I remember the Bradford Royal Infirmary very well. A massive Victorian building, it now has glass and steel add-ons in a vain attempt to make it look modern and practical. It is a labyrinth of corridors and rooms and seems very disorganised when you go there.
My two boys were born there and as a copper I was always in Accident and Emergency with assault victims, car crash survivors and people who sadly did not make it. I was there myself too with various injuries sustained by dealing with the great and good of Bradford.
It was always very hot in there, airless and oppressive. The only shining light were the staff. People run around in various coloured uniforms and white coats. No one looks at anyone, not out of rudeness but an obvious stress that is palpable. The people who work here are collectively marvelous. They work in a Victorian building in a modern fast moving chaotic but much- loved institution which was, but is not now, in any respects, the envy of the world.
The NHS is a political football and has been for all my lifetime. Unless it is wrested from the hands of successive governments and politicians of all colours it always will be. Each change of government brings with it a fiddling interference which, together with absolutely vast amounts of money has never brought peace and quiet to the service. The money thrown at it is staggering and yet we still have the problems running through its veins that we had in the seventies, eighties and nineties, yes problems from the last century are still there.
Money does not alone solve the problems, it is a sticking plaster over an ever widening fissure. The trusts cannot be fit for purpose. The salaries and subsequent pensions of chiefs and their management teams are so way beyond the achievability of the front- line staff, it is embarrassing. A person who wields a scalpel and cuts into a human body to make it better should in my opinion be paid much more than the person who signs off the time slot for the operation.
PFI contracts introduced by John Majors Government and expanded by Andy Burnham of Labour with gusto are one of the reasons the NHS is in such a mess. A hospital costing £170 million to build initially, but under PFI, when finally paid off, will have cost £980 million – it just makes no sense.
In the truest sense, “buy now pay later” was the mantra by which Labour sold out the NHS. Current spending of £397 million a week cannot be sustained with the current structure and practices in place. A friend of mine took her daughter for a pre- op appointment. They live four miles from Calderdale Hospital but were sent to Huddersfield hospital nine miles away. The nurse who attended them when chatting said she had come from Calderdale in a taxi to conduct that one pre-op interview and was going back in a taxi. My friend gave her a lift. I am sure readers of this will have many such and more varied stories.
So, post Brexit what can be done, what should be done? For sure the current status quo cannot continue. The first thing is to stop the lies and deliberate obfuscation by the politicians scared if their own shadows. Yes, the “ageing population” is a fact, we do now, due to strides forward in medical procedures and the pills we take, live longer. Life expectancy in 1840 was 42.2 years and is now 82.8. Those statistics say it all.
But, and it’s a big but, since 2010 it is estimated that 6.7 million people came to this country for whatever reason. This without a shadow of a doubt has had an enormous effect on the viability, short, medium and long term of the NHS. It cannot be disputed that the costs of the influx of people guaranteed access to the NHS, free at the point of use, on both manpower and fiscal are enormous. This must be addressed and costed into future planning.
As I stated earlier, the sooner, the NHS is wrested away from politicians, who have in the main never had a job, the better. Just because someone is promoted to the Secretary of State for National Health does not give them the skill set to manage this office which affects every single person living here.
Why not, for instance on a consultancy basis, give different aspects of the NHS to the business men and women who sit in the Dragons Den? They are all hard- nosed ruthless business people. They have been measured very many times and they know what to do to turn around failing companies and make them viable again. They cut out waste, sack those who are surplus to requirements, those who do not actually contribute to a streamlined successful enterprise. For sure they could not do worse than the MP’s we charge with this task.
We must be prepared to put our big pants on and have a long overdue grown-up conversation about the NHS. A parity between private and public monies needs to be established. Insurance for those who can afford it cannot be ignored. People arriving here on whatever standing they do so will have to pay for a certain amount of time or be told clearly and honestly that they cannot access health care free of charge having contributed nothing.
NHS tourism must stop and stop soon. The very thought that anyone can simply fly into this great country, be given treatments free of charge and fly off home again is an anathema to me. Those against this promulgated the argument that surgeons could not and should not be walking around with credit card machines in their pockets. This is the sort of juvenile nonsense conversation we have all the time.
A change must come. It is going to implode at some time, the sticking plaster is being stretched to breaking point. The fissure is getting much more wider.
If Margaret Thatcher were alive today, she would explain the solution in simple terms.
The NHS is a bloated, inefficient state run organisation.
