a better way. The building blocks are already there scattered across the organisation, it is the front line staff.
    Invest in just one Trust or even department and introduce Self Directed Work Teams (SDWT) working. Smaller teams empowered to make decisions, change their working practices to meet the operational demands and above all give them the opportunity to use their brains and skills as individuals, to think outside the box and break the pattern of auto pilot working. These people know where the waste is they live with it on a daily basis. With the millions wasted on the existing arrangements the trial will be miniscule by comparison. Talk to big industries they have been doing it for decades, because it works and is fully cost effective.

    Reply
  9. Donna
    September 22, 2022

    “Unfortunately the senior management refused to use the Nightingale capacity…..”

    And, presumably, the same senior management also refused to make proper use of the private sector which had been made available to the NHS at great cost as well.

    In which case, why is that senior management still in a job? They obviously don’t want to deliver a HEALTH service.

    Everyone (apart from itself) admits that the problem with the NHS is the Management and the bureaucracy it has created. So change it.

    Reply
    1. Peter Parsons
      September 22, 2022

      Refused how and why?

      Simply refusing to do something isn’t a reason to fire people. Unless reasons why and/or explanations are given, it is simply impossible to judge.

      Did they refuse, for example, because staffing the Nightingale hospitals would have meant closing the majority of intensive care wards? (To give a hypothetical example.)

      Reply
    2. Narrow Shoulders
      September 22, 2022

      Where is my refund for private insurance unavailable to use because the NHS bought up the capacity?

      Reply
  10. Stephen Reay
    September 22, 2022

    The government is to blame, you are their employers. If the employees,ceo’s or anyone else refused to carryout a reasonable request to use the nightingale or private hospitals the government certainly had the right to show them the door. This is another reason why this country is in so much debt, bad management by the Conservatives.

    Reply
    1. Shirley M
      September 22, 2022

      Nobody will be sacked. Nobody will be demoted for taking such appalling and life threatening decisions, apart from the total waste of money they cause. What possible excuse could there be for not using private services already paid for, and instead, allowing people to go without treatment with possible lethal results?

      Just WHAT does it take for the health and wellbeing of people to be put ahead of grossly incompetent managers and employees? FGS get rid before they do more damage and cause more deaths.

      Reply
  11. Cuibono
    September 22, 2022

    A trocious behaviour on the part of our unfeeling politicians.
    B ad decisions taken over whatever it was they thought they were doing
    C atastrophic results ensuing from everything done by politicians.
    D ubious apologies (scarcely) and explanations for the 2 year horror show.
    E lephant in the room…How could we move so swiftly onto the next “current thing”?

    Reply
  12. Nigl
    September 22, 2022

    It needs new management in the NHS as well. The existing team have been shown to be in denial about their failings and only one mantra, more money, more money.

    I would like to see you take on the political risk of substantial change looking to bring in the best bits of other countries systems including greater use of the private sector and health insurance.

    Constant tinkering umpteen targets etc seems to have done little to achieve structural change.

    Reply
    1. a-tracy
      September 23, 2022

      Nig1. The NHS could have more money, especially in London, if they simply hire accountants, and billing systems that are used on the continent, already working, rather than hiring all these green, diversity coordinators; the NHS in London is already very diverse with 27% of new hirings from outside of the UK. If I were Coffey, I would look at precisely what these frequently critiqued people do, not allow job advertisements next month and share resources between hospitals. Everything seems to be viewed from the London-centric prism.

      Reply
  13. formula57
    September 22, 2022

    And E is for entropy and F is for failure?

    The managers are always taking a fresh look (the Lansley reforms for example) but success remains elusive. The likelihood is that cultural change is needed first and that of course is very difficult to bring about.

    Reply
    1. Lifelogic
      September 22, 2022

      A failure to understand Entropy, Energy, on demand and Climate are largely the reasons for the insane Net Zero war on CO2 religion.

      Can someone tell me why the Gov. push EVs when they cause more CO2 not less, are rather range limited, damage the environment hugely and cost far more to run too?

      Reply
      1. Ian Wragg
        September 22, 2022

        To get you off the road. It’s the latest act in the quest to destroy private motoring.
        You won’t do as you should so we will force your WEF anyone.

        Reply
        1. Lifelogic
          September 22, 2022

          Seems so.

          Reply
    2. graham1946
      September 22, 2022

      The Lansley proposals were never going to work. It was the wrong solution to the wrong problem at the wrong time, mainly because of Tory dogma and a faulty idea. Unfortunately virtually no-one other than Lansley knew what he was doing or tried to understand it. I heard at the time that it was too difficult for Cameron to comprehend so he let him get on with it hoping for the best. We got the worst, more expense, less service.

      Reply
  14. Pominoz
    September 22, 2022

    Sir John,

    The mistakes of the past two years are one thing, but the NHS has proven it is a failing system for decades. ‘Free’ treatment it is not, but the concept of ‘free treatment’ undervalues it in the eyes of the recipient and possibly, for too many of those at all levels involved in the delivery of that treatment, they become complacent about service standards. Doctors’ practices need to be stimulated to compete for patients, as do individual hospitals. A fee paid by patients (albeit modest) at point of delivery would deter flippant use of the health system, although a safeguard for those who genuinely could not afford the fee would be necessary.

    A complete re-think on health treatment is required and the Australian system should be studied as an example. If I need to see a doctor, I can phone my local surgery, speak to an actual person and arrange an appointment, normally with my regular doctor, that very day if it is required.

    Friends and relatives in the UK tell me of horror stories where they cannot even speak to anyone at a surgery and a 92-year-old lady friend has very recently been fobbed off for weeks despite suffering a painful condition.

    Sadly, the NHS is past it’s use-by date.

    Reply
    1. Mark
      September 22, 2022

      It can be done in the UK too. My present surgery provides phone and email contact, and will arrange a GP appointment same day if warranted, in person if warranted, or with little delay otherwise. They have an onsite pharmacy, and should the doctor prescribe there is a good chance that the prescription is available for collection immediately. Of course contact with the rest of the system is somewhat more uncertain, but I did get fairly rapid response when the GP wished to rule out cancer, with an Xray in just 2 days and a phone consultation with the consultant within the week after he had other test results in hand. Had the diagnosis been positive I do not know how long I might have waited for treatment, which might have entailed a hospital over 30 miles away.

      Reply
      1. a-tracy
        September 23, 2022

        Mark, our surgery also provides e-consult; the dr will phone you back, and visits will be arranged from that; it is a bit long-winded to fill it in, and the system asks the same questions every time I need to consult about none relevant items like smoking and drinking even though I’ve never done either, there should just be a button at the top saying no change to last time.
        I also got a fast response when the GP wished to rule out cancer, next day x-ray results in a day. Blood tests are available before work locally, which is a brilliant service.

        The near on-site pharmacy is poor quality; they are very blase about their crucial location and treat patients like cattle. I never get my script filled there because I don’t want to wait around for ages. They have also shut down a lot of very good independent pharmacies that treated you like a customer.

        Reply
    2. Mickey Taking
      September 23, 2022

      You are not rushing to return here then?

      Reply
      1. Pominoz
        September 24, 2022

        Absolutely not!

        Reply
  15. Lifelogic
    September 22, 2022

    Indeed vast waste in the system. Ministers rightly take the blame as the system of “free” at the point of use ensures a virtual state monopoly rationing system. With the disastrous result we see. Under Thatcher there was no Insurance Tax (now 12%), income tax and NI relief on medical premiums paid by companies and individuals so far more companies and individuals had private cover.

