The important principle that people like and support is that healthcare should be free. We should all have free access to the NHS, and should expect to receive timely and good quality treatment in proportion to our health needs. All taxpayers of course pay for the service through taxes.
The only major departure from this was when Labour in the early years of the NHS introduced charges for prescriptions and glasses. Subsequent governments of various parties have given more exemptions to prescription charges whilst continuing with them and from time to time increasing them.
The NHS has never been a fully nationalised service. Labour’s original establishment allowed GPs to be private contractors, running their services from private premises as many still do today. The NHS has always relied on the private sector to supply its drugs, bandages, food and other supplies. For many years under governments of all three parties the NHS has employed private company contractors in various locations to clean and cook, to provide a range of services to hospitals and surgeries.
Nor has the NHS ever insisted on all its supplies coming from the UK. Where foreign companies have developed good drugs that UK manufacturers do not have the NHS is willing to import them. The NHS is also cost conscious and usually negotiates a bulk discount or special terms reflecting its buying power.
Most people do not mind the NHS drawing on the best supplies from the private sector as part of its activity, as long as the core proposition of free good quality NHS care is maintained. The present government has no intention of deviating from this. These are common principles and practices shared by Labour and Conservative governments in office.
November 8, 2019
“The NHS is also cost conscious ”
I hadn’t noticed. Perhaps in cutting services where they are most needed, destroying the whole point, granted, BUT
Does it use technology to optimise its costs and services?
Does it look to recoup costs from non-contributors?
Does it have a culture of existing for the staff or patients?
Be honest.
I think we all know the answers to these important questions.
November 8, 2019
Ref delayed cataract operations:
The revelations have sparked warnings that the mainly older people affected are being put at increased risk of a fall because their vision is so impaired while they wait, and also that too many clinical commissioning groups (CCGs) are restricting access to the operation in order to SAVE MONEY.
So people fall, can’t work, need help, and cost MORE just for the NHS to save money!
It’s rather like paying to swim and dive into a pool that’s only been half filled with water, to SAVE MONEY!!
November 8, 2019
Let’s take a country with a written constitution like France.
That is founded on Equality, Liberty, and Fraternity.
Private medicine was illegal in France – I’m not sure of the present position – because it was unconstitutional, in that it made people unequal in the face of illness.
Similarly, unreasonably long waiting times would be unfraternal on the part of those responsible, and so inexcusable.
It also means that healthcare cannot be used as a political football, come election times, as freely and disgracefully it can here.
November 8, 2019
Marty – – Equality, Liberty, and Fraternity.
Explain that to the legal immigrants (trying) to live around Paris.
November 8, 2019
Martin
Youve never been to France have you? You talk total cobblers
ALL French GP’s and clinics are private 40% of hospitals are private . The French health care system is funded in part by obligatory health contributions levied on all salaries, and paid by employers, employees and the self employed; in part by central government funding; and in part by users who normally have to pay a small fraction of the cost of most acts of health care that they receive.
France has one of the best health services because it is mostly paid to use ( albeit small charges) and mostly privately operated
November 8, 2019
As, I said, “was”.
I’ve spent a fair part of my life there as it happens.
The service is good because they have passed the laws to make it so, and which prevent ordinary patients being treated as second class.
November 8, 2019
My cataract operations cost Ā£2,200 each in Southampton, A colleague in the US paid just under $10,000 (Ā£7,600 at the time) for the identical operation, which she considered pretty good value. Her Health Insurance policy, via her employer, cost circa $20,000 a year, of which she pays a third in her payslip.
A common US family of four health policy costs circa $28,000 a year (Ā£21,000). The equivalent coverage for a UK family of four is Ā£9,200 a year.
November 8, 2019
Ā£9,200 is what the government spends on health as defined by Cofog7, not private insurance, sorry for the confusion.
November 8, 2019
acorn
The US system is crap. Now compare the NHS to France, Switzerland or Singapore
November 8, 2019
There is huge waste and need of reform from the left wing NHS management. Health tourism dropped by Tory govt, huge amount of money spent on translators! Vast amount of highly paid non jobs in the NHS. With many tiers of management and bean counters.
Nurses now needing degrees, how did we manage for so long. Why should they bear the extra cost? Back in 2010 we had the Tory scandal of doctors not being supported here to get jobs so we they sought work abroad.
Dentistry is not free! Quite from it. Many cannot register NHS and many cannot afford it. We also have a lot of foreign dentists with different qualifications. When is this going to be sorted out?
Then we still have the adult social care scandal where local authorities charge us in addition to flood defence and normal services on top of their five percent year on year increase that Tories promised to freeze! Mayhab was determined to force us to sell our homes to pay for adult care when your party repeatedly broke promises on the issue! Add to the list of broken repeated promises. Nevertheless Tory govt happy to piss down the drain on overseas aid scandals like Lear jets for Ugandan president, mating programmes for exotic fish! Tory govt gives EU another Ā£3.7 billion for its foreign aid on top of our Ā£15.1 billion!
Taxes, fiscal competence, utter rubbish. Your govt needs to start with basics like tell the truth.
November 8, 2019
The NHS is not ‘cost conscious’. For example there is no central pay roll facility that job is replicated many times over in each trust. A city the size of Brum has around four of them. As you complete your training you will be required to change trusts. Each time you do, you will need to represent your bank details and qualifications again (because the NHS does not appear to have a central record of them either). There are lots of non clerical non jobs that could be done away with and the money spent on frontline medics without more taxes or borrowing.
November 8, 2019
How many billions were wasted on a defunct computer system and who was held to account? Stephens is the product of the Blaire era. When will Tories learn to change staff if it wants true reform? Same with EU ambassadors. Wake up.
November 8, 2019
Indeed. Just when are foreign Nationals going to be charged or checked to see entitlement or recharged in the case of EU? We’re still waiting to see this happen after 9.5 years of more legacy Party incompetence!
November 8, 2019
One of the choke points of hospitals is A & E. It seems to me that many of the patients who go to A & E are neither accidents nor emergencies. They are people who can’t be bothered to make an appointment with their GP – or who don’t even register with a GP service.
It is interesting that the car park at my local hospital is sometimes very crowded, but not during school holidays or half terms. Strange how we can save up our ’emergencies’ until schools have gone back.
