Despite the extraordinary success in Rochester and Strood last night my moment of the entire evening was an unusually pertinent and incisive question that arose on Question Time just a few hours earlier.

An A&E doctor, Nicola McDermott, (I hope I have the spelling right) asked:

I feel a large part of the problem is unrealistic expectation and abuse of the service by patients, how do we tackle this elephant in the room?

She might easily have just announced that the king is dead, or that Martians have landed in Hyde Park for all the enthusiasm there was to answer her. The pause was palpable and nobody really wanted to respond at all. The silence was finally broken by our own Douglas Carswell but only to say ‘after you’. However as seasoned politicians it didn’t take long for them to talk about anything but the question and we were again led along the well trodden path of miniature party political broadcasts and the puerile points scoring that is the usual accompaniment.

Things weren’t helped by the irascible Ken Clark, a master of stumbling and stuttering indefinitely whilst saying nothing of any note. The usually misinformed and immensely dislikeable Alibhai-Brown had a stab at the second bit but with no real intent and, of course no insights as to a solution.

Dr McDermott must have known the Question Time format would never be able to provide any enlightenment about such a fundamental issue and not simply because politicians themselves avoid these ‘elephants’ routinely, but it was entertaining even if highly depressing at the same time.

When she said “I feel a large part of the problem is” the problem in question wasn’t defined leaving many options for answering but I believe she meant the following.

The NHS as a self contained organisation with a limited remit on national health but an unlimited one on the provision of service that has become conceptually unsustainable and as a result we are in the process of a decline which is manifesting itself through a plethora of apparently unrelated failures in all sections of the organisation, depressing the morale and commitment of those subject to the pressures of such a decline and progressively and routinely failing its customers and workers.

Simply, offering everything and anything to everyone unconditionally and without charge is a philosophy that cannot be met all the while dependency as well as service options continue to increase.

She rightly highlights as principle causes of this the expectation placed upon the organisation and the regular abuse by patients. There are, actually, two more fundamental issues:

  1. The reactive nature of the NHS, only becoming involved after one gets ill.
  2. The research criteria of publicly funded healthcare principally driven by the pharmaceutical industry.

The latter two areas are for another time but I wanted to explore what changing expectation actually means and look at an option for limiting abuse and misuse.

I’ll take the second issue first as it is by far the easiest to conceptualise.

Abuse of Service

Dr McDermott cited her experience of an 11 hour shift, dealing with 40-50 admissions all of which were self inflicted by direct or indirect consequence of excess alcohol consumption. Other examples might be missed appointments or drugs requested but unused.

As a caring and pseudo sophisticated society we are unwilling to step over dead bodies in the street so withholding such emergency care or enforcing criteria led prohibition on use of the service is not a politically palatable option. However, where abuse exists, there also lies an opportunity to place sanctions of one sort or another on those who fall into the ‘abuser’ category. This is a relatively simple and politically acceptable concept. A principle one would, of course, be charges or fines. Individuals faced with personal cost for attending A&E when drunk or as a result of being drunk would reduce their willingness to attend.

The expectation issue is much more difficult and, I think, un-resolvable. I say that because politicians will never attempt to address such systematic unsustainability preferring instead to pretend that the solution lies with more money, a reorganisation or two and all the well worn and unsuccessful patches that have been tried before.

UKIP policy?

Even UKIP is following suit with yet another re-organisation proposal expected in the manifesto that may or may not be a better way. One has to ask if the policy production process within UKIP is robust enough to determine whether it is actually better.

For 2015 UKIP should present the following NHS policy to be adopted between 2015 and 2020

  1. A full and wide ranging review (Royal Commission) on the health of the nation including that currently provided by the NHS but with a perspective upon prevention. Participants to be from varied backgrounds in health
  2. No more reorganisation, we work with what we have.
  3. Use a part of EU, HS2 and overseas aid savings to help buy out PFI deals as a short term measure to stave off financial collapse and address funding issues where they can improve moral and sustain service levels.
  4. Cancel hospital car parking charges just because they are simply wrong
  5. Review all past gagging clauses funded by NHS funds with a view to establishing and pursuing criminal charges for abuse of state funds. Undo all such clauses and establish legal rights for whistleblowers.
  6. Review all revolving door redundancy and re-employment scams with a view to repayment of redundancy money wrongly paid out.


Unrealistic expectation simply means that the NHS is expected to continue to do everything it is doing now. As that is unsustainable then it has to do less to become sustainable.

In a sense I’m not providing an answer but I can elucidate upon what it could mean. After all this would be a fundamental aspect of any health review. Below are simply examples of expectation reduction.

One should expect a sustainable provision of free care to save lives, materially improve quality of life but not necessarily for aesthetic, lifestyle or self inflicted conditions.  If people want this they can use a private provision. Everyone dies, it is therefore an expected event and a suitable full or partial provision can be made to cover the cost of managing that in the same way as the provision of a pension.  Moving away from ‘well person medication’ (the pharmaceutical industry’s idea of heaven) and replacing that with dietary and exercise education. If people fail to follow that guidance that is their choice as would be the health ramifications that follow.

With just a few examples of such thinking you can see why politicians will never address the issues, consequently reformation of healthcare will never happen in the way it is needed but instead continue to decline haphazardly, unfairly and will consequently and adversely affect the less well off in society.

The great benefit of democracy in these instances is also it’s greatest failing and all the while our leaders are more concerned with their own power and status doing the right thing rarely gets a look in. Perhaps UKIP can change the mould.

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