Category Archives: Patient representatives

Even London and the Home Counties are feeling the squeeze… as standards and staff numbers fall re revert to the pre-NHS divide.

Just some of the pain felt in the rural shires is now feeding into London and suburbia. Standards of staffing and clinical diagnosis and speed are all falling. The blame is long term political neglect and denial from an elected elite who always felt they had access to the best – in London. No longer… it is impossible to report on all GP surgery closures as there are so many. The reality is that private services for ambulance, GP, A&E etc will follow… Bevan wanted the same high standards for the miners as the bankers – instead the standards are falling, but as before we had a health service, the bankers can afford the private option.

Owen Sheppard for MyLondon reports 7th September 2019: West London overspends by £112m!!

GP surgeries across Surrey are facing an uncertain future, with two confirmed closures and a third possibly following suit, which are set to put pressure on those nearby.

Patients say they are worried about the pressures on neighbouring services following the announcement of closures of surgeries in Staines and Guildford.

In Burpham, a petition has been launched to save the Burpham New Inn surgery which is also facing closure.

So why are surgeries closing?

The Guildford and Waverley Clinical Commissioning Group (CCG) has cited problems with leases and premises, which have led to the closures of two practices in the area.

In Staines, the Staines Thameside Medical Practice shut on Saturday (August 31) following a decision by the doctors to end their contract with the NHS to provide GP services. This was reportedly due to personal reasons.

Patients will lose the St Nicolas branch surgery in Bury Fields, Guildford, which will close at the end of October following issues with the premises and its lease.

Guildford and Waverley CCG has confirmed the surgery will close on October 24. All services will instead be provided by the main surgery at Guildford Rivers Practice in Hurst Farm, Milford.

One St Nicolas patient, who did not wish to be named, said: “I am very upset about the closure of St Nicolas Surgery, it came as a shock.

“[I believe] this was pre-planned since last year but without telling patients previously. I have not received a letter as yet about the closure.

“I think it’s been about a year that all the telephone calls to St Nicolas Surgery have been re-directed to the general practice in Milford.

“The closure of St Nicolas Surgery will put extra pressure on other GP surgeries in Guildford as patients who are ill, disabled, elderly or who don’t drive won’t be able to get to Milford.”

The CCG has said it will work with the practice to ensure that despite the changes, patients will continue to receive high quality care.

A spokesman said: “The CCG received an application from Guildford Rivers Practice that proposed the closure of its branch surgery, St Nicolas Surgery, due to issues with the premises and the lease which was proposed to have had a negative impact on the service offered to patients.

“Following a period of engagement with patients and neighbouring GP practices, the application to close the branch has now been approved by Guildford and Waverley’s Primary Care Commissioning Committee (PCCC).”

The spokesman added: “Registered patients of Guildford Rivers Practice will remain so, following the branch closure, with GPs from St Nicholas Surgery transferring to the main site and continuing to offer appointments to patients.

“Any patients who require home visits will continue to receive these in the usual way.

“The practice is committed to providing the best service for patients by operating solely from the Guildford Rivers Practice main site and the CCG will work with the practice to ensure patients continue to receive safe and high quality care moving forward.”

The news comes as patients await the decision on the future of Burpham’s New Inn surgery. A decision was set to be made on August 28 but this has been delayed.

A spokesman for Guildford and Waverley CCG said: “The PCCC has been re-arranged to ensure every option put to the CCG is fully explored, before a final decision is made.

“The committee has been rescheduled for September 13.”

In a letter to patients sent on July 31, the CCG said it was likely the New Inn Surgery in London Road would have to close later in 2019 due to problems securing a long-term home.

The letter said the surgery’s lease was expiring and no other suitable alternative sites have been found.

Patients launched a petition to save the surgery, which has been signed by 282 people to date.

Staines

Around 4,500 patients have had to re-register with another GP surgery after Staines Thameside Medical Practice closed its doors on Saturday (August 31).

Other GP surgeries in the area are accepting new patients despite some having recently had their lists capped.

Two Staines councillors are concerned about the additional pressure on those surgeries.

Councillor Jan Doerfel, Green Party member for Staines, said: “Expecting other GP practices to absorb the additional 4,500 patients is likely to result in longer waiting times for all those affected and additional travel for those that had to enrol with those practices. This is not acceptable.”