The other thing the NHS (actually the Govt.) needs to do is to integrate home care and care home facilities with their geriatric admittances. Very often, they have to keep old people in hospital (at great expense) when they should be in a comfortable care home being run by competent qualified staff which would cost a lot less.
November 8, 2019
It’s not the fault of ‘old’ people that they kept longer in hospital than absolutely necessary. It is the fault of the system in place that has failed to arrange the care they need. An ‘old’ person can’t magic up care in their own home, or even in a care home. It also happens to ‘younger’ people who need support outside hospital, but not in a care home. If you can find a ‘comfortable care home being run by competent qualified staff’, please send details. The vast majority of workers in the vast majority of care homes are not qualified in any way whatsoever. They are almost the equivalent of casual labour, paid a pittance, and often imported from abroad, via agencies that don’t care.
Reply My mother spent her final years in a good care home who looked after her well
November 8, 2019
I didn’t say it was the fault of old people. I agree with you, it’s the system that needs be upgraded. Expensive hospital beds could be reduced and the savings go to a better care system.
November 8, 2019
Your mother was very lucky then, and I’m really pleased that she was able to enjoy the last years of her life in a care home. Good care homes are hard to find. My own relative died as a result of the so-called ‘care’ that failed. A.k.a. sub-standard care. In a care home operated by one the biggest care providers. The same care provider that provides lots of NHS care too. (I have no experience of that care provider’s NHS care but I hope it has higher standards.)
November 8, 2019
reply to reply – – so did my Father-in-law in your constituency, but it took the bigger part of the value of his house. He lived there alongside people who he was subsidising….hundreds of thousands of us have not forgotten nor forgiven the fact of parents’ lifetime of being prudent only to see it legally consumed by the state.
November 8, 2019
Reply My mother spent her final years in a good care home who looked after her well
At what cost?
Reply We paid for it from the sale of her flat
November 10, 2019
JR, you still do not get the idiocy of the point you make do you? Tories gave home ownership to the masses under Thatcher to be a vote winner. Those who have struggled to buy their homes feel betrayed to be forced to sell them for adult care while millions who have not contributed a penny, including foreign nationals, get it for free!
What was the point of Thatcher giving hope of home ownership if it is taken away aft struggling to achieve it for yourself or family? Shoot yourself in the political foot but do not complain it hurts.
November 8, 2019
The NHS are not cost conscious in general they are hugely inefficient for the value they deliver. They also spend billions on defending litigation and on pay outs due to incompetence. They also damage the economy in general with endless delay and cancellations preventing people getting back to work.
I would introduce a standard automatic compensation scale systems that you have to agree to if you want NHS treatment. If you want more cover you pay for insurance which (could be a profitable side line for the NHS).
November 8, 2019
Of course people like it to be āfree at the point of useā but they would also like restaurants, supermarkets, holiday, houses, hotels, flight, electricity, clothing and everything else to be free at the point of use.
This does not make it a remotely sensible way to organise matters. It is not for health care either.
Reply Most UK voters think health spending is different and so support free at the point of use.
November 8, 2019
If it is free then you get rationing by delay, poor service and other back door methods for deterring customers. They do not respond to customers needs – why should they they have you cash already.
It depends what question you actually ask UK voters. Of course many of them pay no net taxes anyway so you are asking then āWould like free health care that someone else will pay for or pay for it yourself?ā Many will indeed say yes please to this!
November 8, 2019
Free at point of service. It all has to be paid for …
November 8, 2019
Free at the point of delay and rationing as we have you taxes already. We kill most fair competition by being āfreeā at the point of use so nearly all have to use the NHS and just get what they are given (or not given) after these delays and rationing!
November 8, 2019
Opticians, dentists are not free. Prescriptions in Scotland are! When will we get the Lothian questioned answered not fudged? England the only nation without its own,pawrlianent. We were promised by the Tories to address this. Another promise Failed. Parliament for England anyone?
November 8, 2019
Hope, yes I’m up for that!
November 8, 2019
Well said Hope. We have Nicola Sturgeon saying she will prop up a Labour Government to keep the Tories out even if England votes Tory and she has even had the gall to say she will stop the NHS (English) being used in any trade talks.
You can be sure of one thing – John despite purporting to speak for England and his colleagues won’t dare utter one word of condemnation of Sturgeon and Scots MPs yet again meddling in English only matters for fear of raising attention to the rotten deal England gets from this so called union and even more disgracefully this Tory Government, there only by the grace of England.
November 8, 2019
Not just prescriptions are free in Scotland. Dental checks and eye tests too. All courtesy of the biggest block grant in history of English tax payers’ money as Boris proudly pointed out in the house recently. All things denied to those same English tax payers on grounds of cost.
November 9, 2019
And university tuition fees. What about the English.
November 8, 2019
We don’t have a present government. It is unlikely we will have a majority government after the election.
November 8, 2019
I think we will have. Odds on Boris overall majority currently 6/5 – Labour 18/1. So slightly better than 50/50.
November 8, 2019
“The important principle that people like and support is that healthcare should be free.”
NO! There is no such thing! This is a Labour lie which you are repeating!
Somebody always has to pay!
November 8, 2019
They would like everything to be free! Until they see the tax bill that is. But then about 50% do not pay any net tax after direct benefits they and their family receive.
November 8, 2019
Good Morning,
Here’s the problem, Sir John: When you say something we generally believe it to be true. When Mr. Johnson says/promises something, we know NOT to believe it. So when you tell us something that is the same as Mr Johnson, then we just shrug and ignore you. This is what Mr Johnson has done for you and your party.
(If Mr Gove vehemently states something is the case, we know for certain the opposite is true/will happen)
November 8, 2019
Sadly true
November 8, 2019
……………do or die! Boris’s deal still being peddled as different from May’s when it is 95% the same vassal document. In with no say or control during the no point transition to nothing!