    The breath taking incompetence of the government and NHS management of healthcare and Covid was amazing – which you outline above plus the lockdown the fairly ineffective and often dangerous vaccines was appalling. A case of too many ignorant group think fools spoiling the broth and killing far more than needed to die.

    Reply
  16. Cuibono
    September 22, 2022

    I was under the impression that during our period of house arrest the NHS WAS being “reformed ( aka destroyed even more thoroughly).
    Haven’t the people who shut it down ( thus cheating us out of our contributions and upending the very meaning of healthcare) already decided to automate it?
    ie…NO staff!

    Reply
  17. Michelle
    September 22, 2022

    Where has all the money gone indeed.
    Poor management, over bloated administration, too many with a political aim to their work rather than a medical one.
    Too many staff brought in from overseas without the same level of competence and training to match the service they are going into.
    The event of mass immigration putting huge strains on the service, which has been ongoing for far too long. Add to that the ridiculous overkill of the covid headless chicken panic leading to huge backlogs and unnecessary deaths. The latter I fear we will feel the ripples of for many years.
    Steadfast refusal to put more into training and recruitment of our own people. Countless students turned away from training for lack of spaces, again that has been going on far too long.
    Every attempt to put this right will no doubt be blocked by staunch left wing Unions, aided by the BBC etc. who will tell people ‘our NHS’ is under threat and the whole sorry saga will carry on ( does the new government have the necessary will to fight the latter two?)
    From my mercifully limited use of the need of medical care and from family members who work in the NHS I know these things to be the reasons why it is a huge money pit and a political battering ram for the left wing.

    Reply
    1. No Longer Anonymous
      September 22, 2022

      Mass immigration should have ensured that we have a surplus of staff by now – if pro-mass immigration people are to be believed.

      Reply
      1. a-tracy
        September 23, 2022

        NLA, don’t forget we are told all those immigrants don’t even use the NHS its all of long-living old people.

        Reply
  18. Cuibono
    September 22, 2022

    Since, during our imprisonment, GP surgeries and outpatient/casualty were firmly closed.. as were dentists… and nurses and doctors were spending hours practicing their line dancing routines I have never quite understood where the great pressure on the NHS came from.
    Was it all the conferences they were holding?

    Reply
    1. Fedupsoutherner
      September 22, 2022

      Cuibono. No. They thought they could earn more appearing on Strictly Come Dancing.

      Reply
      1. Cuibono
        September 22, 2022

        +1
        Ah yes!
        Using NHS (I should say OUR ) resources and time to train for their new careers?

        Reply
  19. Lifelogic
    September 22, 2022

    The three extra bank holidays the two we have had plus one for the Coronation will cost the country (mainly the private sector) about £four billion. Which might have been used to perform about about 2 million people off the circa 10 NHS waiting lists had it been used efficiently. Ditching the insanity of net zero and the bonkers HS2 would save many time this hundreds of £billions.

    I suppose it is just a question of government priorities. These seem currently to be net zero, HS2, tax borrow and waste debase the currency, lock down the economy and have lots of bank holiday with operations cancelled.

    Prince William still taking about net zero and the environment yesterday. Protecting the environment is one thing the insane net zero agenda and war on plant, crop and tree food is anti-human and environmental insanity William. As are EV cars. Time to grow up William you are already 40+.

    Reply
    1. Fedupsoutherner
      September 22, 2022

      LL. Agree. I think William is now a mouth piece for his father who cannot spout his nonsense anymore because of his position . We will still be bombarded with CC crap as before.

      Reply
  20. BOF
    September 22, 2022

    Sorry to disagree on the so called vaccines Dir John. Dangerous poorly tested gene therapy that in themselves have caused unacceptable harms, as per the yellow card reports, cost vast amounts of money and caused huge division in society. Wrongly pushed by doctors without full explanation of side effects.

    I agree with the rest of your observations today but T & T was of course an appalling waste of money. From observation, many hospital staff never did download the app, saying that they would spend a great deal of time off work for no good reason!

    Reply
    1. Jim Whitehead
      September 22, 2022

      BOF, +1

      Reply
  21. Lifelogic
    September 22, 2022

    In the Telegraph the other day;-
    Ex-NHS chief resorted to paying for his own cancer care in lockdown
    Rob McMahon, former CEO of Leicester City West Primary Care Trust, says he has lost faith in Britain’s healthcare system.

    Total deaths (non Covid) still running about 10% up on normal levels and after the recent bad years you would expect them to be lower.

    Reply
    1. Lifelogic
      September 22, 2022

      Worse still many of these extra deaths (unlike most Covid deaths) are of young people so higher loss of years of life. So what are the causes of this and what are government or the NHS doing to find this out? Likely causes are delayed or poor treatment from the NHS and their huge waiting lists, side effects from fairly ineffective and often it seems rather dangerous vaccines (still being pushed even at the young), possible post covid issues, more suicides, delayed ambulances, people avoiding hospitals etc…?

      Reply
      1. Mickey Taking
        September 22, 2022

        all of the above.

        Reply
  22. Nigl
    September 22, 2022

    And in other news we see the bureaucratic nonsense and related costs by this nanny state insisting first floor windows in new builds have to have bars because people are getting taller and might fall out.

    The extra hundreds of millions of costs and building delays are based on outdated information and less than 100 accidents a year, I suspect some alcohol related.

    We are told Ministers sighed it off. There is no hope.

    Reply
    1. Ian B
      September 22, 2022

      @Nigl – +1, 100% unbelievable.

      Yet at the same time all upper windows have to open fully to permit egress by even the largest of us humans in case of fire.

      Me thinks, ‘we have a department, we get well paid, but we need to let others believe we actualy do something for our TAX Payer funding’ The minister that signed off on it should resign along with everone in their department.

      Reply
      1. Ian B
        September 22, 2022

        I am also reminded that more people die in bed than fall out of windows – what is nanny going to do about that. MP’s make themselves look more ridiculous – if that is possible

        Reply
    2. Cliff. Wokingham.
      September 22, 2022

      I haven’t seen this but the thought of it sends a chill down my back. What happens in a fire? Many a person has been saved by getting out through a first or second floor window when the stairs are blocked by fire.
      Too much helicopter parenting by the Nanny state.

      Reply
    3. forthurst
      September 22, 2022

      Falling out of a window is quite serious and it is true that some children now are quite tall at a young age and may not be aware of the dangers that stupid adults have placed in their path.
      The issue is probably building regulations with regard to firemen’s access. Low cill heights of large windows which open outwards are clearly dangerous and these types of windows have been introduced by double glazing companies and their danger has been increased in order to meet regulations for firemen’s access. Maybe firemen should be equipped to enter closed windows quickly and safely like burglars.

      Reply
    4. Fedupsoutherner
      September 22, 2022

      Yes. More young and mostly drunk young men falling into the river Severn in Shrewsbury. Instead of making these people grow up and be accountable for their own safety the council wants to spend vast sums on fencing.

      Reply
  23. Sharon
    September 22, 2022

    I heard yesterday that the clinics in the Reigate/Redhill hospitals are going to close soon to free up staff for a Covid onslaught in the autumn. There will be just two clinics in the evening.

    Comparing experiences with this person on our respective hospitals during the lockdowns, it appears some of the mistakes are about to be repeated. What if there is no onslaught? What happens to those patients needing a clinic appointment?

