Category Archives: Professionals

NHS at 70: Five medical experts diagnose NHS problems – and prescribe cures. The BBC is a government organisation, and funds the Radio Times. It cannot be expected to give credence to rationing overtly.

NHSreality is worried that “a little nip and tuck” will certainly not work. In a world of open information, covertly rationing, and not being honest about what is not available, is not good enough. Being honest includes informing the populations of Wales, Scotland and N Ireland that, being in much smaller mutual organisations, they will get less choice, and usually lower standards in a world of large units and specialisation. Regions that do most of their surgery in DGHs (District General Hospitals) will be most affected. The BBC is a government organisation, and funds the Radio Times. It cannot be expected to give credence to rationing overtly.

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The Radio Times Wednesday 27th June prints five opinions: NHS at 70: Five medical experts diagnose NHS problems – and prescribe cures

The NHS may not need a full facelift but a little nip and tuck could work wonders, according to its leading experts

Henry Marsh – Neurosurgeon

What are the biggest changes you observed in your 40 years as a consultant?

The single biggest change has been the European working time directive and its shortened working week. It’s not all bad – it has meant less tiring hours and enabled more women to go into the surgical specialties – but it has also hugely diluted surgical training and fragmented continuity of care so that, their consultant aside, patients are now looked after by committees of junior doctors. Care has become dispersed.

There is also the loss of authority of senior doctors. When I became a consultant there was one pyramid, one hierarchy, and senior doctors sat at the top of it. Now there are all kinds of pyramids – doctors, nurses and management among others – and nobody is in overall charge. The result is chaos. Patients are better informed, which is a good thing, but that, too, has a flip side: greater patient autonomy has resulted in one per cent of the NHS budget – more than £1 billion a year – now going on legal expenses.

What are the most significant issues facing the NHS?

The simple fact is that an ageing population and advances in medical technology mean more expense for the NHS. For instance, if you make operations simpler and safer you end up operating on more people. There are no easy answers, and many of the suggested solutions, be it rationing healthcare, or eliminating some procedures, aren’t really solutions at all.

The reality is that we already have a degree of rationing in the form of waiting lists, which act to some extent as a filter. And while it’s reasonable to question whether procedures like cosmetic surgery should be funded, I don’t think it would make a big difference to the NHS budget if they weren’t. Similarly, while I am an advocate of assisted dying, I don’t think it would make any difference to costs were it to be introduced. Ultimately, most of us cling to life for as long as possible.

So where does the nub of the problem lie?

One of the factors making medicine more expensive is cancer. It’s essentially a disease of old age, and one that has become more treatable with developments such as immunotherapy. But the critical thing is that a lot of cancers don’t need treating – earlier this month immensely important research was reported that showed that a large number of women with breast cancer do not require chemotherapy. A similar study has been done on prostate cancer sufferers, which showed that 25 per cent of those diagnosed did not go on to progress beyond the early stages of the disease. At the moment we can’t ascertain who will and won’t progress – but my hope is that advances in molecular genetic studies will help us get better at selecting who needs treatment. That’s where we should be putting our money – and it might actually save money.

Is there cause for optimism?

Absolutely. I passionately believe that the principle behind the NHS is still the best one. We may have to accept, though, that this is a model that needs to be tweaked, whether it’s by supplementing with insurance or paying for some aspects of our medical care. I’m in favour of a Royal Commission being set up to discuss how this could be done, so the public have some say in what should happen.

Henry Marsh’s book Admissions: A Life in Brain Surgery is now available in paperback


Professor Magdi Yacoub – Cardiothoracic Surgeon

Do you still believe in the NHS?

Absolutely. I have worked for it all my life and I would do the same again. I travel to some of the world’s poorest countries with my charity the Chain of Hope, which works to establish sustainable centres for cardiology, and it’s a continual reminder that what we have is the best healthcare delivery system in the world. Every patient who comes is welcomed and given the best without discrimination, and that is a wonderful thing. But we have to be continually critical and not just congratulate ourselves on what has happened in the past.