Only by making it competitive and commercially operated will it become more efficient and provide the best service at the lowest cost to consumers.
Once we leave the communist inspired EUSSR, we will finally be freed to bring in expertise from the USA who have the best, most up to date, and effective health care providers in the world,
Just say “not” to SOCIALIZED medicine and welcome a true, free market approach to health care, where the buyer can chose from a range of services, all competing to give the best service in terms of price and quality.
Consumer choice, you know it makes sense!
Yes we have an ageing population, but I suspect it is nowhere near as big a pressure on the NHS as the 6 million immigrants plus illegals that have piled in here in the last 6 years.
Also that ageing population have likely paid their taxes for years whereas the illegals are benefit takers or working cash-in-hand, no taxes.
Looking to alternative data sources eg food sales or number of current bank accounts, it is reasonable to extrapolate that the true population of the UK from the officially admitted 66 million figure to some 80-85 million persons.
This of course is another huge and hidden problem, as the funding models for health (and housing and education and transport etc) are predicated upon what the population actually is hence if there are in fact some 14-19 million people more here right now than officially admitted this creates a systemic perpetual crisis of funding across all sectors.
A further factor to consider as regards the NHS is the behaviour of the professional bodies for both nursing and doctors over the entire lifetime of the NHS, effectively acting as militant trades unions by deliberately limiting the training and supply of new staff in order to keep up the pay rates of those already in post. The easy political answer to this situation was and is to mass import immigrant medical staff, to the detriment of their respective countries of course!
According to https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/2016-17 the average GP income is £92000 per year, so halve that and double the number of GPs after all we are all living in the age of austerity to bale out the banksters so even doctors should be happy to do their bit in the national interest.
I believe that locums earn considerably more. That is why many patients rarely see their doctor who they were registered with.
Another absolutely excellent article and analysis by Stephen Place. All of our politicians are liars and hypocrites. Although blaming the Tories, Labour has done more to cynically damage the NHS than anyone in recent times with PFI and uncontrolled immigration – the Tories are just as bad and totally incompetent. Both parties have failed to recruit, train and incentivise home grown nurses – no degree required thank you Tony Blair; nursing is a VOCATION. Instead Governments have STOLEN nurses from abroad where they have been trained and are much needed by their own countries. What have we all done to be governed by such incompetent, self-aggrandising FOOLS?!
In the conference an expert gave a truly amazing speech. showing exactly what had to be done. A first rate analysis.. Ideal for beginner politicians.. Where is he ? where are his ideas? What is being talked about ?A copy of his speech would give us all a clue.
Imagine a situation where you have a patient infested with leeches and parasites, sucking all the blood out of them.
How to deal with the problem? If we compare this with the actions of our governments and ministers, the problem is dealt with by giving the patient more blood. They then boast among themselves about how much more blood has been given to the patient, yet no matter what, the patient eventually needs more blood and there is no improvement in their condition.The government then asks the people if they’d be happy to give more blood to ‘save the patient’. What then happens when all the blood runs out?
From this analogy, it would actually seem the best way to treat and cure this patient is to deal with the leeches and parasites. In other words, address the ‘primary problem’.
The analogy equally applies to the NHS. We keep being told (by whom?) that the NHS needs “more money”. The public never questions “why?” or indeed demands to know “what exactly” is the money going to be spent on.
The NHS has become a financial blackhole, or a lucrative money-spinner. Billions of pounds of public (taxpayers) money gets poured in every year, yet how much of that money is siphoned off into the private bank accounts of chief executives, other highly paid managers and administrators, as well as enriching the shareholders of private companies working under contract to or supplying the NHS.
The NHS only ‘needs more money’ while an ever increasing number of parasites and leeches gorge off it.
While we are discussing the NHS, there’s a lot of drivel being spread about the E11, which morphed into various things like EN 111 etc. This has been available free of charge for free medical care in most European countries since the early 50s .Another Nasty bit of remainer project fear nonsence.
fromPMB I have watched the NHS deteriorate over the years too. Don’t pretend to know much about the why’s and wherefors but certainly have 2 clear impressions of what causes the problems. 1. Poor, muddled management with no real commitment except to their own inflated salaries and pensions. 2. Privatisation in various, usually ‘back door’, hidden methods. The Nhs does need more money but I definitely agree it is not JUST more money that is needed. I suppose it is true that neither politicians nor civil servants are trained to run it yet it surely would help if it was taken back into Public Ownership. Re nationalise the NHS Jeremy, never mind the railways.