    Reply
  24. Shirley M
    September 22, 2022

    Nobody will be sacked. Nobody will be demoted for taking such appalling and life threatening decisions, apart from the total waste of money. What excuse for not using private services already paid for, and instead, allowing people to go without treatment with possible lethal results?

    Just WHAT does it take for the health and wellbeing of people to be put ahead of grossly incompetent managers and employees? FGS get rid before they do more damage and cause more deaths.

    I doubt any politician or ‘person of influence’ will suffer the NHS neglect that is causing absolute misery and despair to thousands but maybe, just maybe, we should all go lodge in the ‘government’ hotels and have the doctors and dentists come to us and taxis laid on for those hospital visits. Don’t try to tell me this doesn’t happen. The government itself publishes that this special treatment is available to illegal immigrants.

    Reply
  25. Nigl
    September 22, 2022

    Alistair Heath in the DT surely right with his list of shame, the PMs from Cameron to Johnson giving in to left wing lobby groups to keep Browns command and control economy with the economic result for all to see.

    Reply
    1. graham1946
      September 22, 2022

      The health service actually worked reasonably well pre 2010 and much cheaper, to boot. In the same way Labour always leave the economy in a mess, the Tories do the same to the NHS.

      Reply
  26. Narrow Shoulders
    September 22, 2022

    Remove the grant funding system and replace it with a system which pays for procedures and patient interaction.

    GPs need to be paid by appointment carried out, not the number of patients on their rolls and trusts need to generate income from actions, not be given grants to exist.

    Only by changing the revenue model of the NHS to one of getting paid for doing rather than just being will things improve. The funds can still be fleeced from the taxpayer but they should not be paid unless requested by invoice with a robust auditing process.

    Reply
    1. Ian B
      September 22, 2022

      @Narrow Shoulders +1

      If the NHI was a Nation Health Insurance it would as with all insurance it would only be paying out to the NHS for services rendered – situation solved

      Reply
    2. ukretired123
      September 22, 2022

      One basic problem with free NHS care is that people choose to ignore their own health by default, often unthinking either poorly educated, lazy or both and rationalise the NHS will solve it anyway and if they don’t can make legal and financial claims on the system funded by the taxpayer.
      If they had to pay before any visit as in other countries or pay upfront for health insurance they would have to seriously consider having a
      more proactive lifestyle and not couch potatoes by default.
      Simple risk / reward economics would work wonders.
      I appreciate that some people cannot deal with this due to being disabled but I know that even when NHS advise individuals with pre-diabetes they excuse themselves and have no appetite for that but the reverse and can invoke, nay demand EU human rights as in the extreme cases!

      Reply
    3. Peter Parsons
      September 22, 2022

      If that were the case, how many unnecessary appointments do you think would happen and how many unnecessary procedures do you think would be carried out?

      Would GPs, for example, be suddenly start seeing every patient every 6 months for a routine screening as they could then bill for it?

      Reply
      1. a-tracy
        September 23, 2022

        Peter, yes, they would but would an annual screening be a bad thing? I have a couple of children who have probably been to see a GP 3 times in 25 years + the other appointments would be with nurses for vaccines. Would it hurt to get their blood pressure, a blood test, weight and lung test performance done? It would also highlight people on GPs lists that are no longer in the area.

        Reply
  27. Dave Andrews
    September 22, 2022

    A cabinet full of PPE graduates can’t run anything. Who’d have thought it?
    Two remedies that seem to have passed the government by.
    1. Engage with the general population to persuade them that the health crisis would be greatly eased if they would stop stuffing hospitals with the consequences of lifestyle diseases.
    2. Introduce a workplace healthcare scheme in the private sector, where members opt out of the NHS entirely taking their tax contributions with them, rather than being taxed more like it was a benefit.
    The second remedy would make recruitment easier, because staff in private care are more likely to be spared stroppy self-entitled patients.

    Reply
  28. Dave Andrews
    September 22, 2022

    Item on the news the other day about childbirth health services in a bad way.
    28% of births are to foreign born women, but they didn’t mention that.

    Reply
    1. Mickey Taking
      September 23, 2022

      A similar percentage has been going on for donkeys’ years.

      Reply
  29. miami.mode
    September 22, 2022

    Labour government altered the contract for dentists so that there were 3 bands of payment irrespective of how many procedures you had within each band. Doubtless this is a major reason for dentists deserting the NHS and needs changing. No matter what job you have you deserve to be paid for the work you do.

    Reply
  30. Roy Grainger
    September 22, 2022

    Nothing the present government can do will help, the NHS needs totally reforming along the lines of the more successful (in terms of patient outcomes) health services in Germany/Netherlands/Australia and many others but it can’t be touched because it’s a religion. I saw that NHS staff were leading a procession during the Queen’s funeral which is odd because she never used the NHS in her life.

    Reply
  31. Mary M.
    September 22, 2022

    GP Renee Hoenderkamp was on the panel in the Together “Question Time” 1st Anniversary event which took place on 1 September 2022. The event can be found here: https://www.youtube.com/hashtag/together

    At 1:06:10 she explains how the queues of ambulances, the busy A & Es, the bed-blocking by 13,000 well people who do not need a doctor but have nowhere to be discharged to are all knock-on effects of what happened in the care sector. When the vaccine mandate came in, there was a mass exodus of staff.

    Renee Hoenderkamp says that sorting our the care problem would put the NHS back on its feet. She makes sensible suggestions, one of which is that the Government entice back, with the equivalent of a golden handshake ‘Hello’, those tens of thousands of care workers who left. The Government should say, ‘Sorry, here’s compensation’, thus giving them back their continuity of service with no breaks in their pensions.

    My comment: Most of those who left the care sector were qualified people with much experience, many of them from the European Union who had made their home here. Welcoming them back would cost the tax payer somewhat less than it would cost to bring in (steal) prospective carers from Third World countries.

    Reply
    1. Peter Parsons
      September 22, 2022

      That was an issue pre-Covid as well.

      One cause is that social care is funded by local authorities (who have had their support grants cut over the last 12 and half years), but the NHS is funded by central government. A local authority can cut their spending accordingly by funding fewer social care places, but that then means that individuals end up staying longer in hospital, and at a higher overall cost.

      It’s down to a lack of joined up thinking, and that lack of joined up thinking comes from government.

      Reply
    2. a-tracy
      September 23, 2022

      MaryM, I wonder if each hospital that has patients that can’t be sent home, your quoted ‘13000 well people’ could have a nightingale wing where more beds could be per wardroom to be staffed by carers to free up acute beds; there were hundreds of beds and dividers available for the Nightingales where have they all gone?

      People that applied for nurse training but there were no places could do a year’s training in those wards, or young men and women who are only offered school training could get their NMW credits in a day job earning money to put up for their years of degree study.

      Reply
      1. a-tracy
        September 23, 2022

        I didn’t mention senior grade HCAs could do the training. I know senior HCAs, some of the most sensible hardworking people I know.

        Reply
  32. SM
    September 22, 2022

    The whole system of the NHS is utterly unsuitable for the modern world of medical advances.

    It was not designed or funded to keep ever-increasing numbers of the elderly (of which I am one) alive for years, albeit teetering on the brink of death. Its instigators had no notion of caring for (and funding) the young and middle-aged who require drastic and ongoing treatment and care for decades, simply because the technology and pharmaceutical backup did not exist at the time.

    Somebody, somewhere in Westminster, MUST start a huge and serious conversation about how to create a new NHS from scratch, and stop endlessly and pointlessly fiddling with the existing rotten set-up and its proto-religious devotees.