What do you think are the main problems we face today?

The very large number of administrators in the NHS and the urge to keep changing things has bedevilled the system. Its effects trickle right through the system: at the coalface workers wake up wanting to do something good and then find there are new regulations and new rules.

What needs to happen?

Doctors have only two masters: patients and science. To my way of thinking we need to spend more on integrating science instead of on new administrators and managers. Allowing for innovation is very important. We also have to encourage the public to work in partnership with the NHS, to be part of the whole system, because they own it. The idea that there is somehow a competition between prevention and hi-tech medicine is a fallacy – it’s a continuum. The drop in the rates of heart disease, for example, is due both to better prevention and better medicine.

You favour changing organ donor laws so that people have to opt out, rather than opt in. Can the NHS afford increasing numbers of transplants?

Organ donation is a gift: when you have seen someone dying in the middle of the night and then you meet them again 30 years later after they have received a transplant – you cannot put a price tag on that. What people forget is that the process of learning about and perfecting transplantation benefits so many other branches of medicine too.


Professor Farah Bhatti – Consultant Cardiac Surgeon

What has changed in the service since you qualified in 1990?

The medical advances have been phenomenal. When I qualified, cardiac surgery was just an emerging field, and now people talk about open-heart surgery as if it were commonplace – which in some ways it is. We’ve got technological advances in all areas of medicine and surgery is no exception. There’s also been a shift towards greater team-working. Today it’s not a hierarchy of doctors and nurses, but a wealth of paramedical and support staff working together.

So what are the challenges?

It’s common knowledge that we are dealing with an increasingly elderly population, with quite complex medical needs, with limited resources: we need an uplift of four percent in spending just to stand still. Everyone within the NHS from doctors to domestics is working incredibly hard to cover shortages, working extra shifts and filling in rota gaps. They do it out of goodwill, but it has implications for the health of the staff and patient outcomes. We also need to think about the best use of the resources we do have – we have patients in hospital who are medically well enough to go home but there is no one to care for them. We desperately need more joined-up health and social care.

Should we be looking at rationing resources?

I don’t think the words healthcare and rationing should be in the same sentence. The focus needs to be resourcing the NHS properly and then using what we have sensibly and logically. That starts with evidence-based medicine – everything I do as a cardiac surgeon I do with that and the patient in mind: ie, is surgery the right choice in terms of survival and quality of life?

I think if you go down the insurance route, the result will be that there are people in need of medical attention who would not seek it. I think where the money conversation should be happening is around how all our taxes are spent, and the proportion going into healthcare. Seventy years ago if you were unwell and you weren’t wealthy, you could die. The landscape has changed immeasurably since then but we can’t lose sight of all we have achieved and what we have created.


Dr Michael Mosley – Writer/broadcaster

What are the most pressing problems faced by the NHS?

The scale of staff shortages is unprecedented. The number of unfulfilled nursing posts is horrendous, and a huge number of qualified doctors are moving abroad. We’ve had crises before – when I qualified in the 80s it was also quite grim – but it’s as bad as it’s ever been.

Does it need more money?

It clearly does, but we are already spending, in real terms, four times more money than when I qualified. So the amount going into it has increased enormously – but so has demand. We’re living longer, getting fatter and people now have more chronic and complicated diseases.

What should we do?

If the primary problem is demand, then that needs to be tackled. The NHS as a system actually works very well – it’s lifestyles that are causing many of the problems. We are getting fatter, and rates of Type 2 diabetes have doubled, which leads to an increased risk of heart disease and kidney failure, and possibly dementia. The rise in obesity is also linked to an increased risk of cancer. All these problems are related. I think the Government needs to focus on getting people healthier earlier and for longer.

How do they do that?

The sugar tax is a good start, but we need to think more imaginatively, such as redesigning cities to encourage people to walk more.

Michael Mosley appears in Celebrities on the NHS frontline, Thursday 28th June at 9pm on BBC1 (BBC2 in Wales)


Professor Robert Winston – Fertility Expert

What angers you most about the current state of the NHS?