Councillor Veena Siva, Labour member for the ward, said: “Yet another GP surgery closes. Smaller practices are closing due to underfunding and insufficient GPs which means they can no longer be run safely and sustainably.”

She added: “As it stands, it is unfortunately no surprise that there was no interest from GPs to take over the surgery when in doing so all they would face is under-resourcing, enormous pressure and stress.”

NHS North West Surrey Clinical Commissioning Group (CCG) was responsible for supporting patients as they switched to a different GP service.

St David’s Family Practice Doctor Jagit Rai works at one of the surgeries receiving patients from Staines Thameside and is a governing body member at NHS North West CCG.

Doctor Rai said: “The closure of this practice does not relate to funding or staff shortages. The CCG was disappointed to receive notification from GPs at Staines Thameside of their decision to end their contract with the NHS to run the surgery.

“They made this decision due to a change in personal circumstances that could not have been predicted or planned for. The CCG asked neighbouring practices about the option to take over the running of Staines Thameside and reviewed their capacity to take on new patients.

“The surgeries decided the best way to care for Staines Thameside patients is at their practices where they can benefit from an established team and range of services.”

It’s slightly brighter news for the residents in Chiddingfold, where a new surgery is being built after the former building was destroyed by a fire.

Chiddingfold Surgery in Ridgley Road was gutted on January 7, 2019.

Plans were submitted in March to Waverley Borough Council for the complete rebuild.

The surgery has relocated to Cedar ward at Milford Hospital, where full doctor and nurse surgeries are in place. Expanded opening hours are available for patients at Dunsfold surgery.

Update : Diane Taylor in the Guardian 8th September 2019: London GPs told to restrict specialist referrals under new NHSThe New “Rationing Plan”. Plans for new cuts sent same day Boris Johnson reinforced NHS spending commitments..

Bradford staff: government breaking its promises….. This needs to be a nationwide rather than a local solution.

If we look at pensions as a promise of  future payment, and we assume that the English Health Service, along with the other 3 dispensations, has a “ponzi” scheme type of pension fund, then it is not surprising that Trusts and their boards of directors try to escape future commitments that they cannot fulfil. The whole of the former NHS (when we had one mutual) is funded on this basis, but by denial of the long term problems, politicians are forcing locally based solutions, inequity, and poverty in their workers old age. In effect they are breaking their promise… just as the Greeks had to …. The problem needs a nationwide solution so that the pain if felt equally. The earliest Trust sare those most likely to get away with it, and some already have. The result is post-code rationing by ethically and legally dubious means….  In any event, the whole state as well as health worker pension situation needs review….

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Unison website reports 8th July: Bradford hospital staff strike to stay in the NHS and picket lines will begin

BBC reported 14th August: Bradford Teaching Hospitals staff to strike over outsource plan

and Susie Beever of the Yorkshire Evening Post reported 1st August that there would be a two week strike over jobs 

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The History: Bradford Hospital has a track record. Simon Freemna in the Times 27th November 2004: Hospital’s rescuers charge £160,000 for the privilege

Sarah Kate-Templeton in the Times 2016: Safer births campaign: Shamed hospitals blame high stillbirth rate on the mothers

Rhys Blakeley in the Times 19th August 2019: Plea for state pension age of 75

 

Closure of many more surgeries…. And there’s an epidemic of dementia coming….

Popular cities like Bristol do not expect to be without GP cover. There have been many more since I last posted on GP closures. The Headline generated by Amanda Cameron in Bristol Live 2nd August reads: 

Health chiefs explain decision to close two GP surgeries in Bristol – The decision left 15,000 patients needing to sign up with another surgery within three months

The shortage of GPs is one thing, due to retirement, career changes, part time, and emigration (as well as early retirement due to stress and overwork), but the fact that we have a wave of demented patients coming in the next few years has not become real to the politicians. And it is not just doctors who are under stress. Midwives and nurses too… After all they will be up for re-election before that time, and may not win. The same explanation applies to the inertia om medical recruitment, acknowledgement of dementia, climate change and several other areas….. A first past the post system means we are all subject to short termism. Mending the 4 health services will take decades. So will addressing climate change… The pace of technology advance, especially following CRISPR, is faster than any government can afford. There is only one solution and that is to ration health care, with co-payments according to means. A quality service needs to have equal opportunity for all, and whilst “extras” such as private rooms or choice of specialist are reasonable in a two tier system, different outcomes and life expectancies are not. Will new tests (such as that for dementia) be available to all? In the end it is caring, continuity and trust  that matter rather than technology, especially when we are old.