November 8, 2019
Well people pay for prescriptions, hospital and other parking, dentistry, opticians and glasses. They also pay by having to wait 3 hours at A&E. Free at the point of use means it gets rationed by delays and other back door methods to deter and inconvenience patients. Hence you have trouble even seeing a GP. No appointments today can you try again after ,9.00 tomorrow! Even then you get insufficient time and can even be told only one complaint, but they might well be relevant to diagnosis. Far more efficient to do in one visit for all. The NHS is generally a sick joke with some of the worst outcomes for a developed nation in the world. This despite having some excellent and very dedicated and long suffering staff.
About 50% of the doctors we expensively train go into other jobs than the NHS of leave the country. So dire can it be working for the dysfunctional NHS. Then they rely on often rather less well trained imported ones who statistically have rather more claims and complaints. A dire socialist monopoly. Freedom and choice please with some sensible safety net.
The system and organisation is often dire.
November 8, 2019
If people can pay for a hair cut, their car, the optician or the dentist then why not for a gp appointment? Cut taxes and charge for health care, with a safety net for the few. Then we get some real competition and choice. Corbyn seems to want nearly everything to be dire state monopolies. Encourage private provision with tax breaks to lighten the load on the NHS.
November 8, 2019
Then the GP would actually want to see them, probably the same day if needed or at a time of the patients choosing and for a less rushed appointment as happens in sensibly organised healthcare system.
James Bartholomew is surely right in the Telegraph a while back – āThe NHS is broken. What should replace it?ā
November 8, 2019
I have come across members of the medical profession who agree with your first point.
Why has medicine become this quasi religious sacred beast?
It is a service and personally I would like to choose who serves me!!
November 8, 2019
Exactly and if you have a specific problem you would choose someone who specialises somewhat in the appropriate area of not just any random GP doctor.
November 8, 2019
If this Tory Government weren’t so clueless they would cancel tuition fees for doctors on condition they work for the NHS for a set number of years. After all they end up writing off the debt for 78% of all the ones doing less important degrees.
November 8, 2019
Cut out the waste and unnecessary costs. For starters, stop being an international health service. I know the NHS staff don’t like the idea of charging, but they aren’t the ones making the decisions, or paying the bills. Start training more home grown nurses and doctors. Stop requiring nurses to be graduates and limit those nurses to ‘nursing’ rather than having them partly taking on the role of a doctor. Stop picking up the tab for ‘fixing’ failed private medical services. Ensure all private medical practice insure their own work and put responsibility on their customers to check that insurance. Stop plastic surgery except in cases of severe disfigurement, including cessation of sex changes. They should fund their own surgery as many others have to fund their own life saving drugs.
November 8, 2019
The NHS does charge international patients. A friend of mine, from the United States, had an accident in central London. The treatment involved lots of stitches, a plaster cast, medication and an overnight stay. The hospital took his credit card – and pre-charged it – before he had ANY treatment. The bill was in the thousands.
It is simply false to claim the NHS just treats anyone.
November 8, 2019
Andy
The NHS is owed Ā£150 million in unpaid bills
https://metro.co.uk/2019/08/27/nhs-owed-150000000-unpaid-bills-overseas-patients-10636586/
November 8, 2019
Andy – first time I’ve heard of a pre-charge and indeed a threat of being charged actually happening. Clearly a poor choice of where the friend went for help. But the experience is what happens in pretty much the rest of the world. Travel insurance should being paying.
November 8, 2019
Shirley – -some very good points.
November 8, 2019
Good morning.
Every election the same old mantra of; “(insert name here) will privatise the NHS” goes up by Labour. They know that it is a sure vote grabber and it is high time the myth is put to bed.
Under the last Labour government parts of the NHS, such as the ambulance service, have had to come up against private competition. The cleaning of NHS hospitals is done by private companies. Only the nurses and admin staff are NHS and they are unionised. It is this unionisation, not the NHS, which the Labour party is keen to save.
The NHS is not free. It is free at the point of service and to those that do not contribute. It has expanded what it offers beyond what it creators wanted and has now become the classic White Elephant. Reform is now long overdue.
I read recently that the NHS is now refusing to treat people if they do not fit into their views. This I fear is the thin end of the wedge. The NHS should not be allowed to select who it treats and does not treat. It is OUR NHS, not theirs.
November 9, 2019
Your first sentence is correct. Labour have been saying that at every election for many years. People should learn to think for themselves, and not believe everything Politicians say, especially before a General Election.
Personally, any Party that tries to frighten me to death, with untrue statements, doesn’t get my vote.
November 8, 2019
An honest description of the NHS. Where shortages of capacity occur, the NHS will also sub contract services such as scans or operations to the private sector if they have private capacity. Health service requirements are changing as population grows older and the pharmaceutical industry developes new drugs and proceedures. Consequently services are always playing catchup. It is akin to running a World war. Two years in you are not doing what you did at the outset.
I find it appalling that political parties assume ownership of the NHS at election time. Stop wasting clinical time grandstanding and making promises that cannot be kept. The workforce do not need a photoshoot AOC’s inspection in the middle of the battle they are conducting.
I have had intimate first hand experience of the NHS over the period of the last year that arose unexpectedly during a routine visit to my dentist. Everything clicked into place in a highly professional manner and I came out of the process a year later in a much better condition than I went in. Apart from the excellence of treatment it was done with great compassion. At no time did I feel that I was an object on a production line which in reality I was.
No doubt there are areas that would benefit from more money and personnel, none of which can enjoy an instant cure. Where cures are in the hands of government, such as the pension salary tax burden of some surgeons they should be dealt with swifly and not be allowed to become a running sore that impedes the battle in hand.
Government are there to facilitate and if necessary prioritise, but most importantly to arrange the best tax arrangements to create the wealth necessary to provide the NHS we will all need at some time.
November 8, 2019
Agricola, funny how there is always extra money to be found when there is an election. Before this we are told there is no money for anything.
November 8, 2019
Even more satirically funny is the way in which this money can fall off the radar once whoever it is is in power. Always remember it is our ,often hard earned ,money they are playing political roullette with.
November 8, 2019
now we are told that cheaper fast track visas will be available for doctors and other needed personnel (Half price from Ā£800 odd to Ā£400 odd! Why any cost?)
Why wasn’t this done decades ago?
November 8, 2019
Remember every NHS worker we import comes from somewhere in the World where they took the trouble to train them. Welcome though they are, and they come from different motivations, their country of origin is deprived of their talent which in many places is much needed.