It has become a political football, with different parties clamouring to style themselves as the service’s saviour. This has led to a constant restructuring of the service, which is unhelpful. We should be collectively deciding the percentage of GDP we’re prepared to spend on it, which should be agreed by all the main parties.

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Long waits, cuts and rationing: happy 70th birthday NHS – but there is no NHS, and the “goodwill” is spilling away

NHSreality is surprised that the Guardian still refers to the NHS. There is no NHS. The goodwill that was once there is much reduced, and what remains is spilling away.

Zara Aziz in the Guardian Tuesday 5th June opines: Long waits, cut and rationing, happy birthday NHS. It’s getting harder for doctors to provide good care. But the NHS would be lost without the goodwill of those who work there

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The NHS (2018)

 

They opened the NHS

Seventy years ago

Markets and gain have undone it again (and again)

And now you would never guess

There was once a fair NHS

Before the performance targets

It is within the patient’s and staff

And the overworked nurses

Only the GP sees

That where inequity thrives

And managers count their beans

There was once an NHS

 

Yet, if you enter the service

On a weekend evening late

Where alcohol fuels casualty duels

When the surgeon dreads his mistake

(They fear the managers more

Because of their powers)

You will hear an aside, as philosophies collide

And post code dice rattle on embers

Consistently blinded to

The covert rationing

As though they perfectly knew

My old lost, fair, NHS

But there is no NHS.

 

 

Roger Burns

 

After Rudyard Kipling – The Way Through The Woods.

 

Where are UK trained doctors? How do we get them to stay in the UK, and encourage more equal distribution?

I am trying to persuade people in Wales that we deserve better. The successful applicants for medical school come from city suburbs and from females. If we are to have applicants successful from all areas and schools, then we need adverse selection, and if we are to correct the gender bias we need graduate entry, or adverse sex selection at 18 years. If we are to encourage medical students to settle in an area, then my suggestion is a virtual medical school in Wales. The Cardiff Deanery can supervise the examinations and assessments, but the delivery of teaching can by internet talks, and local practical learning. We have a net 20% loss of all graduates, but in medical sciences I am suspicious that it is much higher. Doctors will often want to travel, but most will return. Training an excess will mean more competition for all posts. The problem in London is the cost of overhead for self employed GPs…  and lack of enough modern premises.

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in the BMJ  31st May 2018 : (BMJ 2018;361:k2336  )

Where are UK trained doctors? The migrant care law and its implications for the NHS–an essay by Julian M Simpson

The proportion of locally trained doctors tends to vary inversely with the needs of the population served. Once doctors have qualified they are in an international jobs market. South Asian doctors made it possible for the (then) NHS to develop as a system built around primary care.

Locally trained doctors tend not to want to work in areas of high deprivation and need, and we continue to rely on foreign trained doctors to fill massive gaps. Medicine should acknowledge this historical trend and tackle the dysfunction arising from its contemporary manifestations, writes Julian M Simpson

When I started researching my recent book,1 and speaking to members of the first generation of South Asian GPs to work in the NHS, I was struck that I kept returning to parts of the UK that for the first four decades of the NHS were predominantly industrial and working class. The people I was interviewing had mostly had careers in inner cities and industrial areas. I met them at their homes and practices in the former coalfields of South Wales, Fife, and Yorkshire, and in the urban areas that made up Britain’s industrial heartlands: Glasgow, the Midlands, Manchester, and the East End of London.

This was no coincidence. Medical migration from the former British empire in South Asia was a fundamental aspect of the working class experience of healthcare in Britain in the period I researched (from the 1940s to the 1980s) and beyond. By the end of the 1980s, although about 16% of GPs in England and Wales were from South Asia, their distribution was hugely uneven.

In fact, there was a stark divide. Few South Asian doctors practised in areas that were generally more middle class and rural. In Somerset or Cornwall or the Isles of Scilly, for instance, less than 1% of doctors in 1992 had qualified in South Asia. GPs from the Indian subcontinent were largely catering to the residents of generally working class and industrial areas. In some parts of England, such as Walsall in the Midlands and Barking and Havering in Greater London, they …

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Having the same GP halves chance of early death. Seeing the same GP will help older people… An association is not owever a cause..