You may wonder “Perhaps a new health secretary will change things”. No chance.

Scream, Jeremy Hunt, NHS, cartoon

“..Announcing the closure, the CCG said supporting patients to transfer to a neighbouring practice was the “best long-term solution”.

At a meeting of its primary care commissioning committee on July 30, it emerged that the CCG considered three options before deciding to close the Bishopston and Northville surgeries.

Those options included keeping both surgeries open, merging them with other practices, or closing them and sending patients elsewhere.

Following extensive consultation with patients, the CCG concluded that closing them would have “on balance, a neutral impact” on most patients.

Patients might also benefit from “improved provision of care” from practices offering a wider range of services, CCG papers show…..”

Owain Clarke for BBC News 31st July 2019: Cwm Taf maternity crisis: Midwife stress adds to staff problems

Rhys Blakely on June 13th reports in the Times: NHS creaking under the strain of record dementia diagnoses

The head of the NHS dementia strategy has warned that the service is struggling to keep up as cases of the degenerative condition surge.

NHS figures released yesterday showed that nearly 454,000 people aged 65 or over in England have formally had dementia diagnosed: a record. The number of diagnoses has increased by 7 per cent in the past three years…… Alistair Burns, the NHS national clinical director for dementia, said: “The NHS is having to run to keep up as dementia becomes a challenge for more and more families.”

BBC news today: Alzheimer’s blood test ‘one step closer’ ( By testing for amyloid )

Researchers say they can accurately identify people on track to develop Alzheimer’s disease before symptoms appear, which could help the progress of drug trials.

US scientists were able to use levels of a protein in the blood to help predict its build-up in the brain.

UK experts said the results were promising – and a step towards a reliable blood test for Alzheimer’s to speed up dementia research.

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

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The “Economist” acknowledges health rationing, but does not recognise that it is covert…. More and more anger to come.

How long will the UK citizens put up with untruths? How long will it take for the proper debate to begin? The Economist recognises rationing, Enoch Powell in “A new look at Medicine and Politics” recognised rationing in 1966. We cannot go on without knowing what (for us) will be unavailable. It is surely a human right to be able to plan for your own health, your family’s health, your death, and illnesses. No wonder citizens are getting more and more angry..

If we want to win the cooperation and hearts and minds of medical staff we need to find out the truth about what they think. BMA conferences full of retired and burnt out doctors may reject the “long term plan” but there is no link with the doctors at the coal face.

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Not only is devolution a failure (certainly in Wales) but the 4 different systems allow different language of obfuscation, different methods of rationing, and outcomes. The anger will be the same.

The East Anglian daily Times shows how angry and dissatisfied the citizens are becoming. If you multiply the figures up over 200 health staff are attacked daily in the UK.

NHS GPs Economist 0619 Whats up Doc June 2019

Enoch Powell 4 Supply and Demand – Rationing  Minister of health for 3 years 2nd Edition 1974

Toni Hazell 28th June in GP mag: Here are two potential problems with primary care networks.  Huge hurry, and who takes responsibility?

Andrew Papworth reports 30th June 2019 in the East ANglian Times : “NHS staff aren’t punchbags”: Shock as six workers a day attacked in Suffolk by patients.

BMA ARM: Doctors spurn NHS long term plan

NHS patients ‘face more treatment rationing since coalition restructuring’

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

Image result for angry patient cartoon

Image result for angry patient cartoon

 

Methods of rationing in 1966. Warrington shows that we have since invented many more….

A new look at Medicine and Politics: chapter 4 –  J Enoch Powell 1966. We have invented many more since Enoch Powell’s day, and the latest from Warrington is how rich or poor you are…

The answer for this post-code lottery is for GPs to send all their patients elsewhere. Since the money moves with the patient, Warrington and Horton will get none.

https://www.sochealth.co.uk/national-health-service/healthcare-generally/history-of-healthcare/a-new-look-at-medicine-and-politics/a-new-look-at-medicine-and-politics-4/

METHODS OF RATIONING

The preceding pages have been devoted to examining how the medical profession is affected by the system that has been adopted for the purchase by the state of a certain quantity of medical care outside the hospitals. That quantity, as already explained, is indirectly fixed by the remuneration the state offers, which determines in the longer run the number and quality of those contracting to provide that care.