    Reply
  33. Bloke
    September 22, 2022

    Much of the rot began with Tony Blair.
    In a David Frost interview, Frost asked him if he would be matching European spending levels on health, and he nervously replied ‘Yes’ without prior thought. He was then compelled to follow through, but further thoughtlessly increased the expense by heavily overpaying doctors at that time.
    Gordon Brown then added wastefully expensive contacts for hospital building.
    The early morning bunfight where patients compete for their phone call to be answered started about then, but as Blair admitted to a TV audience complainant in a pre-election discussion, he was not even aware that such national obstruction existed.
    It remains, and Govts since then have just added more expense without attention on achieving efficiency.
    We now await whatever Therese Coffey might improve.

    Reply
  34. glen cullen
    September 22, 2022

    and ‘I’ is for illegal immigration using the NHS

    The data below is for the 24-hour period 00:00 to 23:59 20 September 2022.
    Number of migrants detected in small boats: 93
    Number of boats detected: 4

    Reply
  35. Mike Wilson
    September 22, 2022

    All hip, knee, hernia and cataract operations should be outsourced. And, to prevent howls of outrage, no USA based group should be allowed to run hospitals here.

    The NHS is too big. It is impossible to effectively manage.

    Reply
    1. Mark
      September 22, 2022

      There are some specialisms in the US where they have world leading treatment. I see no point in denying that to patients in the UK unless they can afford to pay to go to the US for it.

      Clearly what we do not need to import is the US system for medical negligence which mainly benefits the legal profession. In fact, we would do well to look at how that is handled in Singapore and New Zealand, where payouts beyond medical costs are limited unless you buy your own top-up insurance, which has to respect the findings of the medical assessors, whose primary job is catching modes of failure and preventing recurrences. The logic is that doing so saves far more cost and pain in the long run.

      Reply
  36. Sir Joe Soap
    September 22, 2022

    1. A phased sell-off of the NHS to a series of competitive bidders such as Google which would replace the whole admin system over time with user friendly online ones. They would have legal leeway to immediately make staff redundant and carry no pension trailing liability. Use of clinicians would become remarkably efficient but 2. below would make it effective.

    2. People would pay to see clinicians face to face through a compulsory insurance scheme, part or whole gov. funded by the vulnerable. Visitors and incomers would need to have proof of ability to pay premiums over the longer term through a points system showing education and employment history. No insurance card, no healthcare apart from basic online self-help stuff. Otherwise people would choose level of service and where they go for care.
    Problem solved.

    Reply
  37. Mike Stallard
    September 22, 2022

    Professionalism.
    My Dad was a Vicar in Peterborough in the 1960s. In those days, he got paid for each of the eleven or so weddings which he enjoyed every Saturday in the summer months. On the proceeds, he would take us (his family) to Hunstanton for a yearly holiday. It was what he called his “perks”.
    When I was a Vicar the “perks” were sent straight to the Diocesans. My motivation to take weddings changed. Now they had turned into “work”. The organist pocketed hers.

    In France, this year, my wife was ill. She needed medicine. €25 to see the doctor. On the spot. If you read Jeremy Clarke in the Spectator, you can see what cancer treatment is like there too.

    Let’s stop the shouting about privatisation, shall we, and reward the doctors when they see patients. Also get the huge bureaucracy out of the way of the expert professionals too and TRUST…

    Reply
  38. turboterrier
    September 22, 2022

    The only thing in life that is a constant, after death is change.
    Something that ministers and their civil servants seemed not to have grasped. They are operating under the illusion that changing the funding will suffice and it happens. This is not how it works.

    Reply
  39. Cliff. Wokingham.
    September 22, 2022

    Two things which need to be urgently looked at within the NHS are the numbers of managers and the levels of sickness.
    We also need to have a serious adult discussion about what we actually want the NHS to do for us. In order to have that discussion, we will need to kick the politics out of the NHS. The political point scoring over the NHS is unhelpful and must stop.
    We need to make it easier to start and pay for nurse and doctor training. I suggest if we fund their training, we could then insist they work for the NHS for a minimum term of say five years. Perhaps we need to look at bringing back enrolled nurses.

    Reply
    1. anon
      September 22, 2022

      Gov loan and they payback from salary levy for staff training. No upper limit on places. Training & loans should meet demand, subject to suitable qualification level not unreasonably high. Bring back suitable on-site accomodation for staff who are unqualified and in training.

      Other training & qualification recognition routes.

      NHS should run its own staff agencies whilst the supply changes take place.

      Remove all diversity , woke regulations and focus on outcomes.

      Reply
    2. Mickey Taking
      September 22, 2022

      There are numerous important but simple roles required to meet and greet, provide admin, record keeping, take patient temperature, blood pressure, wheel round tea/coffee, ‘meals’. etc Just what level of training post school is really required? What place A Levels, degrees? Are we mad !

      Reply
  40. Ian B
    September 22, 2022

    If the Media is to be believed, all the bucket loads of extra TaxPayer funding that has been thrown at the NHS in the past few years has gone directly towards funding WOKE and diversity agendas very little finding its way to the improvements with front line clinicians.

    Or in other words the TAX Payer is funding the political views of management and not ensuring we get the ‘best of the best’ for our health and well-being.

    Everything shouts a total lack of oversight and accountability on how the TAX Payers money is spent. We have our MP’s as our Political Voice we dont need TAX Payer funded entities using our money to take pay for personal and private political stances.

    The Government and Parliment needs to get a grip on how the UK TAX Payers money is spent and it shouldn’t be for Political grandstanding by those that haven’t been elected and are not accountable directly to them.

    Reply
  41. turboterrier
    September 22, 2022

    The complete change process that is needed is nigh impossible without a lot of casualties.
    Too many, far too many administrators with highly paid positions and their woke departments will be fighting tooth and nail to the death to prevent their little empires be disbanded.
    A night of the long knives will take years and that is time the service has not got. If at a stroke thousands of military personnel can be let go, why is that not possible with the NHS?
    The way the world is heading we might regret the defence spending cuts that have happened year on year for decades.

    Reply
  42. a-tracy
    September 22, 2022

    This is going to be an uphill struggle for Coffey, and I wish her well. The NHS appears to be run by the Labour party unions, and when they want to bring the Conservatives to heel, they can.

    All this rubbish in the press about Coffey and the oxford comma is just silly politicking and what a waste of everyone’s time. I read it wasn’t her that wrote the e-mail, so she got set up within and then pilloried; I hope that she pulled in the person that wrote the e-mail for a meeting.

    We are told the NHS relies on EU nurses, we train so many people in degrees that do not provide them with degree-level jobs why aren’t we encouraging more training places in the UK, particularly London? Open up six-year degrees in London with part-time training on the ward/day release, earn while they learn, instead of doing waste of time A levels in travel and tourism or basic healthcare actually do it in hospital from the age of 16 achieving real qualifications at 18 to help them to make the next step up. We are having to hire from abroad (14% nurses from none EU; 5.4% EU the biggest group from Ireland a small Country?), especially in London where 27% of NHS staff aren’t British nationals compared to 7% in the NE.

    I watched a podcast Harris did in the Guardian, and he spoke to two 18-year-old girls in Handsworth who felt they had no prospects! Just what the hell? They live within easy commuting time from Central Birmingham. One said she wanted to be a social worker but typically, she wasn’t asked what O levels or A levels she had done to try to achieve that. She wasn’t asked if she had been told at school how to enter social work and work her way up in that field if she hadn’t got a degree; I know a senior social worker who did it that way, training on the job and achieving her degree whilst sponsored.