 Continuity of care has long been one of the boasts of the RCGP, but with part time working, overburdened GPs , retirement, emigration and career changes, the objective has been one in name rather than reality. There are too few GPs who undertake terminal care, and it is only in the Hebrides that the same hands deliver you as those that close your eyes on death. It is particularly helpful with older patients, and bringing them to terms with the reality of a final illness…

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Chris Smyth reports in the Times 29th June 2018: Having the same GP halves chance of early death

Seeing only one family doctor cuts the risk of dying early by up to 53 per cent, an international analysis has found.

Having repeated appointments with the same GP was as effective at reducing death rates as some drugs, according to an overview of 22 studies.

Sir Denis Pereira Gray, who led the work, said NHS policy needed a “complete change” to recognise the value of a personal relationship with a family doctor, rather than diverting GPs from their regular patients to provide evening and weekend appointments.

“If you can build a worthwhile relationship with a doctor it will be to your advantage and theirs over time,” he advised patients.

Four fifths of the studies covered in the research showed that continuity of care had clear benefits over periods ranging from a weekend in hospital to 17 years. Previous work has shown that patients who see the same doctor regularly are more satisfied and less likely to go to A&E, but Sir Denis argued that health chiefs should stop seeing this continuity as a luxury “like a nicely decorated room”.

He said: “Arranging for patients to see the doctor of their choice has been considered a matter of convenience or courtesy: now it is clear it is about the quality of medical practice and is literally a matter of life and death.”

A study last month found that only half of NHS patients were able to see their preferred GP most of the time, down from two thirds five years ago.

Sir Denis, a former head of the Royal College of GPs and the Academy of Medical Royal Colleges, argued that “if a patient knows and likes a doctor, they are more open to giving more information and things they are worried about that they would be less likely to divulge to a strange doctor”.

Not only does this make a doctor’s diagnosis better and their advice more personalised but, he argued, “patients who have the same doctor are also more likely to follow the doctor’s advice”. Older people were particularly likely to benefit from a personal relationship with their GP, he added.

Sir Denis’s paper is the first to bring together international evidence from nine countries, including Britain, about the relationship between regular appointments with the same doctors and death rates. All the studies pointed in the same direction with one showing a 53 per cent reduction in death rates. The size of the benefit was “in the same range as some treatment effects”, his team wrote in the journal BMJ Open.

Sir Denis said that at the St Leonard’s Practice in Exeter, where he works, 51 per cent of patients see the same GP every time.

However, Kamila Hawthorne, vice-chairwoman of the Royal College of GPs, said: “General practice is facing intense resource and workforce pressures . . . unfortunately, waiting to see ‘their’ GP means patients may have to wait even longer for an appointment.”

The Department of Health insisted that over-75s had a single GP accountable for their care. A spokesman said an extra £2.4 billion a year was being invested to improve access to patients and availability of appointments.

Continuity of care in General Practice

Comment on the New Medical Schools. How will continuity of care improve?

GP Occupational Health – too little too late. Lack of trust may ensure the service is ignored.. Say goodbye to continuity of care…

New Models of Primary Care and the future of general practice: less continuity of care… bigger surgeries…. more foreign trained doctors?

GP A&E Triage – would be a good idea if we had planned for the numbers needed. We have not.. and GP partnership and continuity of care is in decline

GP changes: Continuity for elderly, Transparency of Earnings, Ofsted style Inspractions and fewer Targets

Update 2nd July 2018, the Times letters: 

Sir, The study led by Sir Denis Pereira Gray does not demonstrate that “seeing the same family doctor cuts the risk of dying early by up to 53 per cent” (report, June 29). It found evidence that seeing the same family doctor is associated with an up to
53 per cent lower risk of early death. Association is not causation.