Thus, outside as well as inside the hospitals the figure on the supply side of the equation is fixed at any particular time by those complex forces that determine the state’s decisions on expenditure. With this figure demand has to be brought into balance. Virtually unlimited as it is by nature, and unrationed by price, it has nevertheless to be squeezed down somehow so as to equal the supply. In brutal simplicity, it has to be rationed; and to understand the methods of rationing is also essential for understanding Medicine and Politics. The task is not made easier by the political convention that the existence of any rationing at all must be strenuously denied. The public are encouraged to believe that rationing in medical care was banished by the National Health Service, and that the very idea of rationing being applied to medical care is immoral and repugnant. Consequently when they, and the medical profession too, come face to face in practice with the various forms of rationing to which the National Health Service must resort, the usual result is bewilderment, frustration and irritation.

The worst kind of rationing is that which is unacknowledged; for it is the essence of a good rationing system to be intelligible and consciously accepted. This is not possible where its very existence has to be repudiated.

In the hospital service probably the most pervasive, certainly the most palpable, form of rationing is the waiting list. The waiting list is a complex phenomenon in itself. One component can be likened to a reserve of working materials: if the hospital resources are to be continuously used, there must be a waiting list. The simplest case is that of a consultant available (let us suppose) during a two-hour session. If there were no queue in the out­patient waiting-room, there might be gaps between one consultation and another when the consultant would not be productive— not, at least, in that sense. So it is always arranged that there shall be plenty of people waiting when the great man arrives, so that there is no danger of the expensive mill even momentarily lacking grist. Similarly, if the capital and resources represented by operating theatres and their staffs are to be intensively used, there must be, so to speak, a cistern from which a steady flow of cases can be maintained.

This element of the waiting list is only incidentally a rationing device, though even here time is serving as a commutation for money: a consultant in private practice can accept the dis­continuity of work implicit in a good appointments system, because his patients are in effect buying his waiting time as well as his consultation time or, putting it another way, the patient finds his own time worth more to him than the consultant’s.

Waiting lists, however, normally exceed the minimum related to full employment of the medical resources. They are then directly rationing in their effect. For example, they ration demand for the more able, experienced or celebrated advice and treatment compared with the less: the waiting lists of consultants in the same department of a hospital can differ greatly in length. It is sometimes said that consultants regard a long waiting list as a status symbol and preserve it with the same care and pride as an Indian would a string of scalps. Certainly, consultants are very possessive about their waiting lists. But the taunt is as uncomprehending as it is uncharitable. There has to be some differential rationing for different qualities of an article, and if not price, then, for example, time: better surgeon, longer wait, and vice versa. No wonder consultants, family doctors and patients too resist equalisation of waiting lists, which would mean that rationing by time would have to be replaced by some even less rational or intelligible form of rationing, such as rotation or the initial/letter of the surname.

Generally, the waiting list can be viewed as a kind of iceberg: the significant part is that below the surface— the patients who are not on the list at all, either because they are not accepted on the grounds that the list is too long already or because they take a look at the queue and go away. Naturally, no one knows how many these are. Indeed, the very question is rather absurd, as it implies some natural, inherent limitation of demand. But the part of the iceberg above the water is doing its work, directly as well as indirectly, by attrition as well as by deterrence.

It might be thought macabre to observe that if people are on a waiting list long enough, they will die— usually from some cause other than that for which they joined the queue. Short of dying, however, they frequently get bored or better, and vanish. Here again, time on the ‘waiting list is a commutation not only for money— measurable by the cost of private treatment with less or no delay— but also for the other good things of life. It is an interesting phenomenon of the waiting lists for in-patient treatment that at the holiday season and around Christmas time it may be necessary to go quite far down a lengthy waiting list to get patients willing to accept the long-awaited treatment in sufficient numbers to keep even the temporarily reduced hospital resources fully employed.

