Thoughts from outside the NHS bubble

From time to time the blogosphere has the ability to restore one’s faith in the capacity of social media to provide contributions of immense value.  One such contribution can be found on Cranmer’s website today, written by Rev’d Dr Peter Mullen.

It is a piece that speaks truth to sentimental delusion.

This blog rarely ventures onto the subject of the NHS.  My personal experience of the health service’s impacts on my family and friends is far more negative than positive and as Rev Mullen points out in his piece, the NHS has the same status in Britain as that of a cow among Hindu devotees.

The NHS cannot be criticised in any way without a legion of those devotees hurling bile filled invective at the person offering the criticism.  Never mind that among other failings, the poor and declining standard of care in the NHS resulted in the death of my mother, came within a whisker of ending the life of my wife moments after she gave birth to our precious son, and made the final days of her step-father’s life undignified and needlessly painful.

I have done battle with the Nursing Directors, Consultants and Managers, each of whom attempted to defend clear failings to the point of saying black was white, all because their primary concern was worry about a possible legal case for compensation, rather than a desire to correct the problems at source.  As I found, when all else fails and their argument has been comprehensively destroyed, the next things to be destroyed are the incriminating medical notes and ability to recall conversations held in front of witnesses.  All that could remain is blind faith in the NHS, which is why Rev’d Mullen’s description of the service as the National Health Church is so apt.

The NHS is not fit for purpose.  It is a bureaucratic behemoth, violently resistant to change, and imbued with and unwarranted self belief that is fuelled by those cheerleaders inside and outside it – many of whom have political motives for supporting what has been little more than a charnel house for tens of thousands of people in recent years, whose conditions would not and should not have resulted in death or long term suffering.

The people and businesses of this country are forking over £95.6 billion pounds of our money this year to fund the NHS in England – an organisation that has an unjustified sense of entitlement and expectation.  Entitlement to operate in its own interests rather than that of patients and expectation that people should not criticise it, because it comprises, as Rev’d Mullen so incisively observes, those who are described as ‘angels…wonderful…caring…tireless…salt of the earth’.

There are still NHS staff who don’t feel the job of providing care and comfort and affording dignity to patients is beneath them.  There are still doctors and consultants who recognise their job role is trying to heal patients by treating them for their ailments, rather than constructing departmental fiefdoms and playing politics.  There are even managers who add value to the NHS by trying to administer the hospital effectively so patients get the care they need and the taxpayer gets value for money.  But there are too few of each of them in the ‘modern NHS’.

There are better options for the use of our money to achieve the better medical outcomes.  But all the while the political class, media and National Health Church faithful continue to prop up this broken socialised construct, we will all be stuck with it or be forced to pay more of our money to go private in order to get the standards of care and treatment the NHS is supposed to provide but all too often fails to deliver – with far too many casualties paying the ultimate price in this pseudo-religious war.

9 Responses to “Thoughts from outside the NHS bubble”

  1. 1 Tim Bradley 18/07/2013 at 1:24 pm

    Have a read of the linked article too. Have to agree really. Too much self interest. How do you break the cycle. A good war? Money has to go elsewhere then.

  2. 2 Ian Hills 18/07/2013 at 1:41 pm

    I have similar experiences – my mother was dehydrated to death at Brighton General, a place run by monsters. Their maternity ward had been forced to close decades before owing to record mortality rates.

    Unsurprisingly it used to be a workhouse. The complaints procedure has survived intact, too.

  3. 3 edmh 18/07/2013 at 2:29 pm


    It is of great sadness to me that political dogma manages to blank out any consideration that methods and experience from elsewhere could ever be applicable in the UK.

    This is particularly so in the NHS, where the dogma that the government has to be directly responsible from taxation for the supply of health care have been inbuilt for so long.

    This combined with “free at the point of use” is particularly damaging.

    What is even more amazing is the fact that so little in the NHS is actually free at the point of use, prescription charges, dental costs (if available at all on the NHS) and the endemic rationing, which itself translates into huge costs for the individual patient.

    So why are things so different here in France?

    These are my simple conclusions:

    The French system is run on an insurance basis based on income supported by the state but with no direct participation by the state: the insurers are even competitive amongst themselves. The system has state protection for the low paid, the chronically ill, pensioners, children, etc. Top up insurance can be purchased out-with the system to cover the balance not paid for within the system.

    The insurance organisation reports on all transactions and produces an annual account for each of its clients showing the premiums paid and the amounts disbursed on behalf of the insured so it is abundantly clear exactly what are the actual costs of health services.

    “Free at the point of use” in the UK is a fallacy and only encourages people to use UK medical services unnecessarily and to regard the access to such services as being as of right. The public perception of that “right” may even be one of the causes of violence towards hospital staff in the UK A+E departments.

