Its the “philosophy” sillies – and I am talking to you politicians.

Ron Lilley on and in his e-mail blog to 5000 people rightly points out some of the problems with regard to the disintegrating, formerly National, health services. He points out that a lack of leadership (read “honesty”) leaves us with no idea about how the health service will run next year, let alone in 25 years’ time. Reading his blog he alludes to, but does not mention rationing, making him equally culpable for dishonesty… The workforce is not enough, and is too female biased. Even the spin on Wales recruiting more GP trainees (By bribery) is not reality. We need twice as many in Wales alone to cover the next generation. This can never seem to be said…. and many doctors are working a 3-4 day week but doing well over 40 hours. The reporting is shallow..  How many MPs have Private Medical Insurance (PMI) and why? Its the “philosophy” sillies – and I am talking to you politicians. 

Reasonable rationing is derided, and when reversed because of politics this is celebrated. Laura Donelly in the Telegraph: ‘Monumental’ NHS U-turn

Deserts based rationing is unofficial and facilitated by “privatisation”, especially for the obese.

Despite a “primary care led” Health service, the staffing needs of A&E, so badly planned, trump this as we are in meltdown. In such a situation prevention should rightly be abandoned, and emergency treatment becomes essential. So GPs all need A&E training, (as well as Paeds, Psych, O&G etc….. this is not the case as Deaneries’ decisions are not taken by GPs but Consultants.

Roy Lilley opines: (

The call is for a national debate about the future of healthcare.  The debate, if there is to be one, is as much philosophical as it is practical.

Thus far we have struggled to survive by cutting, patching and repairing.  It is inconceivable we can survive another year of the same.

The way forward is beset with difficult choices as much about how we behave as it is about how the institutions that provide our care, behave.

Setting aside issues of the ‘money’, there are four questions; let’s call them the ‘retains’, that spring to mind.

1.  Will we retain our present willingness to share our risks?

The potential is for middle-class families, presented with options to clunky access to primary care, to elect to pay subscriptions for Apps such as Babylon or Go-Doc and start to undermine the solidarity of the NHS.

The NHS only works because it is ‘our’ NHS, we agree to syndicate the costs and risks of our illnesses, disease, accidents and maternity.

We may be lucky, pay our dues and only have rare occasions to call-in a dividend of care.  On the other hand, disaster may strike and put us on a long and painful road to recovery.

We may not share your pain but we do agree to share the cost.

Employers, frustrated at the thought of losing the skills of key staff to prolonged absence through illness, are already sparking a rejuvenation in the private insured care market, in the hope of circumventing waiting lists, now north of 300,000.

If support is fragmented the NHS fails.

2.  Will we retain power and influence at the centre or are we prepared to give it away in devolution and independence?

How the NHS is organised is important.  We have seen what happens when the NHS is broken up.  The disastrous Lansley reforms gave us a disaggregated, fragmented leadership model and a confusing array of over 200 commissioners; most of them inexperienced, too small to be effective and too costly to run, to be viable.

Devolution may be a seductive alternative to government from Westminister but sharing budgets means sharing risks.  However, we have also seen, from the better CCGs, fragmentation can bring decisions closer to populations.  In the worst, macho CCG management is already set on giving away the NHS, to third parties, to run for ten or even fifteen years.

Do we want to give the NHS away?  How much do we want to break it up?

3.   Will we retain the tendency to ‘accumulate’ healthcare data or will we make a determined effort to ‘use’ personal information for the wider public health.

Do we overcome the reservations we have about sharing data?  The Caldecott conclusions do not bring us closer to solutions for front-line staff trying to work across boundaries.

The extent to which we agree to our data being pooled is the extent to which public health bodies will be able to forecast and plan for a healthier nation.  Thus far, overriding concerns about privacy have slowed progress.

4.  Will we retain our resistance to interference in our lifestyles or will we surrender some choices in the interests of good health and wider societal gains, seeing it as a civic duty.

Perhaps governments have done all the easy stuff with public health; adult literacy, childhood immunisation and clean water.  The future lies in the extent to which governments are prepared to interfere in the lives of ordinary people.

Are we prepared to accept the law interfering in our lifestyle choices?  Banning foods, penalising anti-social life-styles that lead to costs for the NHS.  Refuse treatments to the obese and smokers is one thing but in the interests of equity, do we refuse treatment to a person with a self-inflicted injury sustained in a recreational game of squash.

The four ‘retains’… Public health, data, holding-on or letting-go, sharing our risks.  Perhaps the cornerstones of modern healthcare upon which we either agree and build for the future, or we run the risk of being spectators as, through lack of clarity, vision and determination, we watch it fall apart.

I judge there is an appetite for change if only we knew what it looked like?

How can you paint me a picture of the NHS in 2025 when you can’t sketch what it will look like next year.

Have a good weekend.


 Chris Smyth in the Times 16th June 2017: Young doctors go part-time to avoid long hours

A shortage of family doctors has been exacerbated by millennials’ reluctance to work long hours, the NHS training chief says.
More part-time young doctors means that the NHS now has the equivalent of 10 per cent fewer doctors, said Ian Cumming, chief executive of Health Education England, which supports the delivery of healthcare in England. Ministers have had to downgrade their estimate of the number of full-time equivalent doctors, he said……

Also on the same day: NHS secures deal with pharma for breast cancer drug Kadcyla

Kat Lay reports: GPs reluctant to refer fat men to clubs such as Slimming World

Laura Donelly: ‘Monumental’ NHS U-turn on breast cancer drug…

Neil Roberts for GPonline reports 14th June: Exclusive: Hospitals could need more than 200 GPs to staff NHS A&E plans

Owain Clarke for BBC news 13th June 2017 reports: GP recruitment: More junior doctors choosing Wales

Gender bias. The one sex change on the NHS that nobody has been talking about



This entry was posted in A Personal View, General Practitioners, 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.

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