I  cannot  but  reflect sardonically  on  the  effort  I  myself expended, as Minister of Health, in trying to ‘get the waiting lists down’. It is an activity about as hopeful as filling a sieve, although this is not to deny that some of the measures applied and pressures exerted might conceivably have had some useful side-effect in improving, in a slight degree, the direction of effort. There were the circulars enjoining such devices as the use of mental hospital beds and theatres, or of military hospitals. There were the stiff cross-examinations of staffs and hospital authorities in the endeavour to discover what contumacy might explain their continued non-compliance with the official exhortations. There were the special operations to ‘strafe’ the waiting lists, urged on the fallacious ground that a stationary waiting list is not evidence of deficient capacity— otherwise it would lengthen —but of a backlog which, once ‘cleared off’, ought not to be allowed to recur.

Alas, the waiting list that melted under an assault of this kind was back again to normal before long. There were always special, local and temporary explanations that could be cited, such as a sudden coincidence of staff off duty through leave, sickness or change of post. But all too evidently the causes at work were general and deep-seated. There was a mean around which the figures fluctuated, but that was all. Naturam expellas furca, tamen usque recurret: though you drive Nature out with a pitch­fork, she will still find her way back.

In a medical service free at the point of consumption the waiting lists, like the poor in the Gospel, ‘are always with us’. If at any moment of time they do not exist, they have to be re-invented, or rather they reproduce themselves effortlessly and automatically. Ministers come and Ministers go: the hospital service spends a rising fraction, or it spends a falling fraction, of the national income; but the ‘waiting list at 31st December’ in the Ministry of Health’s annual reports still stays the same, a reliably stable feature in an otherwise changing scene. On New Year’s Eve 1959 it was 442,519; on New Year’s Eve 1960 it was 475,643; I962, 474,353; 1963, 470,297; 1964, 475,863; 1965, (oh dear!) 498,972. And what had it been, pray, on New Year’s Eve 1951, back in those early, primitive days of the National Health Service? Why, 496,131.

At the same time, Ministers of Health are broadly truthful when they say that for cases diagnosed as urgent or critical the waiting list, practically speaking, does not exist. This is far from disproving the function and necessity of the waiting list as a rationing device. For one thing, ‘urgent’ and even ‘critical’ are not objective magnitudes; on the contrary, they are assessments that have already taken the volume of supply into account. In any case, there is no clear-cut dividing line between the ‘urgent’ cases, seen or treated at once, and the ‘non-urgent’ cases on the waiting list— or, as the case may be, not on the waiting list at all. The latter are squeezed down— or off— by the former. To point to the fact that no ‘urgent’ case goes untreated as evidence that supply and demand can be brought into balance without rationing is like arguing in a famine that because nobody dies of starvation, there need have been no rationing system.

A  DOUBLE  STANDARD

In the last resort the waiting list, or the queue in the general practitioner’s surgery, is one aspect of rationing by quality. In the days of the reform of the poor law and abolition of outdoor relief for the able-bodied, this used to be known as the principle of ‘lesser eligibility’. What are called the ‘deficiencies’ of the National Health Service— the large number of patients per general practitioner, the age and quality of many of the hospital buildings, and so on —are not deficiencies in the literal sense of the word, that the service falls short to a measurable extent of an objectively definable standard. They are those consequences of the quantity and quality of medical care being purchased by the state that help to equate the demand with the supply. The supply of medical care of all kinds through the National Health Service is rationed by forcing the potential consumer to choose between accepting the quality and quantity offered or declining the care offered. If he declines the care offered, he can either renounce or defer treatment altogether or he can endeavour to purchase it outside the National Health Service.

This is why it is absurd to declaim against a ‘double standard’ of medical care, inside and outside the National Health Service respectively. The standard inside is that which balances demand with the amount supplied by the state; the standard outside is that at which the supply and demand for medical care balance in the market, given the existence of the National Health Service. The standard in question is not necessarily one of purely medical treatment, if indeed the purely medical aspect of care can be divorced from the others. For example, it may well be that a patient acutely ill or gravely injured may be treated as skilfully, efficiently and safely in a National Health Service hospital as in an expensive private hospital or ‘nursing home— often, I would guess, more so. But the paradox is capable of rational explanation. The ancillary aspects of medical care— amenity, privacy, attention in convalescence, a degree of freedom, choice and individual self-assertion—may be valued no less than the essentials that affect life and limb. Indeed, they are sometimes valued more highly, surprising though that may seem. There can also be an element of pride, prejudice, snobbery— call it what you will— that values the identical article more highly when it is purchased than when it is received gratis.