Healthier people are at reduced risk of early death, and they are more likely to be able to wait to see their own doctor. Those who are more ill need to see whoever is available at the earliest opportunity. Perhaps articulate and motivated people work the system better in order to see the doctor of their choice, and they may be at reduced risk of early death for many reasons.

I, too, think continuity of care is a good thing and am sad that we are losing it. It may indeed prevent premature death — but the evidence presented does not show that.
Dr Simon Dover
Glasgow

Sir, The only surprise about news that seeing the same GP is beneficial is that it took 22 studies to establish the fact. It must be more efficient, apart from cementing trust between doctor and patient. Many routine questions and answers will not be necessary after the first visit, whereas fresh doctors have to establish some of this information for themselves.

We are told that older people are particularly likely to benefit from a personal relationship, and they are the ones who take up most time at any surgery. They will not be the patients demanding evening and weekend appointments.
Jennifer Rees

Cardiff

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Which party will be brave enough to open the discussion, on a new financial form of health service provision, and be honest about what cannot be provided?

Which party will be brave enough to open the discussion, on a new financial form of health service provision, and be honest about what cannot be provided? Otherwise we progress to a No Hope Service in each post code / jurisdiction. The Times completely missed out the need to ration overtly, and that technology is advancing faster than any government’s ability to pay.

On June 28th the Times leader opines: Health Disservice

The NHS is 70 and showing its age. Instead of treating it as a religion, leaders must find the courage to explain why a new century needs a new sort of health service


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It is six years since Danny Boyle turned the NHS into an object of quasi-official mass veneration at the London Olympics’ opening ceremony. When 300 luminous beds spelt out its initials in the stadium the message was clear: Britain considers its health service the envy of the world and anyone who does not agree is just plain wrong. Before the Olympics there was already a strict political taboo against challenging the basic purpose and funding mechanism of the NHS. Since then, the taboo has endured as the service has lurched from crisis to crisis, never solvent, sapping staff morale and failing to deliver the world-class care that taxpayers are led to believe they can expect.

At present funding levels they cannot expect such care. Nor do they get it. An estimated 10,000 British cancer patients a year died early a decade ago because of late diagnoses, and the number has scarcely fallen since. The NHS has fewer than half as many scanning machines per head than the average for 11 comparable countries. It has one doctor for every 356 people compared with an average in these 11 countries of one for every 277.

NHS care is not bad overall, but it is mediocre. Despite this, as the 70th anniversary of its founding approaches, parliament is full of politicians wearing outsized NHS lapel badges as if they were party rosettes on election day. Theresa May knew she would be expected to find more money to mark the anniversary and duly announced an extra £20 billion a year by 2023, without explaining where it would come from or how it would be spent. No other area of public spending could expect such largesse or such a willing suspension of critical thinking.

The principle enshrined in the NHS charter, that care should be free at the point of need, is noble and valuable as a broad goal. It is also the reason the service retains such high levels of public affection despite its failings. But enshrining anything is bad policy. The NHS is not a religion. It is an overburdened public service too bureaucratic to be truly efficient, too big to cater to the individual rather than the herd, and too preoccupied with the critically ill to do a better job of preventing people getting ill in the first place.

The best 70th birthday present for the health service would be an admission from a sitting prime minister that there is a reason why no other rich country has adopted the British system. As populations age and the treatments available to them become ever more expensive, paying for them out of general taxation ceases to be possible.

One undoubted NHS strength on which all contributors to the latest international survey could agree is that it protect patients from financial calamity should they fall gravely ill. The importance of this safety net function should not be underestimated, but even a left-leaning US health think tank that consistently praises the NHS in principle admits that in practice it ranks last among comparable systems for keeping patients alive.

It is not enough to be content with equitable access to healthcare. Outcomes matter too. Most alternative systems that do better at restoring cancer and heart disease patients to health spend more per capita than Britain, but the NHS also suffers from fundamental cultural failings.

