We must think the unpalatable to stop death of NHS, say doctors

Somehow the doctors say the truth without mentioning the “R “word. The problems are well outlined, but there is no  analysis of the short termism inherent in the system which underlies the crisis,  the political collusion of denial, and lack of courage: it is going to get worse.


Sarah Kate Templeton reports 20th November 2016 in The Sunday Times: We must think the unpalatable to stop death of NHS, say doctors

More than 60 NHS consultants call today for a royal commission to consider every option, including “even the most unpalatable”, to boost funding for the health service.

The doctors say radical funding measures must be debated because standards of care are “increasingly poor by international standards”.

While they do not say where the additional funding should come from, they argue that all potential sources should be considered. These would include increased taxation, an obligation on patients to have a form of social insurance or charging for some treatments and services.

Almost all the signatories of the letter, which is published in today’s Sunday Times and in full online, are consultants working in the NHS.

The letter says: “Outcomes for many conditions are becoming increasingly poor by international standards. This means many unnecessary deaths for British patients from treatable conditions. It means higher infant mortality. It means more human suffering as medicines and treatments routinely available in most developed countries are withheld in the NHS. Waiting times for treatment in emergency departments, for the diagnosis and treatment of cancer and for surgery are lengthening.”

The letter demands “an honest and transparent debate that considers all options for increasing health spending” and calls on parliament to “establish a royal commission . . . to look at all the options, even the most unpalatable”.

Professor Karol Sikora, a cancer consultant and one of the signatories, said increased funding could come from taxation, patients having a form of social health insurance or a charge for some medicines and treatments.

“There are lots of models [of social insurance] in Europe. They are all different but they guarantee that everyone will have insurance cover to pay for what we would call basic NHS services,” he said. “It could be that you pay for certain services, co-payment.”

Sikora said many forms of co-payment existed or had existed in the NHS, including paying an NHS hospital for extra nursing care.

Social insurance would be a form of health insurance that individuals would be obliged to contribute towards, based on their earnings, to cover basic health services. Usually, the government would cover the contributions of the unemployed and elderly.

Co-payment involves NHS patients paying for treatments or services not available on the health service. In 2008 the government ended the ban on co-payment after this newspaper exposed how NHS treatment for cancer patients had been withdrawn after they paid privately for drugs that it did not fund.

The consultants’ letter follows a report last month by Owen Paterson, a former minister and founder of the UK2020 think tank, which found that 46,000 people died unnecessarily each year because the NHS failed to match the best international health outcomes.

A Department of Health spokeswoman said: “The NHS already has its own plan, designed by NHS leaders, which set out how we can transform services and improve standards of care . . . We are investing an extra £10bn per year in the NHS by 2020-21 . . . to do just that.”

The letter 20th November 2016:

The NHS is in crisis! Doctors, by their nature and training, are not prone to exaggeration. But every day we see more evidence of crisis. We are not politicians but professionals trained to act in the interests of our patients. And we care.

The UK medical profession itself is in crisis. Young doctors are leaving the NHS in droves, either to practice abroad or to leave medicine completely. The recent junior doctor’s strike was born from the deep discontent that drives some of the brightest young people in the country to abandon years of study and commitment. And, at the other end of the profession, senior doctors are now retiring at the earliest opportunity. In some towns there are virtually no general practitioner partners over 55 and similarly, consultants are increasingly leaving the NHS. This is an appalling waste of talent, skill and experience and of the clinical leaders that the NHS needs. Just one generation ago these events would have been unthinkable. Doctors’ morale has deteriorated because of the appalling decline of the quality of patient care.

Outcomes for many conditions are becoming increasingly poor by international standards. This means many unnecessary deaths for British patients from treatable conditions. It means higher infant mortality. It means more human suffering as medicines and treatments routinely available in most developed countries are withheld in the NHS. Waiting times for treatment in emergency departments, for the diagnosis and treatment of cancer and for surgery are lengthening. Our hospitals are increasingly full of people who should be cared for elsewhere, either at home or in nursing homes. They occupy expensive facilities meant for acute care. These failures affect every family in the country.

We understand and accept that the NHS has to reform and use its resources as effectively as possible but while no healthcare system is perfect ours is increasingly failing the people who need it most. Outcome evidence suggests that it is increasingly failing by comparison with other similar countries. But while the reasons for this failure are complex, we believe fundamentally it comes down to money and use of resources. We now spend just 7% of the wealth the nation produces each year on healthcare. Most similar countries spend nearly half as much again and many far more. This amounts to tens of billions of pounds each year. While we applaud the optimism of the Five Year Forward View we worry that it will not deliver the £22billion of savings it promises and that it will necessitate cuts to local services that the public will find unacceptable and risk the quality of clinical care.

Virtually every healthcare expert in the country knows that the funding gap between demand and supply must be closed if we are to have the quality of healthcare we all want and if we are to retain the confidence of the medical profession and of the public. These funds can be raised from only three sources – taxation, insurance and cash. All healthcare systems use a combination of these sources. The deteriorating situation facing the NHS now necessitates that all of us, professionals, politicians and the public have an honest and transparent debate that considers all options for increasing health spending.