PMB again. I’ve a feeling all these separate ‘trusts’ are to blame for some of it too. Is it the area trusts that want to send me from Hope Valley Derbyshire, many miles away to other side of Sheffield or to Chesterfield for routine treatment. Sometimes it can be done in Buxton. Other things it would be far more convenient, transport wise for me to go to Stepping Hill.
Also, what is the Derbyshire out of hours service? I recently dialled 999, was downgraded to 111 was then called to answer the landline phone 4 times during the night to answer the same irrelevant questions. I was in agony and all that was needed was a home visit from a nurse, doctor, or ambulance man/woman. Eventually this out of hours service was mentioned, no details.
Why not say at the start. Sorry we can’t immediately help. Bear it as best you can and we’ll get a nurse to you in the morning.
since 1950 I have watched industries being nationalised, denationalised, renationalised, re organised, and generally messed about by hopeful fools’
It has been clear that any change is usually temporarily beneficial. Bur very quickly the problems re appear.. In the 50s and 60s there was a lot of research and understanding of these problems. A huge amount of research was done from 1950s till late 1980s on future problems, now creeping up.Some were far too difficult for politicians to handle or even comprehend…. some stand out a mile , but are too simple and obvious. Some were not invented till the 60s and 70s, or at least not known about. Others cost money..Others,while quite useful have been grabbed at and swollen ridiculously..
Added up and summarise they can be considered as good management .
There’s probably no body left who was good at these things. I was just a humble practitioner ( Well not that humble )
Of course NHS tourism must stop. We have a NATIONAL Health Service, not an International Health Service. But if the NHS clamps down on this, there’ll be people dying in the streets, and doctors, who have taken the Hippocratic oath to do whatever they can to help the sick and injured, will have to make a decision to either treat them or break that oath and watch them die.
Just like that Nigerian woman who had quadruplets and now owes the NHS half a million pounds, there will be more pregnant women coming in to Heathrow and heading to the nearest hospital to have their babies. She was turned away from Chicago before she came to London but because she was so close to giving birth, she was treated here. Should the obstetric team have told her to go away and have her babies in a gutter somewhere, risking their and her lives? That’s the sort of decision the doctors must have been faced with.
But what to do about the situation. Get patients to pay before they get treatment? What if they don’t have the money? Take a credit card payment? Then there’s the problem when the payment is rejected.
It’s a very difficult situation and one for which there are no easy answers.
Fine the airlines that bring them in. No travel, no problem. Those that apply for a visa can be given a pregnancy test and a short period of validity for the visa. Legal immigrants have to undero a TB test so what’s the difference?
Excellent idea Jack. Certainly for those who fly in.
Surely, the simple answer is that all ‘tourists’ should be required to have medical insurance, as well as visas, before entering the UK. If they haven’t, they are refused entry. Other countries seem to mange this fairly well.
PMB again. Yes of course as you say the NHS tourism MUST be stopped.
About fifteen years ago, the NHS refused me treatment because I’d been out of the country for too long, me a born and bred Brit. Well, if they can refuse me, the NHS should surely be able to refuse somebody that has never before set foot in the country and is only here to steal from us, a criminal in other words. We’re being taken for fools!
In fact there are practical solutions which would not be THAT difficult to implement ~but the political will to implement them is necessary.
For example ( just thinking aloud ~there may be better solutions ) : it would be possible to institute a Visa system for persons from all over the world wishing to visit the UK for whatever purpose.
Crucially, that Visa would be issued ( or not issued ) by officials in the Embassy / High Commission of the country of residence of the intended visitor. It is madness to have officials at airport arrivals issuing these.
A lot of the checks could be done online ~possibly most of them ~but with the official having an option to require the visitor’s attendance for a face to face interview. This is how the ESTA system for visiting the States works.
It would be perfectly possible for the official to check whether the intending visitor had any kind of criminal record and so on.
It would also be possible for the Embassy to make it a requirement for the visitor to show that s/he possessed comprehensive health insurance for the duration of the visit, such that if s/he had any need to use NHS facilities the insurance would cover it.
Although the USA does not impose such a requirement anyone with any sense visiting the U.S. does, in fact, take out such insurance as we all know the trouble we will be in if we needed an emergency admission.
And the cost of making all these checks could be reflected in the fee for A] application for the visa ; and B] Issuance of the Visa.