The principle of lesser eligibility has always been applied, cannot help being applied in some form, wherever provision is gratis. It was applied before the National Health Service started in the voluntary and municipal (ex-poor law) hospitals and, indeed, from the beginning of time wherever medical care was rendered free at the point of consumption. Since eligibility is a form of rationing, we naturally find that it, like the waiting list, is also used to establish an order of priority. This is the reason why, for instance, the geriatric and long-stay mental hospital wards are, and have always been, the most ineligible in the service. The priority accorded to the demands of acute illness requires that rationing be applied more severely to the chronic.

Two instructive contrasts outside the National Health Service will illustrate the rationing function which lesser eligibility performs in it. One is the striking contrast between the two forms of old people’s accommodation: the workhouse and the new-style old people’s home. The former was designed to meet a legally unrestricted duty to admit; the latter corresponds to a discretionary and highly discriminating right to admit or not to admit. Consequently the poor law institution had to ration by ineligibility, and still in practice does if it continues to exist, while the new-style home explores ever-rising standards of amenity and care under the shelter of a rationing system of a different kind. Similarly, the paradox of the relatively high standard of the subsidised local authority house, although it is subsidised, is explained by the fact that the demand is tailored to the supply by the discretionary waiting-list itself, and consequently the supply can be rendered in a relatively eligible form.

Parkinson’s Law

The fact that the necessity for these covert forms of rationing springs from the very nature of the National Health Service and not from any particular level of supply attained in it is borne out by ‘Parkinson’s law of hospital beds’, which asserts that the number of patients always tends to equality with the number of beds available for them to lie in. Thus, the ratio of hospital confinements to total births ranged in 1965 from as low as 53.8 per cent in East Anglia to 78.4 per cent in Wales—the national average   was  69.8  per cent. Yet the pressure on maternity accommodation was at least as high in the latter part of the country as in the former. Again, the number of hospital beds for acute disease in the North-West of England is almost twice as great as in the South-East: in 1961 there were 3 per thousand population in East Anglia against 5.6 in the Liverpool region. Yet the pressure of demand, as evidenced, for example, by length of waiting lists, shows no comparable variation. There is, as has been said above, no reason to suppose that an increase in the quantity or quality of care provided by the National Health Service would reduce the need for rationing. On the contrary, every increase in eligibility must involve an intensification of the other forms of rationing, such as waiting.

It is unfortunate that the nature and the value of rationing by waiting and by ineligibility in the National Health Service are not recognised, at least by the professions. For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidences of ‘inadequacy’ and as blemishes that it lies within the power of politicians to remove, given the insight and the will.

Martin Bagot in The Mirror updated 2yh June reports Warrington’s plans to charge 20K for a hip replacement. It would be cheaper and safer to go abroad.

 

 

Everyone as an opinion on their Health Service. Enoch Powell saw through its weaknesses in 1976.

The small book by Enoch Powell “Medicine and Politics 1975 and after” (his period was 3 years as Health Minister) should be obligatory reading for all doctors. He could less politely have said that the Emperor has no clothes. . Read a review by retired BMJ Editor Richard Smith. 

He tells us that of course the health care is rationed, and that this is deliberate but covert. He (page 37) discusses some methods of rationing, but since his day we have invented many more than the waiting lists and waiting times that he refers to.

Parkinson’s Law of Hospital Beds (page 43) “asserts that the number of patients always tends to equality with the number of beds available for them to lie in”. But he was not aware that clever administrators can use trolleys, but not count them as beds. Therefore more and new covert rationing….

Finally I wish to quote his last word on rationing:

“It is unfortunate that the nature and value of rationing by waiting and by ineligability in the NHS are not recognised, at least by the professions (and by implication the rest of the country). For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidence of “inadequacy” and as blemishes that it lies within the power of politicians to remove, given the will.”

Richard Smith non-medical blogs on Enoch Powell’s book – The best book ever written about the politics of the NHS

The Socialist Health Association also summarises the book (A large part or almost all – I failed to spot omissions)