    Reply
  43. miami.mode
    September 22, 2022

    The irony of today’s tweet. The Bank of England “need to monitor and control money and credit, not punish us for their past errors”. Does a 12-year Conservative governance come within a different category?

    Reply
    1. formula57
      September 22, 2022

      @ miami.mode “Does a 12-year Conservative governance come within a different category?” – yes, quite different for it will punish us for its errors planned but not yet committed too. I had hopes, with Liz evidently listening to Sir John, but those may fade away tomorrow depending upon Kwasi’s special fiscal operation.

      Reply
    2. Mark
      September 22, 2022

      The difficulty for the Bank is that having made errors there is no way back, like a skier going over a precipice instead of staying on piste. Fail to raise interest rates sufficiently and the pound depreciates, raising import costs and causing faster inflation, amplifying the problem to be solved. Raise interest rates and you cause economic stagnation and perhaps puncture asset bubbles uncontrollably. There is no longer a happy medium path available.

      Reply
  44. ChrisS
    September 22, 2022

    I am sure the NHS would respnd to criticism of the Covid period by saying it was a learning process and that we are criticising with the benefit of hindsight.

    However this would be completely wrong. All through the pandemic, led by you, almost everyone commenting here was pointing out the mistakes being made such as not using the Nightingales and paying for private hospital beds then leaving them empty. The biggest mistake, of course, was the stupidity of releasing elderly patients back into nursing homes when they were infectious with Covid. We KNEW this was stupid, but it kept happening! How many people died as a result ?

    Looking at the test and trace system, who signed off consultancy fees of £1200 a day which went on for months ?
    The outcome was pretty poor, but then the system developed in other countries such as Germany were no better.

    I am sure these decisions were mostly made by NHS management, not ministers, yet nobody has been held accountable. But that is business as usual in the NHS or the civil service. It needs to change.

    Reply
    1. R.Grange
      September 22, 2022

      Yes, Chris, I am sure that the Covid business was a learning experience. But what was being learned? How to manipulate the public into doing things they would never normally have contemplated doing, how to restrict our freedom and wellbeing, how to make us accept harmful policies imposed on us by technocrats. Let us hope those who’ve learned that lesson will never again be allowed to put it into practice.

      Reply
      1. ChrisS
        September 22, 2022

        I very carefully did not mix the medical mistakes and costs, with the political decisions taken over lockdown.
        Of course, I accept that the decisions over lockdown may have been taken by politicians but acting on the advice of Doctors and Professors. It was a huge mistake to lead with the slogan “Protect the NHS.” It was patients that needed protection, not the NHS.

        As a 70 year old man, all I will say is that until the brilliant vaccines were made available, lockdown worked well. It was draconian, but it saved hundreds of thousands of lives, probably including my own and that of my wife.

        With hindsight, lockdown should have been applied selectively and only to older age groups like us, but it took a long time to work out just how vulnerable different age groups actually were.
        Without lockdown, we would certainly have lost more younger people but most of those in the younger groups would have caught a mild dose of the virus in droves and likely become immune to reinfection.

        Reply
        1. R.Grange
          September 23, 2022

          It did not take a long time to work out the effects of Covid on different age-groups. They were clear from reports as early as March 2020, such as the medical report on the Diamond Princess passengers and crew. The Infection Fatality Rate was found to be similar to that of flu shortly after. You are welcome to hold on to your ideas if you find them comforting, Chris, but when the reality of the disastrous and unnecessary Covid policies soon became apparent they should not have been inflicted on the rest of us.

          The slogan ‘Protect the NHS’ was not a mistaken choice of words. The Covid response was never about keeping people safe, in my view. It was about getting them to see themselves and their fellow-citizens as a health threat, and protecting institutions such as the NHS.

          Reply
          1. Mickey Taking
            September 23, 2022

            I don’t think a cruise ship full of older, frail and inactive over-fed people is a good test for Covid outcomes!

  45. Denis Cooper
    September 22, 2022

    Off topic, there’s a lot in the media telling us that Liz Truss had good discussions about the Northern Ireland protocol with Joe Biden, and also with Ursula von der Leyen, and Tony Blair has been involved, and that she is going to let negotiations run on for another six months:

    https://www.euractiv.com/section/uk-europe/news/truss-sets-april-2023-deadline-for-ni-protocol-settlement/

    “Truss sets April 2023 deadline for NI protocol settlement”

    Given that the Irish Foreign Minister Simon Coveney insists that any settlement whatsoever must keep Northern Ireland in the EU Single Market, and the Irish have a veto on any new agreement, and if the province stays in the EU Single Market then the UK government will have to abandon all of its July proposals, and crucially those proposals do not include replacing irrational import controls with rational export controls as an alternative means to regulate the carriage of goods across the land border into the Irish Republic, I wonder what is the point of dragging it all out for another six months?

    And what a pity that Liz Truss could not reassure Joe Biden by saying:

    “Mr President, to help protect the EU’s Single Market we’ve just passed new UK laws to prevent people sending unacceptable goods across the border into the Republic, and we are determined to enforce those laws, and we would very much welcome the cooperation of the Irish authorities in doing that.”

    That she will not take the obvious step of getting those laws passed must call into question her sincerity.

    Reply She got them through the Commons. They are now trying to get them through the Lords, so talking while that is happening is sensible

    Reply
    1. Denis Cooper
      September 22, 2022

      There is nothing in the Bill about ending all EU import controls and replacing them with EU export controls, which is the obvious and correct solution. Instead there is just tinkering with the EU import controls:

      https://www.gov.uk/government/publications/northern-ireland-protocol-the-uks-solution/northern-ireland-protocol-the-uks-solution

      “Red lane for EU goods

      Goods going to the EU, or moved by traders not in the new trusted trader scheme, would be subject to full checks and controls and full customs procedures—protecting the EU Single Market.”

      Reply
    2. believe me
      September 22, 2022

      Denis- we hear too much about this protocol – so please give us a break – lets just work with what we have and see how it goes. We can’t just go on forever arguing about every little nuance in these grand agreements. Time and the next GE will tell a lot and put a new slant on things.

      Reply
      1. Denis Cooper
        September 23, 2022

        We know how it goes, and we do not need another six months of futile negotiations with the EU.

        Even Tony Blair has said that the EU’s proposals will not work:

        https://www.politico.eu/article/tony-blair-helping-in-uks-northern-ireland-protocol-row-with-eu/

        “Tony Blair ‘helping’ in UK’s Northern Ireland protocol row with EU”

        “He’s explaining why the EU’s proposals will not work. He doesn’t agree with the government on every point, but he certainly has been a helpful voice in that and I’m sure he will go on being so.”

        Unfortunately the government’s proposals also will not work, because no matter what is done about the goods being brought into Northern Ireland from outside, imports, that will do nothing to protect the EU Single Market against non-compliant exports produced in the province and carried across the border without any checks.

        Quite simply the EU checks are being applied to the wrong flow of goods.

        Reply We need U.K. legislation. To get that either the Lords agrees or we use the Parliament Act. Either way the Lords is delaying the solution.

        Reply
        1. Denis Cooper
          September 23, 2022

          But there would be no reasonable grounds for the Lords – or anyone else including the EU – to object to new UK laws specifically designed to help our neighbours by protecting their EU Single Market, without in any way contravening the protocol or any other international agreement. Because the protocol does not say that its mechanisms to protect the EU Single Market are the only permissible mechanisms for that purpose, and no alternative mechanisms may be introduced in parallel.