November 8, 2019
The NHSs monopoly needs to be broken up. No doubt there will be loads of comments here about the poor outcomes it delivers for patients. However you need to consider what it is like to work there. Due to its hectoring management style, the BMJ estimates that it wastes the the taxpayer around Ā£2.5 billion a year through the effects of bullying. Trusts frequently use non disclosure agreements on whistleblowers that it forces out. At the moment it has around 100,000 vacancies, so I do not know where the Tories are going to get the staff for their 40 new hospitals. Thats despite many millions spent on a recent ad campaign asking former staff to come back to the NHS. Despite all this the medics still put in many hours of unpaid overtime, of which without the whole thing would have collapsed years ago.
November 8, 2019
How do you square breaking up the NHS when your reply to Sir Joe above complains that their are no centralised systems for managing staff paperwork?
November 8, 2019
The NHS ceases to exist and is replaced by a social insurance system, where medics can chose to who they work with and patients can chose who treats them and where. The NHS model disappeared from the rest of Europe in 1989
November 8, 2019
The NHS does not provide good quality care. Itās truly dreadful in a lot of cases mainly because the money does not come āviaā the patient. We need a real insurance system so that the insurers can withhold payment and thereby keep the NHS up to the mark. This is urgent and very disappointing that the Conservatives have no proposals to improve the delivery of healthcare.
November 8, 2019
I canāt let this go. You are using the āpoor careā trope to justify your personal view about the need for break up. I personally received excellent care for a second major back surgery which was better than well known private hospital next to the NHS one, that did je the first time. No difference in the op, indeed the same surgeon but apart from a private room, a marked in improvement in post op care and recovery.
In the family we had a less than 1 lb 2 oz preme baby. The care in the specialist unit and subsequently was world class and she is thriving. Of course there are niggles and I am sure (big) improvements possible but have you looked at insurance premiums especially as they increase due to age and their affordability for people on low incomes. The angst caused by the fact that your pot might run out because your problem is so serious etc.
From your comments, I guess not.
November 8, 2019
You were lucky.
It should NOT be a question of luck …which it is.
Those who have been lucky with the NHS should NOT preach to those who have suffered at its hands.
November 8, 2019
It is impossible for ordinary people to get health insurance if you have a pre-existing problem or are getting old. Insurers do not like paying out. Even with things like life insurance things become more difficult as we age and time draws near for the payout. I have on my desk at the moment a letter from my life insurer saying that they have reviewed my policy and they are cutting the payout unless I double my premiums, simply for getting old. I have had this policy since the 80’s, no warning then that they would not honour their side of the bargain or acknowledgement of paying in all those years. Insurance for the NHS would be a disaster and a rip off to the benefit of the big money people. As a matter of fact our costs for the NHS are among the lowest in the world for comprehensive cover and half of that of the USA which has a much poorer system. It could be improved, but insurance is not the way. It was made much worse by the Tory re-organisation of 2012 – that is what needs scrapping, not trying to make the Lansley system work, which it never will.
November 8, 2019
Lynn, I have to say that the only gripe I have about our health service is the waiting time now to see specialists. We moved from Scotland to England in January this year and it has taken until this month for my husband to be referred to a specialist for his chest condition. In Scotland he was being seen once every 3 months and so he hasn’t seen anyone for nearly a year. This is hardly surprising if you consider how many immigrants are coming into the country not forgetting the ones we don’t know about. Now he is under a consultant here and he is very happy with the way they are going to treat him and they have put him in for extensive tests. On the other hand I had a knee replacement in Scotland and it was done wrongly and it took me 4 years to get someone to take notice and do it again. Then, while in hospital I told the staff I couldn’t take certain drugs as they made me ill but they still insisted I take the painkillers and with anti sickness tablets they caused me to have a seizure which then prevented me driving for 6 months. Sometimes NHS staff need to listen to their patients and what they are telling them. Other than that I am grateful our health service is free but it needs reform desperately and nurses and doctors that have just qualified need to be made to serve at least 10 years in the NHS before they can leave and go abroad. My brother has recently moved from London to Sussex and thought seeing a doctor would be easier but he has to wait a month for an appointment just to see his own GP.
November 8, 2019
Thank you, Sir John. Such truthful clarity is needed, because of the hateful lies and distortions that swirl around this subject., especially at election time.
Sadly, however, the NHS system itself is highly politicized, and needs the challenge of private enterprise. There are no doubt many good people working within the NHS whose best efforts are frustrated by monolithic dogma, although there are signs of numerous examples of breakthroughs in clinical and service excellence.
November 8, 2019
Under the current management, some treatment is no longer free when not considered life threatening. For example hemorrhoids, ear syringing and deaf aids for special frequencies and varicose veins, but when they are no longer free the price of private treatment goes up. A quick ear syringe went up to Ā£35 and the cost for hemorrhoids started at Ā£1000 and is now Ā£1250. Yet these conditions can cause accidents and lack of exercise, which shortens life.
At the same time of course, the NHS is happy to provide sex change treatment for children and adults and possibly tattoo removal.
Why is it that all the Labour and Liberal politicians that love the EU get apoplectic when anyone suggests that we adopt continental health systems, which kill far fewer patients than ours?
November 8, 2019
Listening to a LBGT+ campaigner on the radio the other day. The NHS is currently paying for a 96 year old to change sex
November 8, 2019
Stred – – here in Wokingham a large GP group no longer provide ear syringe – so buy an olive oil spray (Ā£7) and visit an ‘optician’ – yes an optician who does it for Ā£50.
November 8, 2019
The person I know went to specsavers and they charged, Ā£35 for two minutes. I always used cotton buds and the GP said my lugs were exceptionally clear.
November 8, 2019
Stred – cotton buds! My GP refused to clean my ears as I had used cotton buds – they push in the wax further making cleaning much more difficult he said.
November 9, 2019
You have to push them up to the eardrum, being careful to stop when you hear the contact, and twiddle them.