We call on Parliament to demonstrate the leadership required in a crisis and to establish a Royal Commission. Its remit would be to look at all the options, even the most unpalatable, for raising spending on healthcare in the NHS to levels that will restore it to once again become the envy of the world. Without this debate we will inevitably condemn the nation to increasingly poor healthcare. Without radical change the NHS will wither and die.

The NHS is in crisis. The first step is to acknowledge that this is the case. Failure to do so demonstrates a failure of leadership. Failure to hold the debate we ask for and indeed demand would amount to the same. All of us, senior members of the UK medical profession, ask you to display the leadership that is expected of you as our elected representatives and insist on the establishment of a Royal Commission to consider how to adequately fund and reform the NHS.

Charles Akle, Consultant Endoscopist; Jonathan Appleby, Consultant Anaesthetist; Georg Auzinger, Consultant in Intensive Care Medicine; Simon Bailey, Consultant Surgeon; Ian Beckingham, Consultant Surgeon; Jenny Bird, Consultant Haematologist; Mark Bower, Professor for HIV Malignancy; Nick Boyle, Consultant Surgeon; Jane Brown, Consultant Oncologist; Jacqueline Butler, Consultant in Emergency Medicine & Major Trauma; Jonathan Byrne, Clinical Director of Cardiovascular Services; Santiago Catania, Consultant in Neurophysiology; Shan Chetiyawardana, Consultant Oncologist; RN Clayton, Professor of Endocrinology; Chi Davies, Consultant Anaesthetist; Ann Drury, Consultant Clinical Oncologist; Albert Edwards, Consultant Oncologist; Mark Farrar, Orthopaedic Surgeon/Consultant Anaesthetist; Roshan Fernando, Consultant in Anaesthesia, Graham Fleming, Consultant in Trauma and Emergency Medicine; Andrew Gaya, Consultant Clinical Oncologist; Tom Geldart, Consultant Medical Oncologist; Ashley Grossman, Emeritus Professor of Endocrinology; Matthew Hacking, Lead Consultant Anaesthetist; Marcus Harbord, Consultant Physician & Gastroenterologist; Jamal Harisha, Consultant Surgeon; Clive Harmer, Clinical Oncologist; Catherine Harper-Wynne, Consultant Medical Oncologist; Adam Harris, Consultant Physician & Gastroenterologist; Michael Harvey, Consultant Upper GI Surgeon; Ian Holloway, Orthopaedic Surgeon ; Maxim Horwitz, Consultant Hand and Orthopaedic Surgeon; Tom Hurst , Consultant in Intensive Care, Major Trauma and Pre-hospital Care; Alberto Isla, Consultant Upper GI Surgeon; Cara Jennings, Consultant in Emergency Medicine; Sritharan Kadirkamanathan, Consultant Upper GI Surgeon; Scott Kemp, Consultant Anaesthetist; Hemant Kocher, Consultant in General Liver and Pancreas Surgery; Pardeep Kumar, Consultant Urologist; Michael Kuo, Consultant ENT Surgeon; Mark Lawler, Chair in Translational Cancer Genomics; Sara Leonard, Intensive Care Consultant; Nick Linton, Consultant Cardiologist & Electrophysiologist; Charles Lowdell, Consultant Clinical Oncologist; Gitta Madani, Consultant Radiologist; Katie McLeod, EM Consultant; Nigel Mendoza, Consultant Neurosurgeon; Julian Money-Kyrle, Consultant Oncologist; Amir Montazeri, Consultant Clinical Oncologist; Tariq Mughal, Professor of Haematology/Oncology; Ramesh Nair, Consultant Neurosurgeon; Asif Qasim, Consultant Cardiologist; Victoria Rose, Consultant Plastic Surgeon; Neil Rowson, Consultant Opthalmic Surgeon; Karol Sikora, Professor of Cancer Medicine; Matthew Solan, Foot and ankle surgeon; Margaret Spittle, General Specialist Oncology Consultant; Justin Stebbing, Professor of Cancer Medicine; Henry Taylor, Consultant Clinical Oncologist; John Timperley, Consultant Orthopaedic Surgeon; Sancho Villar, Consultant in Critical Care; Oliver Warren, Consultant Colorectal Surgeon; Mark Wilcox, Professor of Medical Microbiology; Ana Wilson, Consultant Gastroenterologist; Jonathan Wilson, Consultant Colorectal Surgeon; Crellin Perric, Consultant Oncologist, Andre Vercueil, Consultant in Intensive Care

This entry was posted in A Personal View, Consultants, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

2 thoughts on “We must think the unpalatable to stop death of NHS, say doctors

  1. Pingback: We now need to sacrifice the last “sacred cow” | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Robin Brown

    I completely agree that there should be a Royal commission to look into NHS funding . I would like to support this effort with both my time and , if needs be , financial assistance. How can I support this worthy group if professionals .
    Robin Brown


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