    Here the modest fee €22 payable to the GP, most of which is reimbursed later, is a disincentive to time wasters and malingerers, even in country of hypochondriacs. It is amazing how effective the cash flow consequences of having to pay the doctor his €22 fee, even though it can be claimed back later, is in making sure that patients really need to be there.

    Of course anyone with a noted chronic condition or socially disadvantaged will be reimbursed 100% and if he has a Carte Vitale the GP is credited automatically without money changing hands. The GP’s or consultants’ s fees are his income and he like other health professionals are in overt competition with each other.

    The Pharmacist will provide over the counter advice and drugs for almost any common aliment. He will also provide prescription drugs (un-reimbursed) if needed at his discretion. Thus the load on the GP is much reduced.

    All the providers in the system, the GPs, consultants, diagnostic labs, district nurses, etc. are self-employed private contractors within the system. They normally work at proscribed fee scales. The contractors in the system choose their mode of working from the point of view of their own businesses, within those fee scales. This results in the outcomes, most of which would be remarkable in the UK except in the costly private sector:

    The GP has no secretary and no appointment system. Turn up when you need and wait perhaps 20 minutes on a busy day.
    GPs are not paid by a capitation fee based on patient numbers, but on their actual patient appointments. And only recently a system of affiliating patients to GP’s has been introduced, before that it was totally open to the choice of the patient on any particular occasion/
    The patient also has the choice of which consultant to see but the GP will always recommend the one he considers suitable.

    The GP will also be happy to make home visits: (the fee being slightly higher, based on kms, travelled by the GP) the reimbursed charge is rather more.

    The dentist has no dental nurse and runs the practice single handed. A large proportion of his fees are reimbursed to the patient.

    The busy cardiology practice with three consultants has just one administrative assistant.

    The district nurse will turn up at on the doorstep to take a blood sample at 7.00 am in the morning for a fee of €6.35 (reimbursed).
    The consultant dermatologist answers his own phone and makes his own appointments without any need for administrative help.

    As well as doing major surgery, the consultant orthopedic surgeon does his own splint work on the spot. Etc. etc.

    Thus the administrative load created by centralised control and rationing of consultants and hospital appointments does not exist.

    As separate private contractors, all health professionals work as if “their time was their money”.

    Most UK hospital consultants are already private contractors as well as being well-paid part-time government employees.

    There is a real emphasis on preventative medicine and prompt treatment is considered to be economically worthwhile. Thus certainly in my experience waiting lists just do not exist.

    There is an abundance of medically qualified people in the system and indeed there is a degree of competition between them. According to OECD figures, there are almost twice as many medically qualified professionals per head of population as in the UK health service.

    The medics run the hospitals and other facilities not the government or the administrators. They see the benefit of having an absolute minimum of administrative overheads. Those that exist are mainly involved with ensuring that the Insurance organisations are charged correctly. This also means that there are no artificial limits placed on maximising the use of expensive capital equipment and the hospital installations.

    Also, crucially, as the government is not supplying the service, the state does not own the product of the service nor most importantly the patients medical records.

    Patients have bought the service either directly at the proscribed rates or via their insurance and they are therefore the owners of the results. Responsibility for the ownership of such records is reasonably unloaded on to the patient. This eliminates another whole swathe of administrative costs. And as there is no government duty of care with regard to patient records, there is no need / apparent obligation / or demand to create an expensive nationwide database of everyone’s medical records.

    I believe that it is only in very few chronic cases that longstanding records are essential for treatment.

    Any minimal useful information (such as the fact that one may be diabetic, allergies, blood type, etc.) is retained on the chip of the Carte Vitale. The Carte Vitale is a type of credit card with a chip, that is used to organise the data required for the insurer to pay the sums necessary to whichever part of the health system has been used. The card can be updated automatically with any changed circumstances when visiting the pharmacy. This seems to be a truly efficient use of Information Technology as applied to the health service.

    Along with a pragmatic hands-on approach to consultant referral and appointment making, the need for a failing £20 billion government organised Health IT project collating everyone’s medical records is eliminated at a stroke.

    Here a much simpler IT system works and it has been working for decades.

    I certainly I believe that health outcomes for a similar percentage expenditure of GDP are much better here than in the UK. The NHS is certainly not the only way of organizing a health service and the clear evidence is just across the channel.

    The care about hospital infections is particularly impressive. This is because the staff all know that it would be quite possible for patient to choose to go elsewhere and therefore having an outbreak of MRSA etc. would be disastrous to the business of the hospital and thus their livelihoods.