          In July 2021 in the Command Paper the government said that it was ready to introduce new UK laws for that purpose:

          https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1008451/CCS207_CCS0721914902-005_Northern_Ireland_Protocol_Web_Accessible__1_.pdf

          43. “We also stand ready to bring in new legislation to deter anyone in Northern Ireland looking to export to Ireland goods which do not meet EU standards or to evade these enforcement processes.”

          62. “ … we are also ready to put in place legislation to provide for penalties for UK traders seeking to place non-compliant goods on the EU market.”

          That could have been done, and the legislation could easily have linked the case of goods crossing the land border into the Irish Republic to the existing SPIRE system for export licences:

          https://www.spire.trade.gov.uk/spire/fox/espire/LOGIN/login

          “Using SPIRE, you can apply for an export or trade licence for your activities and items … ”

          By now a rational system of export controls could have been well bedded in and the irrational import controls demanded by the protocol could then be permanently discontinued.

          Reply
          1. Denis Cooper
            September 25, 2022

            This is what some people are offering as an alternative:

            https://www.sundayworld.com/news/northern-ireland-news/uvf-warning-winter-of-discontent-if-uk-pm-liz-truss-fails-to-deliver-on-ni-protocol/1542863006.html

            “The UVF is warning of a winter of discontent if Liz Truss fails to deliver on her Protocol promise.

            Terror chiefs have made it clear the removal of the controversial Irish Sea border is a minimal requirement – and if not met they will take to the streets.

            The paramilitary group has adopted a wait and see strategy as Truss takes up the reins at Number 10, but alarm bells have sounded in the days after her arrival in Downing Street.”

            Leo Varadkar irresponsibly used the implied threat of renewed republican violence to get the UK-EU customs border moved away from its proper place, the international frontier between Northern Ireland and the Irish Republic, and they are using the threat of unionist violence to get it moved back to where it should be.

            https://www.irishnews.com/opinion/columnists/2022/09/24/news/patrick_murphy_time_for_jeffrey_donaldson_to_play_his_wild_card-2837358/

            “… the Dublin government’s change of policy when Leo Varadkar became taoiseach, a year after Brexit. His predecessor, Enda Kenny, had instructed Irish civil servants to co-operate with northern and British civil servants to facilitate post Brexit, cross-border trade.

            Varadkar ended that co-operation and switched Dublin into a confrontational mode with Britain and, of course, unionism. More loyal to the EU than Ireland, he began using the north to punish Britain for Brexit.”

    3. Mickey Taking
      September 22, 2022

      ‘trying to get them through the Lords’. Says rather a lot about the situation Commons vs Lords?

      Reply
  46. Lifelogic
    September 22, 2022

    Tell Kwasi not to do the usual Chancellor’s trick that we have suffered from for most of my life. That of announcing tax cuts that come years ahead and tax increase that start immediately or are even backdated. Not even sure to have a Tory Government after May 2024 so anything not immediate is a pure con trick. We still have not had the £1M IHT threshold each promised by Osborne many years back and have the highest and most complex tax rates for 70+ year. Perhaps Kwasi could finally keep that promise and undo all Sunak’s serial Manfesto ratting.

    Otherwise why will we trust any new promises the Tories make? Be they on tax rates, triple locks, pensions, immigration levels or anything else.

    Reply
    1. Lifelogic
      September 22, 2022

      The ones that come year ahead almost never happen. Either they rat on them or they lose office to Labour.

      Reply
    2. formula57
      September 22, 2022

      Lifelogic “We still have not had the £1M IHT threshold each promised by Osborne ……Perhaps Kwasi could finally keep that promise “ – or perhaps we could all have the same deal King Charles enjoys?

      In the last Farage-led UKIP general election manifesto it said IHT was incapable to effective reform, it should just be abolished.

      Reply
  47. acorn
    September 22, 2022

    “Unfortunately the senior management refused to use the Nightingale capacity to create covid specialist hospitals” More NHS bashing BS. The NHS had 4,000 acute beds prior to the pandemic. The Excel added another 4,000. Six further sites were set up around England, these other units were not set up for intensive care, a total of 15 000 beds. The only thing that was missing were the Doctors and Nurses to staff them. Splitting hospital shifts and busing them to Nightingales would have just reduced the capacity of the whole system. £400 million to treat less than a thousand patients that would have been better spent on staffing hospitals rather just building more of them.

    Reply
    1. a-tracy
      September 23, 2022

      acorn, couldn’t they have put the covid negative bedblockers in them that we are told so much about to free up acute wards?

      Reply
  48. agricola
    September 22, 2022

    Let me open with a recent experience of the Spanish Health Service. You need to see your GP, you book an appointment, anything from same day to three days hence. GP does not like what he sees and arranges a CT scan at the local hospital within one week. This indicates first problem irrelevant but need for internal examination of something new. One week and they take a look and the subsequent biopsy is negative. Within one month problem sorted.

    The fundamental problem with the NHS is not going to get sorted by moving the deckchairs on this medical Titanic. One could investigate the need for so many layers of deckchair executives however. The basic problem within the GP service is a shortage of 10,000 GPs and 10,000 Practice Nurses and similar medical professionals. You can import them. We have no problem in attracting Albanian illegals and criminals in even larger numbers every year, so why not medical professionals. You can also train your own but then you are looking at a ten year wait. This does not mean not starting today and it should not involve university fees.

    Hospitals need to increase their medical practicioners by recruiting from overseas. The bedpan end of nursing does not require a degree but practical on the job training of people with a vocation. Start doing it.

    The last point I would make is that administratively the NHS needs someone from Toyota to organise the way they work by maximising the way they use such an expensive array of capital equipment plus how they purchase and do not waste a vast budget of consumables.

    Finally, stop importing 250,000 potential patients per annum we do not need.

    Reply
    1. Mark
      September 22, 2022

      We could do without the haemorrhage of people to early retirement, family career breaks and simply because they can no longer tolerate working for the toxic culture of the NHS.

      Reply
  49. Iain Gill
    September 22, 2022

    1 Fundamentally all politicians know the NHS provides rubbish quality service, if at all. They should stop treating it like a sacred cow and say so.

    2 There are far better healthcare systems around the world, stop reinventing the wheel and copy a system that works. Copy the Australian, New Zealand, Belgian or Italian healthcare systems, dont tweek them just copy them completely. It can be branded NHS but ffs please please just give up on this Stalinist nonsense and copy a system that works.

    3 Start giving the patients real power. Start by giving cheques for treatment to patients, those that have been waiting the longest, let them take the cheque anywhere they like including abroad, and including topping it up if they choose.

    4 Sack some of the obvious no hope failures, start with some of the ambulance trust exec officers, they are so obviously no capable of doing the job just get rid of them asap.

    5 Ban ambulance trusts from being the out of hours GP provider, they cannot do their own job, please dont let them mess up out of hours GP care in those regions where they have been allowed to “win” those contracts.

    6 Out of hours GP phone number to be different to the failing 111 number, which is answered very unprofessionally by unqualified people.

    7 Get rid of “Advanced” the 111 IT managed service provider, they have failed massively.

    JFDI, round people up in waiting rooms complaining about the NHS and just give them cheques to go elsewhere. Dont give NHS centrally more money, give it to the patients.