Studies suggest that those who pay for it often feel unwelcome at its surgeries and hospitals unless they are severely ill. Their reluctance to see a GP, and GPs’ reluctance in too many cases to refer, are the crudest sort of efficiencies. When cancers go undetected as a result, such efficiencies cost lives. Mrs May has said that she is willing to reverse the last government’s least successful reforms if the health service can suggest genuine improvements. There are no easy answers, but there is a vital rule of thumb: no sticking plasters. Sooner rather than later the NHS needs to be rethought from the ground up.

Letters June 20th: We need a proper discussion about the NHS

Sir, As a retired GP deeply concerned about the welfare of the NHS, I concur with Graham Smith’s letter (“Healthcare models”, June 28). Politicians need to grasp the nettle and admit that the present model of the NHS is unsustainable. Other models, while not perfect, are vastly superior to our system. In Switzerland, for example, no one who cannot afford healthcare is excluded. Instead they are served by the state, thus maintaining one of the foundational principles of the NHS. We collectively need to have grown-up conversations about what we want and can afford. Who among our politicians, I wonder, has the courage to start such?
Dr Anne Aitchison

Corbridge, Northumberland

Sir, Your leading article on the NHS (“Health Disservice”, June 28) draws on data presented by my organisation and other leading think tanks. Yet its conclusion that poor outcomes on some of the big killers such as cancer are down to the tax-funded nature of the system is spurious. In fact, there is no reason to think that the funding system is part of the reason behind our poorer outcomes. Several other countries that do better on saving lives — such as Sweden and Canada — also have tax-funded systems.

Our below-average survival rates from cancer and other killer diseases are likely to be due to a combination of reasons, including fewer doctors and nurses and less provision of vital equipment. But the way health systems are run and operated also plays a crucial role. Few other health systems, including those modelled on the NHS, are as highly centralised and politicised as the health service in England. Perhaps the best birthday present we could give the NHS is to swap our obsession with how it is funded for a healthier obsession with improving our clinical outcomes.
Nigel Edwards

Chief executive, Nuffield Trust

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Sir, I applaud your leading article: the NHS really must be reimagined. However, you do not address the thorny issue of how. Insurance schemes are one possible alternative. Countries such as France, Norway and Germany, which have not adopted the NHS model, have such schemes in place alongside outcomes that make some of ours look shameful. Yet in the UK the very mention of health insurance can invoke incendiary reactions. It is high time we began a brave and open-minded debate about our NHS and took a close look at how other countries do healthcare.
Venetia Maltby

Alton, Hants

Sir, People often do not appreciate something they get for nothing. In New Zealand and Australia, patients pay for GP visits; in Australia we get back about two thirds of the cost from Medicare, although poorer patients can visit a GP without charge. We can also visit more than one GP if we wish and it is our choice whether we go to one who is covered by Medicare or pay extra to go to a doctor who charges a little more.
Marianne Stevens

Halls Head, Western Australia

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Sir, I fear that Graham Smith may have shot his own argument in the foot. If, after 70 years, the best minds in healthcare have been unable to come up with a successful “reform” plan (and there have been many such reorganisations) then it is unlikely that any other great minds will be able to do so in the next 70 years.

Rather than focusing on changing how the NHS does what it does, we should be looking at what the NHS should not do. There is a good deal of “futility medicine” in the present system; just because we can do some very clever things does not mean we should. A review based on that premise would have some chance of success.
Dr Andrew Bamji

Rye, E Sussex

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A letter on Healthcare models 28th June in the Times letters:

HEALTHCARE MODELS
Sir, Melanie Phillips is right that there are better models of health care than that offered by the NHS (“The elderly deserve better than NHS care”, June 26). It has been clear for years that the present model is unsustainable, given its perpetual crises and insatiable demand for more money. Yet politicians of all parties have deferred any proper reform, resorting to pointless organisational tinkering allied to occasional splurges of money. The NHS is far too big an organisation and, as Phillips makes clear, is “an instrument of arbitrary and unaccountable power”. It is also, as reported by you on the same day (“NHS is way down international league for healthcare”) not very good at its job, notwithstanding the efforts of many brilliant staff.

