Tuesday, 10 January 2012

NHS Reforms ...

Right, I'll be straight up and honest. I'm not a fan of the NHS in its present form. It is, at best, the result of a series of ideological ambitions, with which I do have some sympathy, and a whole slew of compromises which have had to be made at various times to bring or keep people on board, to satisfy some vested interests and of course, the political meddlers who simply can't keep their noses out of things. Largely speaking, it works. It delivers health care and it does so reasonably well for the most part, though, here and there, it is a lottery when it comes to certain treatments and medications.

One of the reasons I do believe it needs root and branch reform is not because I want to see it broken up and privatised. What I want is less political interference, less spent on the massive administration and plethora of clerical posts that all detract from the delivery of medical care in one way or another, and far, far less central direction of the manner in which a doctor treats a patient.

The taxpayer puts in an enormous amount of money to the NHS, yet the hospitals are in a shocking state, cleaning being one "service" "contracted out" according to the bureaucrats to "free medical staff to deal with medical matters." And there lies the problem. The opinion of the medical staff - and often their wishes - are ignored by the "managers" who actually run the hospitals. As I have said many times, "management" is a function of every job, task and profession, and no one can "manage" a professional function if they are, themselves, not members of that profession.

All of that said, The Postulant has provided me with a very thought provoking article. It is on a blog called "A Better NHS" - something even I would wish to see. In a series of questions and answers regarding the current government's draft legislation for reform, the writer provides some very interesting and valuable arguments. Despite what I said in my opening paragraphs, I do believe this article is correct. The NHS can be improved, but David Cameron's plans are not the right way to do so. While this may satisfy the Treasury and its ambitions to sell off every service the government provides, and will certainly make the shareholders and the Boards of various companies such as Capita dance for joy, it probably won't make a better NHS.


  1. Well, over the years my opinons have changed. When I was younger I believed that all BASIC health care should be free at the point of delivery. Experimental, cutting edge surgery and medicine, cosmetic surgery and the like could and should in my opinion be the preserve of private medicine. The problem with my ideology came when such things as Kidney transplants became routine rather than exceptional. Dialysis is very expensive. So is the drug regime for a post operative transplant patient, no matter which organ is involved.

    So, my youthful self saw maternity homes closing and casualty departments merged into fewer more specialised units. I thought, for one transplant, you could keep the maternity home and the local A&E open for a year, which benefits most? The socialist / communist theory here is obvious. Use the limited money to benefit the masses in terms of basic need. However, now we have several real specialist central units in place. Prince Philip probably would have accepted any hospital at Christmas, having been born on a kitchen table on a Greek island, however, if my heart ever goes 'poof', I'd kind of like to be within reach of Papworth. Spinal injury, Stoke Mandeville, suspected cancer, Christies. What we need then is a transport infrastructure to remove the post-code lottery effect.


  2. The transport question:
    The current ambulance services are not (usually) designed for that function. So the problems still exist. Charitable 'big society' work is of value, but is it universally valuable? I'm not sure helicopters are the best use of funds either, although any seriously injured person must be glad to see one. I've worked with rescue helicopters, I know how valuable they can be, but are Air ambulances a universal benefit?

  3. The NHS was a product of a wonderful socialist initiative in post-war Britain. The 1942 Beveridge report laid the path out. The NHS and the Welfare State shaped the world I grew up in, as did the nationalised British Railways. Of course, they were working with worn out and exhausted systems. Post-War Germany rose from the ashes to take over as the engineering giant of Europe, we white-washed the old Victorian factories and carried on as if nothing had happened.

    Perhaps now, after Bliar/Broon have spent billion upon billions weighing and measuring the NHS but not improving it, is the time to have a complete review of what the NHS could and should provide. It cannot be all things to all men, that is not possible (1Corinthians 9:19 ff) so how do we encourage the debate about what could be possible?

    Political short-termism is with us to stay. The major issue with democracy an a governmental form. the beauty of democracy is not in electing your own choice, it is with dismissing failing governments. So why think beyond the next election? Spend, spend spend until they see through you, then run and hide...

  4. Fortunately, for all their other faults, the 1945 Labour administration did think beyond...

  5. The reason I sent that link to the Gray Monk is that I have experienced private healthcare and seen friends and relatives go through it. Every time you are treated for something, it's removed from the list of items that your insurers will cover. Very few working people can afford the actual cost of healthcare when something goes seriously wrong. I was sadly reminded of this this morning, when a cyclist was killed outside my office. The two ambulance staff and large number of police officers who arrived on the scene and stayed for between an hour and 4 hours all cost a lot of money. I'm glad that no one will be presenting his surviving spouse/ girlfriend/ parents with the bill for his treatment and the investigation that had to be conducted afterwards.

    If healthcare is privatised, the very rich will be fine and the very poor will probably have a safety net - not as good as being rich, but better than nothing. The people who will suffer the full cost of any "tough luck", such as appendicitis, or a careless truck driver, will be the middle classes, who have been struggling just to stay in the same place for the last few decades and who are about to be squeezed out of existence. The middle classes are particularly vulnerable when it comes to healthcare, because the poor tend to have children when they are younger and physically healthier. The rich can afford private healthcare at any stage in their life that they feel like having children. The middle classes are being forced to wait until later in life (if they don't want to be scroungers), because they're being priced out of housing, childcare etc and therefore are more likely to need expensive medical interventions.

    Saving the NHS isn't just about socialist ideals any more. Politics has become meaningless these days anyway - all parties are there to line their pockets and do whatever will benefit their friends. This is about saving society and saving the people who actually fund roads, hospitals etc. Shareholders won't get any profits when the people who are actually working, paying taxes and buying goods have been squeezed out of existence.

  6. Your point is very well made, it is always those between the two ends of the spectrum who suffer when "sacrifices have to be made for the 'benefit' of the majority." This has always been my complaint, as a "middle income earner" it was always my fate to be "earning too much to benefit from ..." whatever it was.

    Jospehus and I agree, in the main, that the NHS does provide a safety net for those who cannot afford "private" health care, I think the real question revolves around the "luxury" provisions - like "full body transplant of organs" and the costs of administration that seem to keep going up while delivery and service is cut back. No, it isn't about socialist ideals anymore, but somewhere there has to be either a levelling out of services, or a rationalisation - the constantly expanding costs simply cannot continue.

  7. Interesting that VC focusses on child-bearing, it is, after all, one of society's most important activities. My own experience, including the birth of my own Son over 30 years ago is that what should and could be a local effective NHS provision that a large percentage of families and women in general would use at some point in their lives is an appalling mish-mash of provision in varying quality. When the last cottage hospital maternity unit closed in Aberdeenshire, any mother in need of hospital intervention had the thrill of a med-evac helicopter to Foresterhill. not an "air ambulance" but a full scale North Sea Oil Med-Evac. If the contractions didn't start after that, there would be problems!