    Reply
  50. Vernon Wright
    September 22, 2022

    221027Z

    One of the biggest problems — relating to item ‘D’ — is the absurd life-time limit on pension funds, which deprives the N.H.S. of senior doctors &c. faced with what amounts to a huge tax bill if they do more than a certain amount of work.

    A similar effect is seen elsewhere in the economy. Just as there ought to be no limit on bankers’ bonuses (boni?), there ought to be no limit on the size of one’s pension pot.

    ΠΞ

    Reply
    1. Shirley M
      September 22, 2022

      As far as I am aware, there is no limit to personal pension contributions nor to those contributions paid by the employer. There is just a limit on the amount of tax relief available on those contributions.

      Reply
    2. a-tracy
      September 23, 2022

      Vernon, it would only get a vote to change if the public sector employees couldn’t earn more than a million-pound pot would buy them in the private annuity market without paying the extra taxes too.

      Reply
  51. Denis Cooper
    September 22, 2022

    Again off topic, this is an interesting article in the Irish Times today:

    https://www.irishtimes.com/opinion/2022/09/22/newton-emerson-truss-brings-down-curtain-on-uk-us-trade-deal-pantomime/

    “Newton Emerson: Truss brings down curtain on UK-US trade deal pantomime”

    I’ve emailed him to point out that a UK-US trade deal might have been worth about 0.1% of GDP to us.

    Reply
    1. Graham
      September 22, 2022

      Yes Denis a big difference from the 4% overall loss to GDP that resulted by leaving the EU. You should stop reading those Irish newspapers you could develop a squint.

      Reply
      1. Denis Cooper
        September 23, 2022

        2.25% according to the EU Commission.

        Reply
  52. acorn
    September 22, 2022

    With twelve different Health Secretaries in twenty years you should be amazed the NHS is as good as it is for the price. Every one of them comes with a new way of buggering it up. The only way to stop this nonsense is to privatise it; (The one privatisation Maggie never achieved) and introduce some Treasury backed not-for-profit HMOs (Health Management organisations), the state continuing to own the buildings. The Israeli system is considered one of the most effective.

    “What does an efficient health system have? – A strong primary care system. “Nowhere is this better evidenced than Israel, which has made easy access to family physicians in the community a cornerstone of its services,” writes Britnell. “This is then ingeniously aligned by having the same four health maintenance organizations [membership compulsory] pay for and provide all types of healthcare – so there are strong incentives to keep patients well and at home, rather than create ever larger hospitals.”
    https://www.weforum.org/agenda/2016/04/which-countries-have-the-most-cost-effective-healthcare/

    Come to think of it, converting the whole socio-economic system of the UK to a Pay-As-You-Go model, would be a good way to rebase government spending and expose and flush out unnecessary mountains of legislation.

    Reply
    1. a-tracy
      September 23, 2022

      acorn, perhaps too many men are getting that great position, Coffey is only the second female in 27 years, let’s give her a chance.

      Reply
  53. Barbara
    September 22, 2022

    ‘The NHS then spent a fortune on a Test and trace scheme of very variable quality which some people gamed to carry on their normal lives. This spending has now rightly been wound down.‘

    Anyone know where the £37 billion went?

    Reply
    1. acorn
      September 22, 2022

      Barbara. The UK government makes that question difficult to answer, there is no highly detailed Treasury Daily Statement like there is in the USA. The Supply and Appropriation (Main Estimates) Act, voted for the DHSC in 20/21, £138 billion but the Contingency Fund (overdraft) had to cough up £434 billion to cover the Covid. Test and Trace is in there somewhere. 21/22 voted was £174 billion plus £68 billion contingency. 22/23 voted for DHSC is £146 billion. Have a look at the “Schedule” in https://www.legislation.gov.uk/ukpga/2022/39 . See how much the HoC Administration is now costing; £493 million per year. The Lords, £207 million.

      Reply
    2. Mickey Taking
      September 23, 2022

      off-shore personal accounts?

      Reply
  54. forthurst
    September 22, 2022

    The top down NHS needs to go. It’s only purpose is to provide employment for unqualified people i.e. Arts graduates. Healthcare should be managed by medical staff at local area level where services are delivered. The management of ancillary services like laundry and procurement of consumables can be delegated; the management by the unqualified of qualified medical staff needs to end.

    There needs to be changes to the recruitment for medical training and the terms of service for students getting a medical education here to discourage them from waltzing off to pursue their careers abroad to be replaced by large numbers of third world medical staff whilst large numbers of qualified A level students are blocked from a medical education. The need for universities to recruit armies of foreign students on full fees to subsidise the one-size-fits-all fees paid by English students for the courses which will actually help to maintain this country in the 21st Century i.e. expensive science-based must cease.

    Go and find out why e.g. France and Germany have far better healthcare than the Arts graduate run, top down NHS model and stop pretending that yet another ‘reorganisation’ will deliver a working model. The sadness is that there are very many dedicated professionals in the NHS who are totally frustrated by being in such an incompetent setup. A local male GP whose consultations were very thorough has left the medical profession because he become so disenchanted with the way it is run.

    Reply
  55. paul
    September 22, 2022

    I don’t think bedside stories will cut it this time around john, and then a snap election.

    Reply
  56. The Prangwizard
    September 22, 2022

    OT. So big announcement that fracking is in the national interest. Quite correct, but Gov says it can not go ahead if local nimbys don’t want it. Guess what, there will be massive intimidation by the eco fanatics to ensure the vote goes against it, and in addition if the producers want to start they have to pay big bribe money. Will the producers want the trouble?

    This is the kind of deceitful claims of leadership; so the country can forget the idea we will benefit from our own resources.

    I dare say Gov leaders are hoping that in a couple of years the energy supply problem will resolve itself overseas and they can then go back to rushing to NetZero and ban fracking again. Around the election time?

    Reply
    1. acorn
      September 22, 2022

      Fracking is going nowhere in the UK, the geology is totally different to the USA. What Shale gas there was in the UK, leaked out via the multitude of fault lines a few million years ago. Even the pioneers that set up Cuadrilla Resources have given up and are turning to geothermal plays.
      “Fracking won’t work in UK says founder of fracking company Cuadrilla Chris Cornelius says geology is too challenging and government’s support is merely ‘soundbites” (Google ” “).

      Reply
      1. Peter2
        September 22, 2022

        It certainly wont work if the tremor level remains at 0.5.
        A level a human cannot discern.

        Reply
        1. acorn
          September 23, 2022

          Don’t be surprised if it is raised to 2.9

          Reply
          1. Peter2
            September 23, 2022

            Nice cheap gas in America.

          2. Peter2
            September 24, 2022

            2.9
            Defined as micro tremors over one million recorded events per year on Earth
            Felt very slightly by only some people.
            EG
            A lorry briefly passing by you on a road
            If you want to stop fracking find a different argument.

      2. Mickey Taking
        September 23, 2022

        But the CEO of a failed company has to blame something else!

        Reply
      3. The Prangwizard
        September 23, 2022

        I understand Cornelious left Quadrilla about ten years ago and has had nothing to do with the company since. If so does his view represent them now?

        Reply
    2. Original Richard
      September 22, 2022

      The Prangwizard :

      The Cabinet Office and the Home Office are funding the organisations taking the Government to court against its Rwanda plan.

      So it would not surprise me to learn that the Cabinet Office and BEIS are funding opposition to fracking.

      Expensive energy has always been a necessary part of the Net Zero Strategy and our new PM has said in the House that she is “totally committed to Net Zero”.

      The Government/BEIS still believe net zero CO2 is possible using wind turbines and electrification of heating and transport.