November 8, 2019
Staff first, patients second. Budget expansion at all costs. A political employer. A promoter of progressive politics. One of the primary sources of Labour’s political power and funding. The ambushing of Johnson in a hospital only a few weeks by a Labour activist posing as a concerned father reveals how the public sector work with Labour nobble provision and attack outside interference
Waste, Inefficiency, and in a sweet-spot now that it can demand what it likes and politicians bend over backwards to throw cash at it
Wake me up when the Tories embrace reform of all of Labour’s power bases that now exist in the public sector. From the BBC, the NHS and the CPS right through to OFCOM and the Electoral Commission
If Labour can construct a client state why can’t the Tories?
November 8, 2019
Dominic you are so right. It is blindingly obvious. All forms of selection procedures in the public sector, judiciary, civil service etc need radical overhaul. Tories even appointed former Labour ministers to quango posts! Tories had nine years to bring about change and have not achieved anything substantive on any issue. Most of thier policies could be swapped with New Labour and there would be no difference!
November 8, 2019
Hope- that is why we all need to vote Brexit party, except for sir John and a few other Tories.
November 8, 2019
That is the root cause of the NHS’s problems – It has become a political football much like State run / subsidized industries were in the 60’s, 70’s and early 80’s. Those running such places put their own positions above that of patients. It is time this was broached.
November 8, 2019
Funding the NHS constitutes the largest chunk of state expenditure. Inefficencies in the present system are well known. I’m surprised you’ve made no mention of them. Healthcare in this country is in desperate need of reform. But none of the political parties has the guts to say so because ‘our’ NHS is ‘precious’. This position is contemptible, and it is held equally by Conservative, Labour and the rest.
But the NHS isn’t solely an economic scandal. Mandatory funding of morally questionable medical procedures wounds individual consciences deeply. Abortion is the most obvious example. I strongly believe that the right of a mother to act in what she perceives to be the best interest of herself and her child should be protected. However, I should not be compelled to financially support her decision. The integrity of an individual’s conscience is the most important principle in political considerations. The manner in which healthcare is provided in this country runs roughshod over this principle.
November 8, 2019
As for doctors leaving the nhs when theyāve qualified the answer is quite simple, back in my days of the 60-70s if you wanted to be put through your HGV driver training for free you had to stay with that company for a set time and if you left in that set time you had to pay the full whack of what the training cost the company , so why isnāt this implemented into the nhs, the nhs by the way is a great institution but the staff from nurses to middle management are taken for granted I know because Iām married to one and believe me she works her fingers to the bone and she doesnāt clock off when sheās home , she will be on the phone or computer sorting out problems at work and doesnāt get extra money for doing it
November 8, 2019
They do not actually leave the NHS. Quite a few newly qualified consultants I know simply do locum work and refuse to take a substantive post. They can make lots of money and know that the ‘gold plated’ pension is a mirage anyway, when the state’s pension liabilities are in excess of 200% of GDP. Anybody considering Oz will soon find out that the grass is not greener there, look at the suicide rate for medics for example. You cannot dodge the paper load either in the US, as one of my relatives says dealing with the insurance companies is just as onerous as dealing with the NHS bureaucracy. Plus you have to requalify
November 8, 2019
Dame – – so going back to the Junior Doctors dispute over contract – many claimed some had already resigned over it, had got better jobs overseas and lots more were in the process of doing it. You claim they do not leave the NHS. So you are saying they lied and nobody leaves?
November 8, 2019
Reread my comment and think about what I have written. I refer to a FEW consultants not junior doctors
November 8, 2019
Mick started this by saying ‘doctors’ leave – NOT highly paid Consultants. You think about it. junior doctors aspire to become consultants (who do little every day work) who are paid fantastically well – -so OK you are right rich consultants would be silly to leave. But junior doctors do most of the work and did and do leave…..Junior are still doctors.
November 8, 2019
Those people who are sick, not through their own fault, may well find their illness prevents them having the income to pay for treatment. Those deserve compassion.
Those who see the NHS as an entitlement and are reckless with their health should have to pay for their own treatment.
It annoys me that so much NHS cost is taken up with conditions that are the consequence of excess eating, smoking, drug and alcohol abuse, I have to contribute to the cost of treatment and highly trained staff have their attention divided from those in genuine need.
November 8, 2019
And when they ā discoverā that eating breakfast cereal causes XYZ?
You will constantly whittle away at the ādeservingā ailments?
Irrespective of NI paid?
November 8, 2019
As long as healthcare is funded through the tax system it is an entitlement. This is a big part of the problem.
To your point on excess eating, smoking, etc. all these things are taxed, so again, entitlement follows. I would rather see cigarettes untaxed, but smokers pay higher insurance premiums. This is simpler and fairer, and morally sound. For those adopting ‘healthier’ lifestyles, insurance premiums would be far lower.
By the way, I agree completely that those in need should receive compassion and practical help from those able to do so.
November 8, 2019
And what if you donāt get ātimely and good quality treatment?ā
( What if you get ignored and bullied?)
Who is there to support you?
NOBODY thatās who.
November 8, 2019
“We send the EU Ā£350 million a week – let’s fund our NHS instead”. That was the pledge on the side of a referendum campaign bus used by Boris Johnson. It was argued that the figure was overstated. We voted to Leave anyway. Now, having already given the EU about Ā£35 billion since the vote, the Conservative Party is asking the same electorate to hand over to the EU what has been estimated at much more than Ā£39 billion. And what do we get in return for all this money that has been diverted from our NHS? We get the temporary surrender of legislative authority, and the long term surrender of judicial authority to what would henceforth be a completely foreign government. How is this a voteworthy proposition?
November 8, 2019
Activist ECJ judges will decide how much we owe.
November 8, 2019
Kevin – there was no pledge, promise or guarantee even to give a single penny of the Ā£350m to the NHS. Any money given to the NHS from that Ā£350m would be decided later obviously.
It is like -” Lets have fish and chips tonight” – what could be your answer?
November 8, 2019
Prescription charges apply only to England.
When will a Gov. have the guts to end health tourism?
November 8, 2019
I note that you say “Labourās original establishment allowed GPs to be private contractors, running their services from private premises as many still do today”. Was it not the case that GPs forced that issue by refusing to sign up to the original intention and plan behind the establishment of the NHS. In other words, the political point you make by mentioning Labour’s original establishment fails to acknowledge the way that GPs forced it.