    The Nation’s Health not the National Health Service should be the priority of government.

  4. 4 Autonomous Mind 18/07/2013 at 4:10 pm

    Thank you, edmh, for one of the most valuable comments ever left on this site.

    The French model was uppermost in my mind when thinking about alternatives to the NHS, but I did not know anywhere near as much about it as you have shared here.

    Politically, am I right in assuming the French methodology is acceptable to people, inspite of their socialist leaning? If such a structure works for them and produced better health outcomes, why not for their fellow comrades in the NHS?

    Thanks again.

  5. 5 Bellevue 18/07/2013 at 5:43 pm

    Erm, well I have lived in France for the last 16 years and I slightly disagree with the previous comment.
    Firstly, the Carte Vitale…… I have never been asked for my Carte Vitale until it comes to paying, so I have my doubts about medical information being in the ‘chip’.
    Secondly, my husband is a retired GP (from the old days of the family doctor who know all his patients, and worked 24/7, weekends and nights on call) and his view is that at least with the NHS you KNEW that unnecessary proceedures were not carried out to earn more money.
    I almost never need to see a doctor, but recently I have had some experience with a dentist who said I needed a tooth extracted. And I have to wonder whether I DO need the tooth extracted or whether the dentist is just trying to make more money out of me? (in the last 16 years, I have had to have 2 teeth capped, and the cost is between 400 and 1500 euros….. for which you are not reimbursed, despite us paying some 199 euros PER MONTH for our top up insurance. French dentists seem to feel that a filling – as it was known in my day – MUST require one of these expensive caps.)
    There also seems to be something of an epidemic of prostrate cancer (or the diagnosis of prostrate cancer) as a result of raised something-levels (sorry, I am not medical myself!) which then involves great worry in the patient, plus radiation and pills etc. which according to my husband is TOTALLY UNNECESSARY!!! but makes the french statistics look good on the curing of cancer.
    It is a thought worth thinking about.
    I have to say, that as well as working in the NHS for most of his working life, my husband did work as a GP for 4 years in Australia…… where he was paid by results. Hence, skin cancer was a nice little earner….. he would cut it out, perhaps unnecessarily. It does make one cynical – if you wonder whether the Dr is doing something to earn more money.
    Not that I think the present NHS is perfect by any means. I just wish my husband had not retired before GPs started being paid 100,000 pounds plus per year!!!

  6. 6 john in cheshire 18/07/2013 at 7:05 pm

    I remember visiting Baragwanath hospital in Soweto in the early eighties and being impressed with the facilities, cleanliness and general professionalism. Yes, even in socalled apartheid and black opressed South Africa, the health system in one of the largest black areas was better than we had then and have now. South Africa had an insurance system for whites; not sure how Baragwanath was funded by the white population. The system was efficient and cheaper than our NHS.

  7. 7 Fear The Ice 19/07/2013 at 8:59 am

    Isn’t the NHS position in the national psyche similar to that of the BBC?

  8. 8 BulloPill 19/07/2013 at 3:29 pm

    I understand from friends, who left England to live in France because of the superior health and education systems, that medical services in France are as edmh describes above in the excellent comment. I believe the Swiss system also offers similar advantages to those who pay for and use it.

    Two members of my immediate family work in the NHS, at the “sharp-end” and I know how dedicated to their work and patients they are. But I also see daily how utterly frustrated they are by the system. The idiocies of bureaucracy, the squandering of money, the easy ride taken by too many of the senior medicos, madcap IT systems changed and re-changed then “upgraded” time after time all “controlled” by empire builder management which is fearful of the unions and the senior medicos.

    It’s plain that this cannot continue, and that reform isn’t actually possible. The present party politicos just cannot dare to effect the necessary revolution.

    I think it’s perhaps worth remembering that much of the present nationalised NHS hospital system was stolen from communities, when locally run hospitals which often provided (at the time) top-notch care funded by local subscription and altruism, were subsumed. Near my home, two such hospitals which were once the property of local citizens collectively were claimed and run by the NHS until the 1980’s property boom, and then sold off for housing development, leaving people with the need to travel miles for care and not much else in return.

  9. 9 Yvonne 20/07/2013 at 10:08 am

    Baragwanath hospital in Soweto is indeed state funded; however, as South Africa leans more and more towards socialism standards have declined. The health insurance model in South African, which worked for those employed or chose to self-fund, leaving the state to take care of the rest, has been tampered with political interference.
    The ultimate sadness of the NHS, apart from the unnecessary deaths, is that there are people genuinely ‘off sick’, on crutches, in pain because the rationed health service is not treating them and getting them well enough to be back at work, while ATOS makes a financial killing ticking boxes that states the individuals are well.

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