The time has surely come for a comprehensive and bipartisan review of the NHS, with a systematic consideration of major healthcare systems around the world and a wide-ranging look at funding options. This review should examine whether there is a better way of structuring health care in the UK and make detailed recommendations. The usual objection to this is that it would take too long. This is nonsense. The NHS has been around for 70 years; we can wait a few more years for some well-thought-out ideas as to how it should be structured for the next 70 years.
Graham Smith
London SW4

Hospital scandals will keep happening because our healthcare system is morally corrosive

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Hospital scandals will keep happening because our healthcare system is morally corrosive

Without proper feedback, the UK health services are never going to change. Exit interviews could be game changing, but they would have to be done by an independent third party, and reported without prejudice and dispassionately.  Elderly people on long waiting lists are treated badly, and have more risks of other problems such as heart attacks, and obesity from inactivity. If waiting lists are very long, as they are, is it right to place those working ahead of those retired or unemployed? After all it is the workers who pay the taxes that fund our 4 health services. Unpleasant rationing decisions need to be taken: for the next decade at least.

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Melanie Phillips opines in The Times 26th June 2018: The elderly deserve better than NHS care”.Hospital scandals will keep happening because our healthcare system is morally corrosive

Next week marks the 70th anniversary of the creation of the NHS. Perhaps instead of any burnishing of moral credentials, this might be an opportunity to start thinking the unthinkable.

Shocked NHS staff are digesting the latest scandal to consume the service. Between 1989 and 2000, at least 456 and possibly as many as 656 elderly patients died at Gosport War Memorial Hospital, Hampshire, after being given opioids at a strength that shortened some lives without any clinical need for such doses.

An inquiry report said there had been a “disregard for human life” involving doctors, nurses, pharmacists, managers and others. This is but the latest example of gross, institutionalised failures of care in the NHS followed by a cover-up.

Between 2004 and 2013, at least 11 babies and one mother were estimated to have died through incompetence and neglect at Morecambe Bay hospitals trust, followed by suppression of evidence and a failure to investigate.

In Mid Staffordshire, as a report revealed in 2013, hundreds of patients experienced “appalling and unnecessary suffering”. People lay starving, thirsty and in soiled bedclothes, with some drinking from flower vases to relieve their thirst.

T

hen there was the Liverpool Care Pathway. Ostensibly a scheme to provide palliative care to the terminally ill, it developed in some cases into a means of hastening death by withdrawing food and fluids. Professor Sir Brian Jarman, who monitors NHS death rates, has said that although after a public outcry this pathway was supposedly abolished, he has heard it continues in other guises. He has also said he wouldn’t be surprised if the issues that allowed Gosport to become a national scandal were repeated.

This isn’t just because, in his words, NHS whistleblowers are even now “fired, gagged and blacklisted”. The problem is far deeper than the culture of blame and secrecy. It’s deeper also than the perennial complaint of lack of resources.

We still tell ourselves that the NHS is the most moral way of delivering healthcare. Yet, as scandals over the years have shown, it often treats elderly people abominably, suggesting that something is fundamentally wrong with the very ethos of the NHS itself.

For attitudes to the elderly serve as a litmus test of moral standards. Are such patients treated with respect, compassion and care? Or are they viewed as a nuisance, wasting valuable resources that could be spent on younger patients, cluttering up beds, and with lives no longer worth preserving in the first place?

It would seem that, too often, the latter view prevails. Even taking into account possibly mitigating factors, the evidence suggests that the NHS discriminates against older people in a variety of ways.

Age UK says access to cancer treatment drops off dramatically after the age of 75, even though one third of all cancers are diagnosed after this age. The Royal College of Surgeons says that rates of elective surgery for the over-65s are considerably lower for a range of common conditions. According to the Centre for Policy on Ageing, under-investigation and under-treatment applies across cancer care, cardiology and strokes.