I doubt that many of us would want this country to return to the situation that existed before the NHS came into being, where people could not afford to see a doctor, not even a ‘panel doctor’. There are many people today who just cannot afford to have prescriptions made up, who may well need several medications but who just can’t afford to pay for them. How would they fare if they needed to pay for hospital treatment?
When a Consultant says to the patient who has an extremely life-compromising diagnosis, that he won’t be able to treat the patient for X days or weeks, and then in next breath asks “Do you have private health insurance?” If the answer is ‘yes’, the reply from the Consultant is ” I can make a bed available in the very same NHS hospital ward tomorrow for your treatment to begin”. That’s nothing to do with Labour, is it?
Nor do you mention the extraordinarily high cost of many drugs, so high in some cases that they remain unused and unavailable. I know that NICE has to keep watch. And I appreciate that pharmaceutical research doesn’t come free, but there comes a point where you have to scratch your head and wonder what on earth is going on in this strange country we now inhabit, where we don’t have a ‘present government’. I don’t want the NHS to be used as the proverbial political football by any government.
Reply All parties in government have used an independent system to assess which drugs are necessary and affordable for the NHS. All parties in government have allowed the private sector to offer alternative treatment to individuals, often provided by doctors who also have NHS contracts. No-one allows an NHS doctor to tell a patient they can cut the waiting time by paying, as it is a free at the point of need service. The NHS has to weighh urgency and need when deciding on treatment dates. All emergency cases have to be dealt with that day.
November 8, 2019
From personal experience
In some parts the NHS is excellent, in others dire.
The medical professionals are usually good to excellent, when you eventually get to see them.
Inefficiency and poor administration is rife.
Buildings, their condition and cleanliness in many cases not fit for purpose due to age, design, or management supervision.
Why not train more doctors, nurses and admin staff ourselves, with a lock in clause for at least 5-10 years service to the NHS needed after qualification as the cost.
Produce more of these people than we need, and if we have a surplus then let them go abroad or go private eventually should they wish, far better to train professionals than just giving away money on foreign aid to treat diseases abroad.
Treatment of visitors to our Country upon payment is a no brainer, it happens in every other Country, travel insurance is needed, so bloody simple, no insurance you pay !.
I could go on and on but others have made many other excellent points
November 8, 2019
Alan – – whats not to like – entirely agree.
November 8, 2019
Many of the most expensive university courses take large numbers of foreign students to subsidise the cost of training, e.g medics pay 9k or nought for a course that costs 50k per year. The government needs to pass a law that medical schools will select British students only and that the government will fully fund their medical degrees. This can also be applied to other courses where the practitioners are essential for the public good and have to be highly trained.
The policy of replacing English people in the professions by foreigners in order to save money when the real motive is turning England into a multicultural quagmire from top to bottom needs to end.
November 8, 2019
I have absolutely no problem with certain professions getting their degrees and training for nothing (at the public expense) but only on the condition that they serve in that institution for which they are being trained for 5-10 years, if they want to leave or not serve the fullperiod then afraid they have to pay for it themselves.
Reason: I have seen too many take advantage of free training and then leave to go somewhere else.
November 8, 2019
No. Their career would be in this country otherwise what is the point of training them?
November 9, 2019
Forthurst
I am talking about the excess doctors or nurses to our requirements going abroad, of course we want as many as possible here first, so we are fully staffed with our own trained people, hence the condition of service I mention.
Nothing wrong with offering excellent training to others from abroad if they pay for it, as outlined by yourself.
Why don’t we try to become the recognised experts in training ?
November 8, 2019
forthurst- there is a giant black hole in the pension contributions for the university principles. Many billions less than is going out. This is a private pension scheme, but the poor tax payer will end up paying their pensions. e.g ( a named ed) principal pays himself Ā£640,000 a year, when he retires he will get 2/3 of that for life. Is it right that we wil have to pay his Ā£425,000 a year pension? That is the tip of the iceberg. Sub prim all over again
November 8, 2019
Most private companies will strive for 99% efficiency across the scope of there business
Because of the complexity of the NHS and all the differing funding mechanisms, trusts, emergency services, staff, hospitals and social care the best that can ever be achieved is circa 80% across the scope of the NHS i.e the pareto effect 80:20 rule
As soon as you realise that 20% of your business is in constant flux under the current structure and there is nothing you can do about it, you should ensure that the 80% of your business is 99% efficient.
The only real way to improve the NHS towards 99% is to use a structural model like the army i.e national planning, staff, purchasing etc
But when you realise that 80% of the NHS is good, and there is nothing you can do about the other 20%, donāt put extra funds and time into something that cant be improved i.e you can ever really fix it
I believe the NHS does excellent work and under the current structures and 80% efficiency is a great achievement
November 8, 2019
The main problem with the NHS is that the responsibility for the nationās health lies with government and not where it belongs – with each of us .
In Singapore each person has his/her own individual health account tied to their NI number from the age of 6? Months I think .
Government credits this account with a fixed amount each year for you to spend as you see fit .
There is a quick individual appreciation of the costs of medicines, gp nursing and consultant time so that money is not wasted .
There are exceptions eg terminal diseases ,but the aim is that by a certain senior age of retirement and when the account has reached a credit threshold then government takes over the responsibility of providing care to the end of life ..
Oh to be rid of the nanny state .
I would either enjoy sugar and caffeine soaked drinks or not drink them because the costs of curing obesity were too high .
And our costs of the NHS are around 10% of GDP , Singapore costs are 3-4% .
November 8, 2019
Indeed and if you smoke & drink too much, eat too much the insurance should cost more as you are a higher risk and it would deter some hopefully.
November 8, 2019
The NHS and its principle of free of the point of delivery should be lauded.
However it should be concerned only with the treatment or prevention of illness, disease and other debilitating conditions. There is no room in its mandate or budget for fertility treatment, cosmetic treatments or gender reassignment.
With its purchasing power the prices it achieves should be rock bottom, we should be hearing about suppliers complaining of their treatment as they do about Tesco.
I fear it is run for its employees (the front line staff do a fantastic job mostly) rather than its customers
November 8, 2019
Forgot to mention that all users should have to prove entitlement to use before gaining access
November 8, 2019
I believe that the media is guilty ā and therefore many politicians are guilty ā of concentrating on NHS spending rather than outcomes.