And yes ~ other countries would probably start imposing similar requirements on UK visitors ~but so what ? The benefit to our society would substantially outweigh the inconvenience to individuals.
Visitors to the UK from many countries can only have a visa issued in their home countries. Usually the process is sub-contracted by the embassy, costs a good deal, requires evidence of support and likelihood that the applicant will return to their home country after the visit.
Settlement visas cost considerably more and carry more onerous conditions including proficiency in basic English, freedom from TB and financial support.
On the other hand illegals get away scot free and are provided with housing and other benefits…
Debbie there is a simple prevention vs cure answer to health tourism as follows:
The right of entry to the UK by non-UK nationals is allowed only on production of a comprehensive medical insurance certificate, covering all eventualities both chronic conditions and emergency accident cover, valid for the entire duration of their intended stay, no insurance = no entry and straight back on the next plane home and at the expense of the airline that has brought any such passenger here.
ie the airlines are incentivized to confirm health insurance in the same way they do for entry visas at the intended point of departure.
I went on a working visa to the USA. They demanded to see my medical insurance, bank details and checked the physical amount of hard cash I had on me.
Let’s do the same.
Lots of good ideas here but our next question is how to sell it to TPTB.
Good idea fenlander. I would add possession of a return ticket as well. Alas much too simple and neat an idea for our crackpot Parliament to implement.
I worked in the NHS for forty years.
What went wrong was when they started parachuting outsider managers in (at vastly increased wages) to replace people who had worked their way up from the bottom. They were clueless but made wrecking “reorganisations” before moving on. There was a reorganisation every three or four years resulting in total chaos. After about three reorganisations, it was back to square one.
Harold. In the NHS there must be Doctors who get fed up or like Martin Clunes etc.Could they not be retrained as Accountants or mainenance or something to move them up into charge. Then you would have a serious person in charge. With understanding.I would have thought something like that would have been tried alreadyyears ago.
Maybe this could explain managers being parachuted in and what’https://wikileaks.org/wiki/Common_purpose#s behind it. I have heard Gerard mention Common Purpose before: https://wikileaks.org/wiki/Common_purpose#. It is said that if you are invited to training and you turn it down then you are either out of a job or have to accept you will never be promoted.
Something not that dissimilar occurred in the Magistrates’ Courts Service during the years ( 1980s~90s ) that I worked in it : inefficiencies were alleged and management consultants bla bla brought in who basically wrecked a system which for all its faults did actually work, and which engendered a lot of ‘lets get on with it’ attitude in the staff ( and Magistrates ).
I know that in my own courts we would if necessary sit late to finish a case ( when we were not contractually obliged to do so ).
And Magistrates would be available who could be ‘phoned to come in , eg if there was an urgent child care application to be heard.
None of it was in the management books but it WORKed.
Was it management experts who decided all nurses had to have a degree ?
Was it management experts who decided that UK medical schools should not have sufficient places to train all the 18 year olds with excellent science A levels who wished to read medicine ?
I believe someone who was a management consultant for a number of years quit the ‘profession’ in disgust and wrote a stinging exposé was it ten or so years ago ?
nhs funds the labor party
to me Dragons Den are essentially merchants, doing deals. more than half are frustrated manufacturers or fixers.. and extraordinarily good at what they do.. And certainly hard nosed and ruthless enough.
But these are not the mighty engines of the 20 th century, or the German car producers. comparable in size to the NHS..We have no idea.
The job of controlling these enormous undertaking requires different skill and character skills. And, totally unknown now, understanding. Now completely misunderstood.
I have watched politicians try to run factories, I’ve watched Civil Servants try to do the same. It’s no wonder we’re a country of strikes and shutdowns and non delivery I watch the knowledgable propound theories of Just in time, Supply Chains and ( worst of all ) traceability, the civil servants god. And idiotic. I watch grandious people being incompetent. It is not pleasant.
So what wehave now is (By default ) Accountants running most businesses. OK they are a good default in an emergency..But nowadays they are all we have. Bu they are a ‘guild’ with all that that implies.
We are back to UKIP
PFI was absolute madness. The only rational explanation is that is was created as a vehicle to reward governments cronies.
Exactly.
But the worst thing you could do, is buy them out. I fully expect Corbyn to suggest that any time now
Yes Jack, that and to perform an accountancy fiddle ie to keep the costs from increasing the published national debt.
All rather ironically irrelevant nowadays since the advent of multi-TRILLION pounds QE