      Reply
  57. Original Richard
    September 22, 2022

    D is for diversity, more important than meritocracy, whose officers are paid the double of many doctors after years of training, and which the NHS still believe they need to increase despite being far more diverse than the population they serve.

    Fortunately, our woke NHS, have an easy solution to hand to increase diversity as self-identification means that HR can now simply assign personnel with characteristics once considered to be immutable.

    Reply
  58. Lynn Atkinson
    September 22, 2022

    Which Minister has taken the blame for this ongoing fiasco?

    Reply
    1. Peter Parsons
      September 22, 2022

      The previous one, as always.

      Reply
  59. The Prangwizard
    September 22, 2022

    I’d like doctors to be quizzed how many days each week they attend their surgeries, how many hours they are there, and where are they the other days and what do they do and how many hours they work.

    Reply
    1. a-tracy
      September 23, 2022

      Prangwizard, presenteeism, how many hours you work, often doesn’t indicate efficiency. There are plenty of pro-privatise people on this board, however, the GP practices are private companies and most of the complaints seem to be about that service. So private doesn’t necessarily trump public in regards to health.

      The number of patients to available appointment slots however needs to be looked at quickly, the surgeries which much higher GP/patient practices need to be sent surveys to check if they are happy with their GP appointment responses. If another GP practice is required for an area it should be advertised as a franchise opportunity.

      Reply
  60. margaret
    September 22, 2022

    Let me explain where you are old fashioned and out of touch with clinical progress by excluding the most efficient of all practitioners. Doctors do not do most of the clinical work and by the insistence on trying to rev up the system with more and more doctors and more from overseas, the system is going slower and slower.
    Clinical nurses were trained in medicine and at the very first exposure to wards need to know and are accountable for medical intervention . I myself remember my medical exams and an oral state examination similar to vivas Phd of today.
    Let me give you an example. Myself as an advanced practitioner would diagnose, investigate , take necessary tests , blood sampling , ECG’s, systems examination , various specimens all in one consultation . Referals arising out of this consultation would also be completed in the same few days.
    A locum Dr would see the patient, decide less than the ANP and forward on to different organisations who had the ability but take weeks for blood sampling, examinations , scans etc, clinical tests to be undertaken as they are not able to complete their consultations effectively. They are not as clinically trained as the ANP who has exactly the same knowledge and aften more so than the Dr and do all that is required on the day.

    The bias against Nurses in higher practice can be seen where there are many Drs in a practice and nothing gets done! The Practices which employ the advanced Nurses complete more quickly. These practices have usually been taken over by private organisations.
    I acknowledge the expertise of surgeons , specialists etc , but they are not the full story in the NHS.

    Reply
    1. margaret
      September 22, 2022

      i.e private concerns employ Drs simply for the title but not for the whole integration into the system at its most efficient.

      Reply
  61. jerry
    September 22, 2022

    So unless our host is suggesting a return to a pre ‘Thatcherite’ era of NHS organization and funding, I somehow doubt it, isn’t this all just yet more of the usual therapy, if you can call rearranging deckchairs therapeutic, blame and reorganize those below.

    “None of this can be done without learning from the mistakes of the last two years.”

    The last TWO YEARS?! Non of this is that new, the problem of unhappy staff, too many patients and long waiting lists etc. has been around a lot longer than the problems caused by and since Covid. Indeed those who like conspiracy theories might even suggest Covid has become a gift-horse used by some to mask past failings, the BMA’s own figures tell us that back in Sept 2015 there was 3.3m on NHS waiting lists for consultant-led elective care – so HALF the current 6.8m, not the same patients (hopefully…), currently on waiting lists were on those waiting lists FIVE years before Covid.

    “So where has all the money gone and why didn’t it buy success?”

    On top-down management most likely; each internal market, each NHS Trust etc, all with their own ‘CEO’ lead management teams, paying themselves market rates (or as close as they could get), as if they are running a FT250 company, but often without the skills needed to run a SME in a railway arch. As for success, was it ever (properly) defined.

    “Ministers who take the blame”

    Thanks for the bellylaugh, not. Take the blame, pass the buck more like. Yes, above, I’m critical of NHS mismanagement but all they have ever done is work to the policies laid down by successive Minsters, and what’s more Labour Ministers between 1997-2010…

    Reply
  62. ukretired123
    September 22, 2022

    Summary of being proactive for one’s health in the UK today:-
    1. Don’t rely on the NHS – overburdened and long waiting Q
    2. Premiums for private health insurance are unaffordable.
    3. Never assume good health as are fit enough as you age.
    So unless you are disabled:-
    1. Depend on yourself.
    2. Get out more beyond your comfort zone. Walk, ride, run etc
    3. Measure your weight, waistline & blood pressure as appropriate.
    4. Gently exercise at home Squats etc after checking with a GP*
    5. Try yoga, Tai Chi (China’s self sustainable answer to NHS problems!)
    6 Try meditation and reap benefits from a clear and calm mind.
    7. Avoid drugs and alcohol addictions – obviously!
    8. If you need more read Wim Hoff, SAS and other elite challenges.
    You are never too old for improvement, it’s just that you have never tried maybe. The advantages of being proactively fit and strong and eating healthy food ward off many ailments that patients seek too late with the NHS and snowball instead.
    The takeaway is “Don’t paint yourself in to an NHS corner” ever.

    Reply
    1. Mickey Taking
      September 22, 2022

      Don’t watch or listen to television or radio news – pretty difficult these days?
      Avoid newspapers and social networks.
      Avoid Political blogs…. (ha ha)
      All the above are really bad for your temper, your blood pressure, your mental health (!).

      Reply
  63. Javelin
    September 22, 2022

    It’s really simple. Redirect money from managers and management consultants to training doctors and nurses.

    Can I have my consultancy fee please?

    Reply
  64. paul
    September 22, 2022

    I think board in charge of each hospital wound be good, to formulate a plan to hand to ministration on how they want the hospital run. Three doctors, three nurses, investment manger, lawyer, acounting officer and CEO.

    Reply
    1. Mickey Taking
      September 23, 2022

      ten ex-patients?

      Reply
  65. ChrisS
    September 22, 2022

    Being realistic and practical, for multiple reasons, we all know that the NHS cannot cope with its current workload.

    Why not recognise this ? Give those that go private, tax relief on health care premiums and on fees paid to the private sector by those patients that self-fund by paying for their own treatment, direct. The take up of private healthcare would undoubtedly increase and ease pressure on the NHS. The only objection would come from the Socialists who can’t stand the idea of anyone with a bit of money “queue jumping.”

    If the A and E and ambulance crisis goes on much longer, we are surely going to see private sector services set up in major centres of population. My wife and I would certainly sign up for one.

    Reply
  66. a-tracy
    September 23, 2022

    It is frequently said ‘in real terms’ the NHS isn’t getting more money, yet when I have looked online, it gets a lot more money over the past 25 years, A LOT. We are told our new immigrants don’t use the NHS much, so the NHS can’t blame the increased imported population, and covid removed the numbers in care homes and acute care significantly, we were told in the over 80’s.
    So can’t we see a simple chart, of how much more money, compared to the clinical and none clinical wage bills over the same period, compared to the insurance payouts for negligence, and compared to the outcomes and procedures delivered? Bed don’t tell any picture because of new technologies so much more is done as day patients even new mothers are despatched after a day when a week was the hospital length of stay 30 years ago. Now all colonoscopies, cataracts and other intrusive treatments are done without overnights.

    Reply

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