Surely we should concentrate more effort on the output end of the telescope rather than the input end.
The whole point of healthcare is to maintain our health and NOT to eat up money!
The BBC and other media always measure NHS performance on the amount of money going into it rather than measures such as the WHO measure of āMortality amenable to health careā.
I think the government should order the NHS to produce its own āoutcomesā report and have it released to the press on an annual basis.
November 8, 2019
From international.commonwealthfund.org (also in healthsystemtracker.org), the “Rate of mortality amenable to health care” in 2013 per 100,000 people was:
Australia 62.
Canada 78.
Denmark 82.
France 61.
Germany 83.
Italy 75.
Netherlands 72.
New Zealand 87.
Norway 64.
Sweden 69.
Switzerland 55.
UK 85.
USA 112.
These countries have different ways to fund their health systems. The essentially private health systems in both the USA and Switzerland are at the two extremes of the distribution, which should indicate that private provision can be good or bad. So the claims made by some here that the UK going fully private would solve all problems is rather more ideological than based on hard facts.
November 8, 2019
hefner – – and of course the USA has the problem of less than half the population has any form of medicare. So halve the rate above representing those who can afford the cost and it becomes the best!
November 8, 2019
Indeed. I see that you are quite happy with half the population of a country having no medical care provision provided the other half has “the best”. Thanks a lot for this insight on your way of thinking. Very much appreciated.
November 13, 2019
Fred H
Total cobblers
I’m no fan of the US system of healthcare , I prefer universal coverage however theres some total nonsense talked about USA and health
The percentage of people with health insurance coverage in USA in 2017 was 91.2 percent ( US gov census data )
The US federal government spent nearly $1.1 trillion on health care in fiscal year 2018 . Of that, Medicare claimed roughly $583 billion, Medicaid and the Childrenās Health Insurance Program (CHIP) about $399 billion, and veteransā medical care about $70 billion.
November 8, 2019
Switzerland has a compulsory subsidised insurance scheme with the government leaning on the insurance companies. Everyone has a choice of clinics and diagnostic services available immediately. The US has expensive insurance and an expensive private treatment with good facilities but those that can’t afford it have to use the US version of the NHS on a small scale. This is why they have high mortality. The Swiss system is expensive and the French may be better for the UK. Here the patient has a choice of facilities and pays but reclaims the cost from the state. The cost of managing the rationing of treatment is avoided. It’s similar to the difference between a market economy and the planned Soviet system, which always had shortages.
November 8, 2019
the US version of NHS? – do me a favour. You might get a band aid- stuck on a cut finger – but investigative scans/mri and operations? – forget it.
November 9, 2019
hefner
Mostly true, although Ive seen no one argue for private healthcare funding in the UK. Like the vast majority of countries we would wish to have universal healthcare free at the point of use. However most countries provide the services via private providers . I think thats wjhat most people would prefer here.
November 8, 2019
It is because there is a very weak connection between patients and funding. For example,
GP surgery funding is determined by patient roles and the roles are determined by bureaucratic rules defining the catchment area. Similarly hospitals and do on. There is no mechanism by which funding follows the patient.
Contrast with a private business whose main or only source of funding is determined by the choices of its customers. When its sales fall the first question is why customers are not buying or are buying elsewhere. You can’t even ask the question of the NHS because there is no means of answering it.
If funding was in the hands of patients, managers and politicians would very quickly start asking the right questions Why do patients prefer doctor x over doctor y, why do they favour hospital 1? And so on. Good service would attract more funding and prosper, bad service would go out of business.
November 8, 2019
The NHS is committing suicide by their refusal to see themselves as a cost to the UK taxpayer. Their attitude of refusing to see that treating the world who turns up here to get free treatment, plus, on many cases, free translators and obviously many multiples of time took in translation – takes the available treatment time and money away from the people who are actually paying for the NHS. The NHS then wants more and more money. That only comes from the UK taxpayer, not the fly-in patients.
November 8, 2019
How many GP surgeries, clinics or hospitals in UK have an EFTPOS terminal? I haven’t been back to UK for some years but I doubt many even have the means to receive payments from patients. The last time I visited, one health centre refused to see me because it couldn’t receive payment even in cash. I was eventually seen in another which could not receive payment either but saw me anyway.
November 8, 2019
The Brexit Bashing Company is today supporting both the Labour and SNP scare tactics that should the Conservatives win, the NHS will be sold off to the US and our medicines bill will increase by Ā£500million a week.
Like most I know that is simply just not true, but the BBC is reinforcing the claim. However it is those 2 or 3 % that believe a soundbite if it repeated often enough particularly if the BBC gives the appearance of it being true, that cause an election to be won or lost.
November 8, 2019
another example of the BBC creating ‘news’ NOT reporting factual events.
Continuing Project Fear. yawn…..
November 8, 2019
I see Ian Blackford in not trusting Boris wants legislation to make illegal any NHS tie up with America. As he has no trust in Boris why doesn’t he also want legislation to prohibit hanging, flogging, etc., etc. With Boris he can be never sure it seems.
November 8, 2019
There is nothing public in the NHS it is all private, funded by public money.
Trusts are private institutions, GP offices are private along with the doctors the equipment is all made by private companies the drugs are made by private companies the, only thing that can think of that is public is the pension staff receive.
November 8, 2019
Oh yer the government get a say in now the private Trusts are run as hospitals for the public and mess it up every time.
November 8, 2019
This analysis fails by missing the obvious criticism of the NHS that it is due.
The uncountable CCG’s deciding to treat some conditions in some places, and not in others.
The poor quality.
The lack of honesty when denying treatment.
And so much more.
I am tired of a political class that treats the NHS like a religion. There is a lot wrong with it. We need some honesty.
November 8, 2019
I think many people feel that a doctor’s appointment should have a small charge applied. My doctor tells me that no-shows are their biggest issue and a small charge would prevent that.
Apparently the non-working sector below pension age are the worst culprits.
Privatisation is desirable in my view. The socialists have “weaponised” the NHS such that others are now afraid to even question the health care model we use.