Jarman says that out of nine developed countries he studied, including the US, the NHS had the highest hospital death rate when adjusted for age, sex, diagnosis and other factors. Information on mortality rates was not properly assessed by NHS officials.“There really is a desire not to know,” he said. What worried him was an NHS ethos that put the reputation of the health service before patients’ needs.

It was ever thus and always will be. That’s because the NHS is a state-run bureaucracy in which patients are viewed as units in a system that is rated principally in terms of political survival and national image. Individual doctors, nurses, managers and others may well be compassionate and caring. The evidence suggests, however, that the system has a morally corrosive, dehumanising and brutalising effect. That’s why the extra billions and assurances that better systems are in place to guard against abuse will not solve the problem.

Continental-style social insurance schemes, although not perfect, offer a far better model. They provide universal cover and higher standards overall because — crucially — they put power into the hands of patients who can choose their healthcare providers.

Yet no one ever suggests that this model of healthcare might be better for Britain. That’s because the NHS is — as the former chancellor Lord Lawson once observed — the closest thing to a national religion. Appropriately, a thanksgiving service for the NHS will take place next week at Westminster Abbey.

Its founder, the Labour politician Nye Bevan, said it gave people “serenity” by removing anxiety over whether or not they could afford to be treated. That’s certainly a principle to hang on to. But social insurance schemes uphold it too.

The NHS treats the state itself as the nation’s ultimate carer, giving it the authority to decide who should be helped to stay in this world and who should be helped prematurely out of it. It is therefore not a temple of compassion so much as a potential instrument of arbitrary and unaccountable power.

How many more scandals will it take before Britain faces the fact that the NHS is not, as its mythology proclaims, the cynosure of decency? Time now, perhaps, to administer the fatal syringe to the NHS itself.

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Why are we so pround of our 4 health services pretending to be one? “NHS is way down international league for healthcare”

With the Nuffield Trust and The British Medical Journal commenting on “70 years of NHS spending” and how much is enough, we are all bound to consider our service in comparison with other rich countries, and we do not compare well in outcomes. In access, equity and cost we are good enough, but not in that most important indicator: OUTCOMES. 

There are several truths, amongst which is the fact that we have a 10 year shortage of diagnosticians, and technological advance faster than any state’s ability to pay.

At a local meeting those present were assuming that being honest about “rationing” would lose votes. I am increasingly worried by the assumption that the R word is unacceptable to the voters, and particularly the professions. It is honest. By obfuscation with other words managers and politicians, leaders, will be asked “is this not rationing” and the answer will lose all credibility, unless it’s yes.

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Kat Lay reports in the Times 26th June 2018: NHS is way down international league for healthcare

The NHS performs worse than comparable international health systems in preventing deaths from eight common causes, including heart attacks and cancers.

New research found that the UK was the third poorest performer out of 19 developed countries at preventing people dying when good medical care could have saved them.

The analysis, published by the research groups and think tanks the Nuffield Trust, the Health Foundation, the Institute for Fiscal Studies and The King’s Fund, compared 19 countries including France, Germany, Japan, Australia, Italy and the USA.

While the NHS was world-leading at treating people regardless of their finances, it had less resources than other countries and spent a slightly lower proportion of national income on healthcare.

Babies were more likely to die at birth or in the week after in the UK than other countries, the research found, with 7 in 1,000 dying within a week of birth in 2016, compared with an average of 5.5 across the other countries.

Lung, bowel, breast and pancreatic cancer patients receiving NHS treatment were less likely than the international average to still be alive after five years.

Performance on preventing deaths from heart attacks, strokes and chronic obstructive pulmonary disease was described as “poor”.

On the upside, only 2.3 per cent of Britons skipped medicine due to cost, compared to an average of 7.2 per cent and on the treatment of some conditions, such as diabetes and kidney disease, the NHS was a good performer.

Chris Ham, chief executive of The King’s Fund, said: “The evidence that the NHS lags behind other countries in reducing premature deaths from diseases like cancer and heart attacks is a timely reality check.

“The UK stands out in removing financial barriers to people accessing care but needs to do better in improving health outcomes.”

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