If people have private health cover, why do they not pay a lower rate of tax or NI? We should incentivise people getting away from the NHS to reduce the strain. And use private companies wherever they can provide a better service for less money (and there are many areas where they could do this).
It’s time to make the argument for this – someone on a party’s backbenches such as yourself would be the ideal person – the leadership can claim that it does not reflect their current thinking, but it starts getting the message out there. Show people what they could have. Australia has a 1.5% Medicare levy and has a superb health service.
November 9, 2019
Forthurst
I am talking about the excess doctors or nurses to our requirements going abroad, of course we want as many as possible here first, so we are fully staffed with our own trained people, hence the condition of service I mention.
Nothing wrong with offering excellent training to others from abroad if they pay for it, as outlined by yourself.
Why don’t we try to become the recognised experts in training ?
November 9, 2019
RB
One of the reason Doctors have so many missed appointments is that people cannot contact the surgery to let them know.
Ring our surgery and it can take up to an hours wait to get an answer, last time I called them I was 43 rd in the queue, and waited 48 mins.
Do you really think people will wait that long to tell them they will not be turning up because due to delay in getting an appointment in the first place they have sorted themselves out or gone to A&E.
November 8, 2019
How disappointing! But I understand why no government in UK will ever try to reform the NHS. Few Brits have experienced any other systeml by living and working overseas.The majority of households are net beneficiaries of the state. There is no culture of paying for state supplied services. They pay taxes, not for service. In the absence of objective empirical evidence of its superiority, the NHS has been raised to religious significance. It is the only thing Brits feel patriotic about. This is curious because in the world of reality it is a truism that people value what they pay for. On the other hand they adore free stuff. So is the NHS free stuff, a running expense someone else pays for, or an investment you value?
I have experienced three health systems: the Armed Services, in the days when they had their own, the NHS, and the Australian system. There is no doubt in my mind the Australian insurance based system is vastly superior to the NHS.
I have not made a detailed comparison of waiting times, mortality rates, life expectancy or costs. The Australian system just works for me as a user. The NHS did not. Every encounter was bureaucrat and illogically so presumably because it is a Socialist system, inefficient and designed to favour the supplier over the customer.
A doctor friend who had been seconded to Australia for 6 mths told me she would rather work in the Australian system but family commitments keep her in UK and on return to UK she set up in private practice and now also does locum work for the NHS because it pays so well.
Government’s cannot easily change culture. UK is stuck with the NHS.
If there is one underlying reason why, as a customer, I prefer the Australian system it is that I pay and therefore I choose my services,
and that gives me ownership. I choose my doc, I choose which hospital I go to, I take advice but decide my treatment. I choose either public or private treatment. In short I feel it is my service and I work with it to get the best service. In UK I felt the NHS went out of its way to make good service difficult unless you were that mythical average NHS patient. There is no such thing as a standard patient.
November 8, 2019
PS. Summary, to the NHS I was a problem. To the Australian system I was a valued customer. We used to joke the Navy would run better without ships. The NHS gives the impression it would run better without patients.
November 8, 2019
Nicola Sturgeon has said the SNP will take steps to protect the NHS across the UK from trade deals made by a future UK Government.
No UK PM/party, accountable to the UK electorate, would dare sell/trade away our NHS to US corporates. They would be out of office at the next election.
On the other hand, if we were to remain full members of the EU, or become an associate member by joining its CU, it is perfectly feasible that the EU would be prepared to trade away our NHS in order to get cheaper tariffs on German cars and French food and wine.
It could do this with impunity as they are unelected and un-removable by the UK electorate.
November 8, 2019
It is because there is a very weak connection between patients and funding. For example,
GP surgery funding is determined by patient roles and the roles are determined by bureaucratic rules defining the catchment area. Similarly hospitals and do on. There is no mechanism by which funding follows the patient.
Contrast with a private business whose main or only source of funding is determined by the choices of its customers. When its sales fall the first question is why customers are not buying or are buying elsewhere. You can’t even ask the question of the NHS because there is no means of answering it.
If funding was in the hands of patients, managers and politicians would very quickly start asking the right questions Why do patients prefer doctor x over doctor y, why do they favour hospital 1? And so on. Good service would attract more funding and prosper, bad service would go out of business.
November 8, 2019
I have personal experience of the Private Sector being involved in the NHS as well as experience directly from the Private Sector via a Company scheme. The quality of the actual operations matched but I would give lower marks to the direct Private Sector facilities to that of the NHS allocated one under these circumstances. Both of my operations were years ago and the latter under a Labour Government Health Department with Frank Dobson in charge of it.
To suggest that involving the Private Hospitals are taking over to accommodate NHS patients is deliberate misleading scare mongering.
From my experience I am now inclined that the NHS is controlled by amateurs compared with the expert management of Private Hospitals.
The NHS is one of the worlds biggest employers and requires to maintain a patient base of around 65 Million people. There is no reason why the NHS with their British taxpayer funded income should not farm the facilitates required out to the Private Sector for tender. Ā£125 Billions is a big incentive to raise standards.
November 9, 2019
It disappointed me to see that the comment I had made on the NHS didn’t make it past your moderation. Today’s headlines in the press allow me to understand why you chose to dismiss my comment, which was based entirely on my own personal experience. It was polite and factual. I also commented on a historical fact about GPs and the creation of the NHS. Again polite and factual. It saddens me to see the extent to which you manipulate comments.
November 9, 2019
Any one in the world can come to UK and get endless free medical treatment.
However, born in UK we have to have medical insurance, to travel to EU countries. If we have illnesses, medical insurance can be refused, making it impossible to travel to EU countries. What are we paying the EU parasite for?
November 9, 2019
This is how is WORKs in Australia.
GP surgeries are generally large, employing many doctors. There are NO appointments, just turn up and you will be seen, But first you have to show your medicare card to access the system. Doors open at 6am and close at 12 midnight. They do not shut for 2 hours lunch. You can usually see a doctor very soon but if you wish to see a particular doctor you may have to wait a little longer. You do not need to take time off work. Small operations are done there and then {bi opsies, mole removal etc}. It was 30 dollars to see the doctor. A&E is usually empty. No waiting for an ambulance {about 1500 dollars} but most people have insurance to cover this. Because of these things the system is not abused.